Prosthetics and Orthotics International最新文献

Background: Travel out of country for medical care is increasing for many reasons including costs, wait-lists, and availability of procedures. Until 2018, when the surgery was offered in only 1 province, Canadians with amputation wanting osseointegration (OI) had to travel out of country for the surgery. The purpose of this study was to understand the lived experience of accessing health care in Canada after having a procedure performed out of country.

Methods: This is a phenomenological study of persons with amputation who had OI outside of Canada. The grand tour interview question was "What was it like travelling to another country for OI surgery and then returning to access follow-up care in Canada?"

Results: There were 5 participants, and 5 themes emerged: (1) lack of support from Canadian physicians; (2) exceptional support from prosthetists and other members of the health care team; (3) continued reliance on the country where the procedure was initially performed; (4) self-advocacy for access to care; and (5) benefits of travelling outweighing the problems faced.

Conclusions: These themes are not unique to OI, but to medical tourism as a whole. The lack of support was countered partly by a strong sense of self-advocacy from the participants and support from other members of the health care team.

Objective: Trigger finger is a common clinical disorder that often results in pain and functional limitations. This study aimed to determine whether joint-blocking orthosis was effective in treating adult idiopathic trigger fingers.

Methods: Fifty-five participants were randomly assigned to either a hand therapy group or an orthosis group that immobilized the proximal interphalangeal joint for 6 weeks. The Green classification of triggering; short-form version of the Disabilities of the Arm, Shoulder, and Hand; and numeric pain rating scale were used to assess participants' data.

Results: The orthosis was "successful" in completely resolving the symptoms of trigger finger in 53.6% of the participants at 6 weeks postintervention, whereas the hand therapy control group did not result in any "successful" outcomes. The Green classification score for the orthosis group decreased from 2.68 (standard deviation = 0.47) at baseline to 0.93 (standard deviation = 1.12) at 6 weeks. The short-form version of the Disabilities of the Arm, Shoulder, and Hand disability score was significantly reduced after wearing the orthosis, F (2, 52) = 74.16 p < 0.001, and improved from baseline (M = 37.6) to 6 weeks (M = 20.26). The pain intensity score was also significantly decreased after wearing the orthosis, F (2, 52) = 52.17 p < 0.001, partial η 2 = 0.67.

Conclusion: Using orthosis to immobilize the proximal interphalangeal joint, day and night, for 6 weeks, is an effective and reasonable option for treating idiopathic trigger fingers with Green grade 2 or 3. Hand therapy without orthosis did not result in significant improvements.

Background: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge.

Objectives: To investigate the complications following major lower limb amputations (MLLAs).

Study design: Retrospective study.

Methods: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included.

Results: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012).

Conclusions: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs.

Lateral wedge insole (LWI) wear is a well-known conservative treatment for patients with knee osteoarthritis and is expected to decrease knee joint loading. Although the effect of LWI length on knee adduction moment (KAM) has been investigated, the biomechanical mechanism has not been fully investigated. Twelve healthy young subjects walked in the laboratory with and without 2 different lengths of LWIs. Three-dimensional motion analysis was performed to calculate the first and second peaks and impulses of the KAM during the stance phase. In addition, the knee-ground reaction force lever arm (KLA) and center of pressure (COP), ankle eversion moment, and ankle eversion angle were calculated. The first peak of KAM was lower, COP was displaced outward, and KLA was shorter with both LWIs attached. On the other hand, the second peak of KAM was lower with longer LWIs, COP was displaced outward, and KLA was shorter. The KAM impulse was significantly smaller in the condition with longer LWI than in the other conditions with smaller ankle eversion motion; longer LWI induced COP to the lateral side through the stance phase and kept KLA short, thus reducing the KAM impulse.

Objectives: Individuals with lower-limb amputations (LLA) often have deficits in balance and community walking ability. As a result, people with LLA are often sedentary. The aim of this study was to explore perceptions of physical activity from the perspective of people with LLA.

Methods: A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semistructured interviews were held by telephone or in person with adults living with major LLAs recruited from rehabilitation hospitals and advertisements on social media. Individuals were included if they were age 18 years and older with a major LLA. Purposive sampling was used to ensure variation by sex, cause, and level of amputation.

Results: Thirty-three people with LLA participated (22 men/11 women; median age 63 years). The majority of individuals had a unilateral, transtibial amputation (∼50% dysvascular LLA). Three main themes were developed to characterize participants' perceptions of physical activity: (1) physical activity is perceived as important but can be challenging after amputation; (2) physical activity has physical and mental health benefits; and (3) physical activity is a means to maintain independence and engagement in community and social life.

Conclusions: Obtaining the perspectives of individuals with LLA about physical activity helps us understand how they think about it, what motivates them, and how we can optimize physical activity levels. Future research is needed to evaluate the effectiveness of interventions to enhance physical activity in this population.

Background: The rehabilitation process for the upper extremities of individuals with stroke requires therapists to use splints for supportive and corrective purposes. The aim of this study was to assess the effectiveness of spiral strapping in inhibiting spasticity and improving the upper extremity motor functions of individuals with chronic stroke.

Methods: Forty Saudi individuals aged 50-60 years with chronic stroke participated in this study. Their degrees of spasticity according to the Modified Ashworth Scale ranged across grades 1, 1+, and 2. Participants were randomly assigned to experimental and control groups. Participants in both groups received 1 h of conventional physical therapy for 3 d/wk to improve the motor functions of their upper extremities. In addition, participants in the experimental group wore an upper-limb spiral strapping with a hand splint 10 h/d for 6 d/wk. The treatment program for both groups was delivered for 4 weeks. Changes in the scores of Action Research Arm Test for elbow joint spasticity, active range of motion of the shoulder, elbow, and forearm joints, and hand grip strength were evaluated before and after treatment in both groups.

Results: Significant improvements in all measured variables after treatment were reported in both groups, except for elbow joint spasticity in the control group. The experimental group showed significant post-treatment improvement in the scores for all measured variables compared with the control group.

Conclusions: Spiral strapping was beneficial in inhibiting mild degrees of spasticity and improving the motor functions of the upper extremities of stroke patients.

Background: Amputee patients in low-resource settings face a heightened risk of skin infections at the skin-liner interface of their residual limb, which can develop into a variety of serious complications. Most research comparing prosthetic liners has focused on mechanical and aesthetic properties. However, the relative propensity of different liner types to host bacterial growth has yet to be explored.

Methods: To address this question, we performed a bacterial comparison study across a traditional sock-EVA combination liner, an advanced Ossur Iceross silicone liner, and a novel silicone liner designed for low-resource hospitals in developing nations. We cultured Staphylococcus aureus within a novel physical model of the skin-liner interface, incorporating a replicate skin layer suspended over a self-regulating heat source. After culturing bacteria for 24 h, we collected and quantified cells in solution.

Results: Statistical analysis of the bacterial growth concentration from 9 trials revealed relative consistency of growth across the 3 liner types, suggesting that none of the liners pose heightened risks of infection, relative to the others.

Conclusions: These results suggest that certain innovative prosthetic materials may safely be considered for fabrication of prosthetic liners in low-resource environments. The in vitro skin-liner model and test method for bacterial growth characterization introduced herein may be useful for future dermatological simulations.

For research in the field of prosthetics to be representative of clinical realities, studies require inclusion of clinical standard prosthetic sockets. This necessitates involvement of a prosthetist (clinical professional) in any study, which is to truly explore the effectiveness of existing or novel prosthetic technologies. Unfortunately, there is a global shortage of prosthetists. With many technological advances in upper-limb prosthetics coming from engineering focused labs, it is unsurprising that studies are frequently conducted with anatomically intact individuals. In this paper, we present a method to clone the shape of a clinical standard prosthetic socket for research purposes. The technique uses silicone to capture the socket shape; this is then converted into a plaster mold, which can be used to manufacture an identically shaped socket using standard clinical manufacturing techniques. The whole process can be achieved without the involvement of a prosthetist. To validate the proposed technique, molds from an original socket and socket clone were 3D scanned. The distance between the aligned meshes were measured using CloudCompare software. The mean distance between the points on the 2 meshes was 0.16 mm (standard deviation 0.38 mm). This proof-of-concept study demonstrates that the proposed new approach to cloning a clinical standard prosthetic socket is feasible and accurate. This technique will facilitate improvements in the assessment of prosthetic technologies. The process is nondestructive, thus also opening opportunities for socket design and electrode placement research with the removal of confounding factors relating to socket shape.

Background: Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown.

Objectives: The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research.

Study design: Mixed methods.

Methods: The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking.

Results: Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students, program evaluation, and clinical education and internship. Protected time and funding, faculty development, and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice, program resources, and program evaluation.

Conclusions: Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.

Background: Bone-anchored protheses (BAPs) by means of osseointegrated implants are increasingly being used in amputees with socket-related issues. Clinical advancements are being published by more and more centers worldwide. Although the number of publications and interest in BAP is growing, a systematic evaluation of scholarly output is lacking.

Objective: To identify scholarly output, understand research trends and make research recommendations in the clinical field of BAP.

Methods: Systematic searches in Medline All, Embase, Web of Science Core Collection, Cochrane Library, and Google Scholar were completed in February 2023. The results were deduplicated, screened, and assessed for quality by independent reviewers. Inclusion criteria were as follows: clinical studies and BAP in the extremities. Articles were excluded if they were animal or fundamental studies, nonclinical reports, had a study population less than 10 patients, or BAP was performed in areas other than extremities.

Results: One hundred twelve articles were included and published between 1993 and 2023. An annual growth rate of 10.3% was found and research was published in 62 different journals. Prosthetics and Orthotics International, Clinical Orthopaedics and Related Research and The Bone & Joint Journal were the most prolific journals. Hagberg K, Aschoff HH, and Branemark R were major contributors to BAP research. Collaborations are predominantly among high-income countries. Main research trends were on rehabilitation, questionnaires, complication managements, and implant treatment.

Conclusions: Research on BAP shows an increasing global trend, highlighting key research areas and authors. A unified global research agenda, stakeholders' collaborations, and consensus are essential for addressing knowledge gaps and development future direction of BAP.