Prosthetics and Orthotics International最新文献

Background: Walking speed is a measure of functional mobility that is relatively easy to quantify. In people with lower limb amputation, reduced walking speed has been linked with specific atypical spatiotemporal gait parameters. However, the influence of atypical spatiotemporal gait parameters on the walking speed of people with unilateral transtibial amputation (TTA) and transfemoral amputation (TFA) remains unclear.

Objectives: To identify spatiotemporal gait parameters influencing walking speed of people with unilateral TTA or TFA.

Study design: Cross-sectional.

Methods: The 10-meter walk test (10mWT) was used to measure walking speed, and an instrumented walkway was used to record spatiotemporal gait parameters. Regression analyses were used to determine the best subset of spatiotemporal gait parameters that influence the walking speed of people with TTA and TFA.

Results: The study included 43 people with TTA and 49 with TFA. In the TTA group, spatiotemporal gait parameters accounted for 65.5% of the variance in walking speed, with prosthetic single limb support accounting for 52.2%, prosthetic terminal double limb support accounting for 8.9%, and stride width accounting for 4.4%. In the TFA group, intact swing accounted for 46.7% of the variance in walking speed. There was no significant difference in walking speed between the TTA and the TFA groups ( p > 0.05).

Conclusions: The study's results highlight specific spatiotemporal gait parameters that affect the walking speed of people with unilateral TTA and TFA. In addition, results suggest that walking speed over short distances is not confounded by amputation level (i.e., TTA and TFA).

Background: Foot drop is a common condition for patients with upper motor neuron syndrome such as cerebral palsy (CP). This study aimed to investigate the effects of functional electrical stimulation (FES) on gait function, quality of life, and FES satisfaction in adults with CP and foot drop. To analyze effects over time, an observational, longitudinal study was performed.

Methods: In this observational prospective cohort study, 8 adults with CP (median age of 22 years; range: 18.5-33.25) received a FES system for 12 weeks. 3D gait analysis was performed at beginning (T1) and end of the study period (T2). To detect effects of FES, ankle kinematics, kinetics, and spatiotemporal parameters were monitored for the conditions FES-OFF and -ON at each examination.

Results: Over time, walking speed increased significantly from T1ON (1.08 m/s) to T2OFF (1.21 m/s) with further improvement at T2ON. The ON-OFF difference of maximum dorsiflexion during swing tended to increase at T2 (2.49 degrees) compared with T1 (1.73 degrees) but with a more plantarflexed ankle position at T2 (range: -7.1 to 1.31 degrees) than T1 (range: -1.53 to 4.51 degrees) resulting in a significant decrease between T1ON and T2OFF. With FES, push-off energy tended to decrease for both examinations and lead to lower values over time.

Conclusion: Positive therapeutic effects are represented in walking speed over time regardless of FES being OFF or ON even with a reduction in push-off energy. Despite no significant increase in maximum dorsiflexion in swing, over time, participants showed the tendency of an improvement in foot lift with FES-ON.

Background: Energy Storage and Return (ESAR) prosthetic feet provide improved walking when compared with previous designs. However, it may not mimic the unimpaired smooth and progressive movement of the foot on the floor (foot rollover).

Objective: To characterize the temporal foot rollover of participants with unilateral transtibial amputation using an ESAR prosthetic foot.

Study design: Cross-sectional.

Methods: Plantar pressure data were collected from 11 participants with unilateral transtibial amputation using ESAR prostheses (2 females, mean age 37 ± 10 years, activity levels K2-K4) and 9 unimpaired participants (3 females, mean age 33 ± 10 years). The Initial Contact, Final Contact, and Total Contact times of 7 areas of the feet (unimpaired, intact, and prosthetic feet) were studied together with the duration of the Heel Rocker, Ankle Rocker, and Forefoot Rocker. Results were compared using a mixed analysis of the variance test.

Results: Statistical analysis revealed an interaction ( P < 0.05) between foot and areas. The contact times were different ( P < 0.05) between unimpaired and prosthetic feet for most foot areas. Furthermore, the prosthetic foot showed the longest duration of Heel Rocker (21.1 ± 8.5% of stance phase vs. 17.7 ± 10.2% for the intact foot and 15.7 ± 8.8% for the unimpaired feet, P < 0.05) and the shortest duration of Ankle Rocker (43.8 ± 18.1% vs. 47.2 ± 16.9% for the intact foot and 50.0 ± 13.4% for the unimpaired feet, P < 0.05).

Conclusions: Results suggest that the ESAR foot does not mimic the unimpaired foot rollover, especially in the contact pattern and the heel and ankle rockers. This might have an impact on efficiency and stability of gait.

Background: Microprocessor knees (MPKs) improve the functional mobility, quality of life, and safety of individuals with a knee disarticulation or above knee amputation and are cost-effective when adjusting for quality-of-life years gained. However, few studies have been conducted on the K2 population, and to this point, the Centers for Medicare and Medicaid Services has not covered MPKs for the K2 population.

Objectives: The aim of this study was to determine the extent to which MPK provision to the K2 population is cost effective at the person and population levels. A secondary objective was to determine the effectiveness of MPKs at reducing injurious falls within the K2 population.

Study design: A retrospective cohort study using Medicare fee-for-service claims data from the Centers for Medicare and Medicaid Services.

Methods: Propensity score weighting using inverse probability treatment weights was used to balance beneficiary characteristics and a generalized linear regression with log-link function and Gamma distribution was run to determine per-member-per-month cost and prosthetic device cost. A 10-year Congressional Budget Office-style score was conducted. A logistic regression was run for the fallers analysis.

Results: Microprocessor knee provision to K2 beneficiaries reduced injured fallers by 18.5% and resulted in medical savings of $1,351 per-member-per-month, amortizing the $25,075 difference between the MPK and nonmicroprocessor knee in 19 months. Providing MPKs to K2 users resulted in cumulative Medicare savings of $410.3 million over 10 years.

Conclusion: The MPK prosthetic device could provide meaningful safety benefits to the K2 population and result in fiscal savings to Medicare at both the person and population levels.

Background: An amputation may lead to not only impaired physical function but also psychosocial consequences including emotional health, personal relationships, and social life.

Aims: The study aimed to highlight osteosarcoma survivors' experiences of the amputation, focusing on changes in emotional reaction with time to the impairment. In addition, the research sought to assess how the survivors' perceived challenges about body image.

Methods: The present mixed quantitative study was conducted among 31 osteosarcoma survivors at the department of ortho-oncology in a tertiary hospital in India. According to the hospital medical records, participants included in the study were individuals who had undergone acquired amputation 6 months to 1 year before, had no history of pulmonary metastasis, were receiving follow-up treatment, and were between 18 and 25 years of age. To assess body-image perception, survivors went through the psychological assessment by using validated tool (Amputation Body Image Scale). A clinical psychologist used semistructured interviews with same group of survivors to collect qualitative data. In this research, quantitative data have been analyzed by applying appropriate statistics and qualitative data transcribed, coded, and analyzed by experienced psychologists for addressing 3 areas: breaking news, adapting the word "amputation," phantom sensation, and self-inferiority complex vs. social insecurity-related impairment.

Results: The age mean of 31 osteosarcoma survivors with amputation was 22.41 ± 4.08. They were 87 % above the knee and 13% had partial hand amputation. Amputation Body Image Scale's average score was 60.1 ± 19.62 and it was not correlated with the length of time of amputation surgery took itself, age, and sex (p ≥ 0.005). Our study emerged 4 themes: amputation was usually the thought of life-ending. Survivors reported a feeling of a handicap when facing the mirror just after amputation. As per the survivor's viewpoint, the self-inferiority complex plays an important role in developing psychological stress that affects their psychological well-being.

Conclusions: Various stages of the diagnostic treatment pathway give rise to unique and diverse influences on physical, emotional, social, and psychological well-being. The entire process, starting from the acquired amputation to coping with everyday life, can be demanding and difficult.

Background and objective: Ankle-foot orthoses (AFOs) are often prescribed for lower leg muscle impairments. In order to conduct impactful research, we aimed to establish a list of prioritized research questions regarding AFO care in the Netherlands from the perspective of healthcare professionals and AFO users.

Study design: A purposefully designed online survey.

Methods: To identify relevant research questions regarding the AFO care process the online survey was sent to rehabilitation specialists, orthotists and AFO users in the Netherlands. The research questions were grouped into specific research needs according to the Process description of medical devices. The priority of the research needs was determined using a 11-point numeric rating scale (NRS), with 10 being the highest priority.

Results: The survey was completed by 62 rehabilitation specialists, 47 orthotists and 184 AFO users. Rehabilitation specialists prioritized research on "Effects of AFO properties" (numeric rating scale score: 8.3 ± 1.2) and "Choice of AFO type and design" (8.1 ± 2.0). Orthotists prioritized research on "How to cast and correct the plaster model" (8.9 ± 1.3) and "Effects of AFO properties" (8.7±1.4). Ankle-foot orthoses users prioritized research on "Improvement of AFO-shoe fitting and information on appropriate shoes'" (8.6 ± 1.8) and "Possibilities to choose and test different AFOs before provision" (8.5 ± 1.3).

Conclusions: Our inventory of research needs has provided a list of research priorities that can be used to structure AFO-related knowledge development. Healthcare professionals and patients have different research priorities that should be taken into account when designing and setting up future AFO-related research.

Background: Prosthesis-specific outcome measures are essential for assessing the quality of life among lower-limb amputees. While the prosthesis evaluation questionnaire (PEQ) is internationally recognized and endorsed by the International Society for Prosthetics and Orthotics through the Consensus Outcome Measures for Prosthetic and Amputation Services framework, no culturally adapted Thai version currently exists.

Objectives: To translate, culturally adapt, and evaluate the psychometric properties of the Thai version of the PEQ (PEQ-TH) for use among lower-limb prosthesis users in Thailand.

Study design: Cross-sectional validation study.

Methods: Following standard cross-cultural adaptation guidelines, the PEQ was translated into Thai, back-translated, and reviewed by a multidisciplinary expert panel. Eighty-three lower-limb amputees from 5 rehabilitation centers completed the PEQ-TH and short form 36 health survey Thai version at baseline; 71 completed the PEQ-TH again after 14 days. Psychometric evaluation included content and construct validity, internal consistency (Cronbach alpha), test-retest reliability (intraclass correlation coefficients), and floor/ceiling effects.

Results: The PEQ-TH demonstrated strong content validity (item-objective congruence = 0.99). Construct validity was supported by moderate correlations between PEQ-TH subscales (e.g., Ambulation, Social Burden) and corresponding short form 36 health survey Thai version domains. Internal consistency was acceptable for most subscales (α > 0.70), though Appearance, Well-Being, and Social Burden were marginally lower. Test-retest reliability ranged from moderate to good (intraclass correlation coefficient = 0.55-0.76). No floor or ceiling effects were observed.

Conclusions: The PEQ-TH is a valid and reliable patient-reported outcome measure aligned with International Society for Prosthetics and Orthotics's Lower Extremity Amputation Data set and Consensus Outcome Measures for Prosthetic and Amputation Services recommendations. It enables culturally relevant assessment of prosthesis-related quality of life in Thai lower-limb amputees and supports patient-centered care and outcome monitoring.

Background: The unavailability of validated outcome measures in local languages limits the extent to which the impact of prosthetic and orthotic devices can be assessed.

Objectives: This study examined the psychometric properties of the Khmer locomotor capabilities index (LCI-5) for use with lower-limb prosthesis users. An additional aim was to explore its psychometric properties when used on lower-limb orthosis users.

Study design: A cross-sectional design was used.

Methods: The Khmer version of the LCI-5 was administered to clients attending 3 prosthetic and orthotic clinics in urban and rural Cambodia. Internal consistency and floor and ceiling effects were evaluated. Exploratory Factor Analysis and Confirmatory Factor Analysis (CFA) were performed on independent samples of prosthesis user data. A separate CFA was conducted on a data from orthosis users.

Results: Four hundred thirty-seven clients completed the LCI-5. The data had high internal consistency; however, a significant ceiling effect was observed. For prosthesis users, the optimal solution arising from exploratory Factor Analysis and CFA was a 2-factor model. A modified 2-factor model produced an acceptable fit for orthosis users.

Conclusions: The results present a 2-factor structure of the Khmer LCI-5, which can be used to assess mobility in prosthesis and orthosis users. It is important to note that the factor structure of the Khmer version is not consistent with the English version. Additional work is required to address ceiling effects associated with the Khmer LCI-5.

Background: During the alignment process, the 3D Laser Assisted Static Alignment Reference (L.A.S.A.R.) is clinically used to objectively aid rehabilitation teams to optimize static prosthetic alignment. Although this device is used routinely within the clinic, its reliability and validity are unknown.

Objectives: To assess the test-retest reproducibility and concurrent validity of the 3D L.A.S.A.R.

Study design: Clinimetric study.

Methods: In this cross-sectional study, participants using a unilateral transtibial bone-anchored prosthesis were recruited by convenience sampling. Reproducibility was assessed by calculating reliability (intraclass correlation coefficients [ICC]) and agreement parameters (standard error of measurement, smallest detectable change, and limits of agreement). Concurrent validity was assessed through ICC and limits of agreement.

Results: The reliability parameters (ICCagreement) ranged from 0.86 to 0.97, with a standard error of measurement (%) of 6.5%‒29.5% in 2D mode and 5.3%‒23.9% in 3D mode and smallest detectable change (%) of 17.9%‒81.6% in 2D mode and 14.6%‒66.1% in 3D mode with no systematic bias. Concurrent validity (ICCconsistency) ranged from 0.11 to 0.87, with systematic bias found between both systems in several perspectives.

Conclusions: The 3D L.A.S.A.R. shows very good to excellent test-retest reliability. However, the measurement errors exceeded clinically considerable deviations. Concurrent validity ranged between poor to very good. Further development of the 3D L.A.S.A.R. and research focusing on clinimetric properties such as responsiveness or interrater reliability is needed.

This study created an orthosis with several functions in addition to the triangular bandage. The triangular bandage positioned the forearm forward, suspended the arm from the neck, and secured the arm from the neck to the wrist. The design was modified from this limb position. Phase 1: Shoulder rotation was changed from extreme internal rotation to 30 degree internal rotation, Kapandji's physiological reference position (flexion/extension, 0 degree; abduction/adduction, 0 degree; rotation, 30 degree internal rotation position), allowing for the partial use of the hand. Phase 2: The sling knot position was changed from the neck to above the ipsilateral shoulder to avoid neck pain. Phase 3: A sling with elbow pads and straps replaced the Velcro to prevent the knot from loosening. Phase 4: To prevent the shoulder straps of the sling from being pulled off by the forearm during external shoulder rotation, the twisted straps pass through the shoulder and forearm loops. Phase 5: Additional straps around the shoulder and axilla were placed outward to prevent the straps from falling off due to scapular movement. Because the humeral head is rotated 30 degree posteriorly, immobilization in the 30 degree internal rotation position of the shoulder joint improves scapulohumeral joint conformity and achieves rotator cuff equilibrium. Suspension from the ipsilateral shoulder also counteracts gravity and reduces the load on intrinsic muscles such as the rotator cuff. Allowing anterior-posterior pendulum motion not only stabilizes the trunk but can also be used for early range-of-motion training. The sling has evolved as an immobilization and a suspension device.