Pub Date : 2024-01-01DOI: 10.1097/JPO.0000000000000494
Zahra Jiryaei, A. Daryabor, Forouzan Rastgar Koutenaei, M. Khosravi
ABSTRACT INTRODUCTION Orthosis and physical therapy are two conservative managements for knee osteoarthritis (OA), but the question is which is better for alleviating pain and improving function? The aim of this study was to compare two interventions of orthosis and physical therapy on pain and function in patients with knee OA. METHODS In this quasi-experimental study, 31 individuals with medial knee OA were recruited into two groups including orthosis group (combination of insole and brace [n = 14]) and physical therapy group (n = 17). Pain severity was measured by visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Also, daily activity was measured by the WOMAC questionnaire at baseline and after 6-week follow-up. Wilcoxon signed rank and Mann-Whitney U tests were used to determine significant difference for intragroup and intergroup comparisons, respectively. RESULTS The orthosis group (using both knee brace and LWLs) had a better result for pain score related to VAS than the physical therapy group immediately after and 6 weeks of using the intervention, with a significant difference between the two groups (P = 0.006). Regarding the WOMAC items including pain and daily activity, both groups had significant differences after the 6-week period of using the intervention, with no significant difference between the groups. CONCLUSIONS Based on the findings, pain and daily activity related to the WOMAC questionnaire were improved in both orthosis and physical therapy groups, with no differences between the two interventions. The orthosis group had better results in pain related to VAS. CLINICAL RELEVANCE The aim of this study was to find whether physical therapy or orthosis best improves pain and function of knee OA patients.
ABSTRACT 引言矫形器和物理疗法是膝关节骨性关节炎（OA）的两种保守治疗方法，但问题是哪种方法更能减轻疼痛和改善功能？本研究旨在比较矫形器和物理疗法两种干预措施对膝关节 OA 患者疼痛和功能的影响。方法 在这项准实验研究中，31 名内侧膝关节 OA 患者被分成两组，包括矫形器组（鞋垫和支架的组合 [n = 14]）和物理治疗组（n = 17）。疼痛严重程度通过视觉模拟量表（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）问卷进行测量。此外，WOMAC 问卷还测量了基线和 6 周随访后的日常活动量。Wilcoxon 符号秩和 Mann-Whitney U 检验分别用于确定组内和组间比较的显著差异。结果 使用矫形器组（同时使用护膝和 LWLs）在使用干预措施后立即和 6 周后的 VAS 疼痛评分结果优于物理治疗组，两组间差异显著（P = 0.006）。至于包括疼痛和日常活动在内的 WOMAC 项目，两组在干预 6 周后均有显著差异，组间无显著差异。结论 根据研究结果，矫形器组和物理治疗组的 WOMAC 问卷中与疼痛和日常活动相关的项目均有所改善，两组间无差异。矫形器组在与 VAS 相关的疼痛方面效果更好。临床意义 本研究旨在找出物理治疗和矫形器对膝关节 OA 患者疼痛和功能改善的最佳方案。
{"title":"Comparison of Physical Therapy and Orthosis on Clinical Outcomes in Patients with Medial Knee Osteoarthritis","authors":"Zahra Jiryaei, A. Daryabor, Forouzan Rastgar Koutenaei, M. Khosravi","doi":"10.1097/JPO.0000000000000494","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000494","url":null,"abstract":"ABSTRACT INTRODUCTION Orthosis and physical therapy are two conservative managements for knee osteoarthritis (OA), but the question is which is better for alleviating pain and improving function? The aim of this study was to compare two interventions of orthosis and physical therapy on pain and function in patients with knee OA. METHODS In this quasi-experimental study, 31 individuals with medial knee OA were recruited into two groups including orthosis group (combination of insole and brace [n = 14]) and physical therapy group (n = 17). Pain severity was measured by visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Also, daily activity was measured by the WOMAC questionnaire at baseline and after 6-week follow-up. Wilcoxon signed rank and Mann-Whitney U tests were used to determine significant difference for intragroup and intergroup comparisons, respectively. RESULTS The orthosis group (using both knee brace and LWLs) had a better result for pain score related to VAS than the physical therapy group immediately after and 6 weeks of using the intervention, with a significant difference between the two groups (P = 0.006). Regarding the WOMAC items including pain and daily activity, both groups had significant differences after the 6-week period of using the intervention, with no significant difference between the groups. CONCLUSIONS Based on the findings, pain and daily activity related to the WOMAC questionnaire were improved in both orthosis and physical therapy groups, with no differences between the two interventions. The orthosis group had better results in pain related to VAS. CLINICAL RELEVANCE The aim of this study was to find whether physical therapy or orthosis best improves pain and function of knee OA patients.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"51 16","pages":"54 - 58"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139127314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT INTRODUCTION The purpose of this study was to investigate the effect of wearing a transfemoral prosthesis (FP) on blood pressure regulation in response to postural change. METHODS We enrolled seven persons with a transfemoral amputation who underwent a head-up tilt test while wearing an FP (PROS test) and without wearing an FP (control [CON] test). Systolic blood pressure (SBP), heart rate variability, and muscle blood flow using near-infrared spectroscopy were measured continuously. RESULTS In the CON (no FP) test, SBP decreased from supine to standing positions in all participants (P = 0.001). In contrast, in the PROS (wearing an FP) test, SBP increased (P = 0.001) during the postural change. CONCLUSIONS The findings suggest that a transfemoral prosthesis increases peripheral vascular resistance in the lower limbs and stimulates the baroreflex, helping to stabilize the circulatory dynamics upon postural change. CLINICAL RELEVANCE Because circulatory dynamics may be hampered in persons with a transfemoral amputation, wearing a prosthesis not only assists in ambulation but can also play a significant role in blood pressure regulation during activities of daily living.
{"title":"Blood Pressure Regulation in Persons with a Transfemoral Amputation: Effects of Wearing a Prosthesis","authors":"Yasuko Nishioka, Sven Hoekstra, Koshiro Sawada, Takeshi Nakamura, Fumihiro Tajima, Yasuo Mikami","doi":"10.1097/JPO.0000000000000493","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000493","url":null,"abstract":"ABSTRACT INTRODUCTION The purpose of this study was to investigate the effect of wearing a transfemoral prosthesis (FP) on blood pressure regulation in response to postural change. METHODS We enrolled seven persons with a transfemoral amputation who underwent a head-up tilt test while wearing an FP (PROS test) and without wearing an FP (control [CON] test). Systolic blood pressure (SBP), heart rate variability, and muscle blood flow using near-infrared spectroscopy were measured continuously. RESULTS In the CON (no FP) test, SBP decreased from supine to standing positions in all participants (P = 0.001). In contrast, in the PROS (wearing an FP) test, SBP increased (P = 0.001) during the postural change. CONCLUSIONS The findings suggest that a transfemoral prosthesis increases peripheral vascular resistance in the lower limbs and stimulates the baroreflex, helping to stabilize the circulatory dynamics upon postural change. CLINICAL RELEVANCE Because circulatory dynamics may be hampered in persons with a transfemoral amputation, wearing a prosthesis not only assists in ambulation but can also play a significant role in blood pressure regulation during activities of daily living.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"19 10","pages":"49 - 53"},"PeriodicalIF":0.6,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139129064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-12DOI: 10.1097/jpo.0000000000000490
Murray E. Maitland, Sheri I. Imsdahl, Donald J. Fogelberg, Katheryn J. Allyn, Kevin C. Cain, Andrew T. Humbert, Alexander Albury, Evandro M. Ficanha, James M. Colvin, Matthew M. Wernke
ABSTRACT Introduction An objective of designing a prosthetic foot is to achieve the natural adaptability of the foot and ankle on various surfaces and different forms of gait. Frontal plane position of the foot relative to the shank changes with many functional aspects of gait, such as turning, stairs, and walking on uneven ground. Prosthetic foot designs have variable frontal plane adaptability. An investigation foot with a linkage with ±10° of frontal plane motion was developed to improve frontal plane response under various conditions. The purpose of this study was to compare the kinematics of locked and unlocked conditions of a frontal plane adaptable prosthetic foot and the person’s usual foot while walking forward on a level surface, on an unstable rock surface, and sidestep, using a crossover design. These different conditions result in changes in frontal plane motion in the anatomical foot and ankle, and the current study evaluates whether there are similar trends in prosthetic feet. Materials and Methods People were included if they had a unilateral below-knee amputation, intact residual limb skin, were over 16 years old, and were able to walk more than 400 m on level ground without using a walking aid and without an increase in pain. The control group was people without amputations who completed the procedures once. Participants with amputations completed forward walking on level ground, on an unstable rock surface, and sidestep with their usual foot. Then after 2 weeks of accommodation, participants repeated these tests with the investigational foot unlocked and locked. Motion analysis data were collected with a 12-camera optically based system. Primary outcomes were sagittal and frontal plane motions of the foot relative to the shank. In addition, step length, step width, and stride velocity were obtained from the kinematic measures. Paired t -tests were used for statistical inference for individual participant comparisons. Unpaired t -tests were used for comparisons between the controls and people with amputations. Results Twenty-one people with amputations and 10 controls completed the tests. Participants with amputation had 16 different usual feet. There was a wide variation in usual foot motion during forward walking, whereas investigational foot conditions showed less variability. During level walking, control subjects had more frontal plane motion than any of the foot conditions, and the unlocked had more frontal plane motion than the usual foot and locked condition. Walking across an unstable rock surface showed similar trends, with control participants having more sagittal and frontal plane ankle motion compared with any prosthetic foot condition. Also, the unlocked had statistically greater frontal plane motion than the usual foot or locked condition. Sidestep results were also consistent with other gait tests. The control participants’ sagittal plane ankle range of motion was significantly more than the prosthetic sagittal p
{"title":"Motion Analysis of a Frontal Plane Adaptable Prosthetic Foot","authors":"Murray E. Maitland, Sheri I. Imsdahl, Donald J. Fogelberg, Katheryn J. Allyn, Kevin C. Cain, Andrew T. Humbert, Alexander Albury, Evandro M. Ficanha, James M. Colvin, Matthew M. Wernke","doi":"10.1097/jpo.0000000000000490","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000490","url":null,"abstract":"ABSTRACT Introduction An objective of designing a prosthetic foot is to achieve the natural adaptability of the foot and ankle on various surfaces and different forms of gait. Frontal plane position of the foot relative to the shank changes with many functional aspects of gait, such as turning, stairs, and walking on uneven ground. Prosthetic foot designs have variable frontal plane adaptability. An investigation foot with a linkage with ±10° of frontal plane motion was developed to improve frontal plane response under various conditions. The purpose of this study was to compare the kinematics of locked and unlocked conditions of a frontal plane adaptable prosthetic foot and the person’s usual foot while walking forward on a level surface, on an unstable rock surface, and sidestep, using a crossover design. These different conditions result in changes in frontal plane motion in the anatomical foot and ankle, and the current study evaluates whether there are similar trends in prosthetic feet. Materials and Methods People were included if they had a unilateral below-knee amputation, intact residual limb skin, were over 16 years old, and were able to walk more than 400 m on level ground without using a walking aid and without an increase in pain. The control group was people without amputations who completed the procedures once. Participants with amputations completed forward walking on level ground, on an unstable rock surface, and sidestep with their usual foot. Then after 2 weeks of accommodation, participants repeated these tests with the investigational foot unlocked and locked. Motion analysis data were collected with a 12-camera optically based system. Primary outcomes were sagittal and frontal plane motions of the foot relative to the shank. In addition, step length, step width, and stride velocity were obtained from the kinematic measures. Paired t -tests were used for statistical inference for individual participant comparisons. Unpaired t -tests were used for comparisons between the controls and people with amputations. Results Twenty-one people with amputations and 10 controls completed the tests. Participants with amputation had 16 different usual feet. There was a wide variation in usual foot motion during forward walking, whereas investigational foot conditions showed less variability. During level walking, control subjects had more frontal plane motion than any of the foot conditions, and the unlocked had more frontal plane motion than the usual foot and locked condition. Walking across an unstable rock surface showed similar trends, with control participants having more sagittal and frontal plane ankle motion compared with any prosthetic foot condition. Also, the unlocked had statistically greater frontal plane motion than the usual foot or locked condition. Sidestep results were also consistent with other gait tests. The control participants’ sagittal plane ankle range of motion was significantly more than the prosthetic sagittal p","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"240 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136057925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-03DOI: 10.1097/jpo.0000000000000487
Asiye Uzun, Yavuz Yakut
ABSTRACT Introduction Lumbar lordosis is important for the spine and pelvis to work in harmony in providing trunk control and maintaining sagittal balance. Children with cerebral palsy (CP) have difficulties in providing trunk postural control and balance, which is critical for independence in daily living activities. This study was planned to examine the immediate effect of a lower-trunk orthosis supporting physiological lumbar lordosis on trunk control and upper-limb functionality in children with CP. Objectives and Methods A total of 30 children with CP, 13 diparetic, 11 hemiparetic, and 6 ataxic, 21 ambulatory (GMFCS I/II), and 9 nonambulatory (GMFCS III/IV) aged 3–16 years were included in the study. The Pediatric Functional Reach Test (PFRT) and the Seated Postural Control Measure (SPCM) were used to assess trunk control; the Pediatric Berg Balance Scale (PBBS) was used to assess balance; and the Box and Block Test (BBT) and the Nine-Hole Peg Test (9HPT) were used to evaluate upper-limb functions. All tests were performed with and without a soft lumbosacral brace. The braces were made of soft, elastic fabric with steel, and were made by the orthotic technician in four different sizes. The angle of lordosis was adjusted with steel underwires according to each child. The existing physiological lordosis of the child is supported by the brace. It is not intended to increase or decrease. Results In the study, the results of all evaluations with a brace were better than those without a brace ( P < 0.05). No significant difference was found only in the functional part of the SPCM test ( P > 0.05). Conclusions Our study revealed that soft lumbosacral orthosis, which supports physiological lordosis, has a positive effect on trunk stability and upper-limb functionality in children with CP. Clinical Relevance In children’s trunk stability and upper-limb functionality studies, the use of soft lumbosacral orthosis that supports physiological lordosis can be added to rehabilitation programs and daily living activities as a support.
摘要:腰椎前凸对脊柱和骨盆的协调工作很重要，可以提供躯干控制和维持矢状面平衡。脑瘫(CP)患儿在提供躯干姿势控制和平衡方面存在困难，这对日常生活活动的独立性至关重要。本研究旨在研究支持生理性腰椎前凸的下躯干矫形器对CP患儿躯干控制和上肢功能的直接影响。目的和方法共纳入30例CP患儿，其中13例为弛缓型，11例为偏瘫型，6例为心性失调性，21例为动态(GMFCS I/II)， 9例为非动态(GMFCS III/IV)，年龄3-16岁。采用儿童功能伸展测试(PFRT)和坐姿控制测量(SPCM)评估躯干控制;使用儿童Berg平衡量表(PBBS)评估平衡;采用Box and Block Test (BBT)和Nine-Hole Peg Test (9HPT)评价上肢功能。所有的测试都在使用和不使用软腰骶支架的情况下进行。矫形技术人员用柔软、有弹性的钢织物制作了四种不同尺寸的牙套。根据每个孩子的情况，用钢丝调整前凸角度。孩子现有的生理性前凸由支具支撑。它不打算增加或减少。结果在本研究中，有支架组的各项评价结果均优于无支架组(P <0.05)。仅在SPCM测试的功能部分未发现显著差异(P >0.05)。本研究显示，支持生理性前凸的腰骶软性矫形器对CP患儿的躯干稳定性和上肢功能有积极的影响。在儿童躯干稳定性和上肢功能研究中，支持生理性前凸的腰骶软性矫形器可以作为一种支持加入到康复计划和日常生活活动中。
{"title":"Immediate Effect of Soft Lumbosacral Orthosis on Trunk Stability and Upper-Limb Functionality in Children with Cerebral Palsy","authors":"Asiye Uzun, Yavuz Yakut","doi":"10.1097/jpo.0000000000000487","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000487","url":null,"abstract":"ABSTRACT Introduction Lumbar lordosis is important for the spine and pelvis to work in harmony in providing trunk control and maintaining sagittal balance. Children with cerebral palsy (CP) have difficulties in providing trunk postural control and balance, which is critical for independence in daily living activities. This study was planned to examine the immediate effect of a lower-trunk orthosis supporting physiological lumbar lordosis on trunk control and upper-limb functionality in children with CP. Objectives and Methods A total of 30 children with CP, 13 diparetic, 11 hemiparetic, and 6 ataxic, 21 ambulatory (GMFCS I/II), and 9 nonambulatory (GMFCS III/IV) aged 3–16 years were included in the study. The Pediatric Functional Reach Test (PFRT) and the Seated Postural Control Measure (SPCM) were used to assess trunk control; the Pediatric Berg Balance Scale (PBBS) was used to assess balance; and the Box and Block Test (BBT) and the Nine-Hole Peg Test (9HPT) were used to evaluate upper-limb functions. All tests were performed with and without a soft lumbosacral brace. The braces were made of soft, elastic fabric with steel, and were made by the orthotic technician in four different sizes. The angle of lordosis was adjusted with steel underwires according to each child. The existing physiological lordosis of the child is supported by the brace. It is not intended to increase or decrease. Results In the study, the results of all evaluations with a brace were better than those without a brace ( P < 0.05). No significant difference was found only in the functional part of the SPCM test ( P > 0.05). Conclusions Our study revealed that soft lumbosacral orthosis, which supports physiological lordosis, has a positive effect on trunk stability and upper-limb functionality in children with CP. Clinical Relevance In children’s trunk stability and upper-limb functionality studies, the use of soft lumbosacral orthosis that supports physiological lordosis can be added to rehabilitation programs and daily living activities as a support.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135789968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1097/jpo.0000000000000485
Sam Chi Chung Chan, Tom Chun Wai Tsoi, Chiu Tai Yip, Lisa Ho, William Pang Wai Chen, Don Hoi Lam Cheung, Toby Sheung Lai Ho, Anthony Hoi Kwan Ng, Zeke Ka Hin Ng, Samuel Chi Ho Wong
ABSTRACT Introduction The aim of this study was to examine the short-term effectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods A total of 109 patients with mild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores ( P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening ( P = 0.005–0.029). Clinical Relevance Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance.
{"title":"Comparison of Effects of Prefabricated Soft Wrist Orthosis and Conventional Wrist Thermoplastic Splint on Symptoms of Carpel Tunnel Syndrome","authors":"Sam Chi Chung Chan, Tom Chun Wai Tsoi, Chiu Tai Yip, Lisa Ho, William Pang Wai Chen, Don Hoi Lam Cheung, Toby Sheung Lai Ho, Anthony Hoi Kwan Ng, Zeke Ka Hin Ng, Samuel Chi Ho Wong","doi":"10.1097/jpo.0000000000000485","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000485","url":null,"abstract":"ABSTRACT Introduction The aim of this study was to examine the short-term effectiveness of a prefabricated wrist orthosis compared with a custom-made wrist orthosis and its long-term effectiveness on alleviating carpal tunnel syndrome (CTS) symptoms. Materials and Methods A total of 109 patients with mild and moderate CTS were prescribed with either a prefabricated wrist or a custom-made wrist orthosis, and the changes in their mean scores on the Carpal Tunnel Syndrome Symptom Severity Scale (CTSSSS) at baseline and the eighth week follow-up. The changes in CTSSSS scores of those prescribed with the prefabricated wrist orthosis were compared with the 32nd week postintervention. Results Repeated-measures analysis of variance (ANOVA) showed significant effect at both mean CTSSSS and subscale scores ( P < 0.001). Both prefabricated wrist orthosis (n = 88) and custom-made wrist orthosis (n = 21) were shown to alleviate CTS symptoms at the first follow-up. Repeated-measures ANOVA showed significant differences after the long-term application of the prefabricated wrist orthosis (n = 62) in terms of CTSSSS score, daytime numbness, nighttime numbness, and nocturnal awakening ( P = 0.005–0.029). Clinical Relevance Along with the conventional thermoplastic splint, the prefabricated soft wrist orthosis could serve as an appropriate alternative to alleviate neurological symptoms of CTS due to its better long-term compliance.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135273792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Postural instability is considered a normal result of aging and is caused by some diseases such as neuropathy. Aim The purpose of the present study was to analyze and compare the effect of subthreshold vibration that was applied to the plantar surface of feet on balance control of healthy elderly and young subjects with simulated decreased plantar feet sensation. Methods Twenty-four subjects (12 elderly persons and 12 young persons with decreased plantar feet sensation) were included in this randomized, double-blinded crossover study. Participants were divided into two intervention groups: 1) orthopedic shoe with vibration mechanism on; and 2) orthopedic shoe with vibration off. Primary outcomes were center of pressure (COP) parameters including mean velocity, phase plane portrait, standard deviation (SD) of amplitude, and SD of velocity. Secondary outcomes were Berg Balance Scale (BBS) score and timed up and go test (TUG). The standing balance was tested with different conditions: eye opened/closed and foam/rigid surface. General linear mixed models tests were used for statistical analysis. The level of statistical significance was set at 0.05 for all analyses. Discussion This study showed very large effect sizes (partial η 2 > 0.2) with application of vibration as compared with vibration off for COP parameters with greater effects in condition with more baseline fluctuations. There was significant change in BBS test (Cohen d , 0.6; confidence interval [CI], −0.215 to −1.421). The time on TUG test was decreased and approached significance ( P = 0.06). Conclusions The immediate effect of the study showed that subthreshold vibration can improve static and dynamic balance in healthy elderly people and people with decreased plantar feet sensation. However, long-term studies are needed to establish the clinical value of the subthreshold vibration on balance control. Clinical Relevance Subthreshold vibration applied to the feet soles via custom-made shoes can reduce the postural sway in subjects with decreased feet sensation. By conducting more studies with conclusive results in the field of vibration effectiveness in the elderly, we can hope to reduce the rate of falls in the elderly.
姿势不稳被认为是衰老的正常结果，是由一些疾病如神经病变引起的。目的分析比较阈下振动施加于足底表面对健康老年人和模拟足底感觉下降的年轻人平衡控制的影响。方法采用随机双盲交叉研究方法，纳入24例受试者(12例老年人和12例足底足感觉减退的年轻人)。受试者分为两个干预组:1)带振动机制的矫形鞋;2)矫形鞋与振动关。主要结果为压力中心(COP)参数，包括平均速度、相平面肖像、振幅标准差(SD)和速度标准差。次要结果为伯格平衡量表(BBS)评分和计时和走测试(TUG)。在睁眼/闭眼和泡沫/刚性表面下测试站立平衡。采用一般线性混合模型检验进行统计分析。所有分析的统计学显著性水平设为0.05。本研究显示了非常大的效应量(partial η 2 >在基线波动较大的情况下，COP参数的影响更大。在BBS测试中有显著变化(Cohen d, 0.6;置信区间[CI]，−0.215 ~−1.421)。TUG测试时间缩短，接近显著性(P = 0.06)。结论阈下振动可改善健康老年人和足底足感觉减退者的静、动平衡，立竿一影。然而，阈下振动对平衡控制的临床应用价值尚需长期研究。临床意义:通过定制鞋对脚底施加阈下振动可以减少足部感觉下降的受试者的姿势摇摆。通过在老年人的振动有效性领域进行更多的研究并得出结论性的结果，我们可以希望减少老年人的跌倒率。
{"title":"Effect of Subsensory Vibration on Postural Control of Healthy Elderly and Subjects with Simulated Reduced Plantar Feet Sensation: A Randomized Crossover Controlled Trial","authors":"Atefeh Aboutorabi, Mokhtar Arazpour, Mohamad Hadadi, Masoumeh Veiskarami","doi":"10.1097/jpo.0000000000000489","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000489","url":null,"abstract":"Abstract Introduction Postural instability is considered a normal result of aging and is caused by some diseases such as neuropathy. Aim The purpose of the present study was to analyze and compare the effect of subthreshold vibration that was applied to the plantar surface of feet on balance control of healthy elderly and young subjects with simulated decreased plantar feet sensation. Methods Twenty-four subjects (12 elderly persons and 12 young persons with decreased plantar feet sensation) were included in this randomized, double-blinded crossover study. Participants were divided into two intervention groups: 1) orthopedic shoe with vibration mechanism on; and 2) orthopedic shoe with vibration off. Primary outcomes were center of pressure (COP) parameters including mean velocity, phase plane portrait, standard deviation (SD) of amplitude, and SD of velocity. Secondary outcomes were Berg Balance Scale (BBS) score and timed up and go test (TUG). The standing balance was tested with different conditions: eye opened/closed and foam/rigid surface. General linear mixed models tests were used for statistical analysis. The level of statistical significance was set at 0.05 for all analyses. Discussion This study showed very large effect sizes (partial η 2 > 0.2) with application of vibration as compared with vibration off for COP parameters with greater effects in condition with more baseline fluctuations. There was significant change in BBS test (Cohen d , 0.6; confidence interval [CI], −0.215 to −1.421). The time on TUG test was decreased and approached significance ( P = 0.06). Conclusions The immediate effect of the study showed that subthreshold vibration can improve static and dynamic balance in healthy elderly people and people with decreased plantar feet sensation. However, long-term studies are needed to establish the clinical value of the subthreshold vibration on balance control. Clinical Relevance Subthreshold vibration applied to the feet soles via custom-made shoes can reduce the postural sway in subjects with decreased feet sensation. By conducting more studies with conclusive results in the field of vibration effectiveness in the elderly, we can hope to reduce the rate of falls in the elderly.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135273793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01Epub Date: 2023-09-11DOI: 10.1097/JPO.0000000000000488
Walter R Frontera, Wouter DeGroote, Abdul Ghaffar
{"title":"Importance of Health Policy and Systems Research for Strengthening Rehabilitation in Health Systems: A Call to Action to Accelerate Progress.","authors":"Walter R Frontera, Wouter DeGroote, Abdul Ghaffar","doi":"10.1097/JPO.0000000000000488","DOIUrl":"10.1097/JPO.0000000000000488","url":null,"abstract":"","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 4","pages":"239-241"},"PeriodicalIF":0.6,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/b5/j-p-o-35-239.PMC10545072.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41152134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.1097/jpo.0000000000000463
Max Donahue Krueger
ABSTRACT Introduction Approximately 75% of Medicare patients sustain vascular-related major lower-limb amputations and die within 5 years postamputation. Studies have examined factors influencing mortality rates at 1 and 5 years postamputation. Lower-limb prosthesis users are assigned Medicare Functional Classification Levels (i.e., K-levels) at prosthetic evaluations. Higher K-level patients tend to ambulate faster and have lower comorbidity index scores. To date, no known studies have examined K-level classification as a mortality indicator. The study objective was to examine mortality rates and major nontraumatic lower-limb amputation Medicare patient demographics in the Chicago metropolitan area. A secondary goal was to explore how K-level classification coincides with mortality rates. Materials and Methods A total of 2833 lower-limb prosthetic patient evaluation records ranging from June 2014 to February 2019 were exported from Futura Practice Management. Only Medicare patients with major-lower limb amputations and information related to vascular etiologies were considered. Type and comorbidity quantity were assessed per record. K-levels used were those recorded; raw Amputee Mobility Predictor scores were not considered. The patients' living status was based on the dates of death found in the MYCGS database; living patients were assigned dates of database access. The number of days the patient survived postamputation was calculated as the difference between their living status and date of death. Descriptive statistics, binary logistic regression models with a confidence interval of 95%, and 5-year Kaplan-Meier plot were generated in SPSS. A truth table was created to determine eligible records for use in plots and mortality calculations at 5 years postamputation. Results A total of 502 patients were included after inclusion criteria application. Overall mortality rates at 1 year and 5 years postamputation were 33.6% and 73.59%, respectively. Transtibial and transfemoral mortality rates for 1 year and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. Comorbidity quantity had no statistical significance or influence on mortality rates at 1 year and 5 years postamputation. End-stage renal disease (ESRD) and heart condition had greater mortality association and increased mortality by a factor of 2.3 and 2.4, respectively. Kaplan-Meier results suggest that as K-level classification increases, so too does cumulative survival. Conclusions One-year and 5-year overall mortality rates fell within the ranges reported in the literature (33.6%, 73.59%). Transtibial and transfemoral mortality at 1 and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. ESRD and heart condition were indicators of mortality relative to other comorbid conditions. Higher K-level was associated with greater survival probability per Kaplan-Meier results. Clinical Relevance ESRD demonstrated greater association with mortality
大约75%的医保患者维持与血管相关的下肢截肢并在截肢后5年内死亡。研究调查了影响截肢后1年和5年死亡率的因素。下肢假体使用者在假体评估时被分配医疗保险功能分类水平(即k水平)。高k水平的患者往往走得更快，合并症指数得分更低。迄今为止，还没有已知的研究将k级分类作为死亡率指标。研究的目的是检查死亡率和主要的非创伤性下肢截肢医疗保险患者在芝加哥大都会地区的人口统计。第二个目标是探索k级分类如何与死亡率一致。材料与方法从Futura Practice Management导出2014年6月至2019年2月共2833份下肢假肢患者评估记录。仅考虑有大下肢截肢和血管病因相关信息的医保患者。评估每条记录的类型和合并症数量。使用的k -水平为记录值;未考虑原始截肢者活动能力预测评分。患者的生活状态基于MYCGS数据库中发现的死亡日期;在世患者被指定访问数据库的日期。患者截肢后存活的天数计算为其生活状态与死亡日期之间的差异。在SPSS中生成描述性统计、置信区间为95%的二元logistic回归模型和5年Kaplan-Meier图。创建了真值表，以确定在截肢后5年的地块和死亡率计算中使用的合格记录。结果按纳入标准纳入502例患者。截肢后1年和5年的总死亡率分别为33.6%和73.59%。术后1年、5年经胫和经股死亡率分别为33.07%、72.32%、35.59%和77.78%。合并症数量对截肢后1年和5年的死亡率无统计学意义。终末期肾病(ESRD)和心脏病的死亡率相关性更大，死亡率分别增加了2.3和2.4倍。Kaplan-Meier结果表明，随着k级分类的增加，累积存活率也会增加。结论1年和5年总死亡率均在文献报道范围内(33.6%和73.59%)。术后1年、5年经胫和经股死亡率分别为33.07%、72.32%、35.59%和77.78%。ESRD和心脏状况是相对于其他合并症的死亡率指标。根据Kaplan-Meier结果，较高的k水平与较高的生存概率相关。临床相关性ESRD与截肢后1年的死亡率有更大的相关性，而心脏状况与截肢后5年的死亡率有更大的相关性，这表明应该鼓励患者采取更健康的生活方式/选择。他们的活动水平和相应的k水平表明，以提高k水平为目标实际上可能提高他们的存活率并降低死亡率。
{"title":"Mortality After Nontraumatic Major Lower-Limb Amputations in Medicare Patients at a Large Metropolitan Prosthetic Facility","authors":"Max Donahue Krueger","doi":"10.1097/jpo.0000000000000463","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000463","url":null,"abstract":"ABSTRACT Introduction Approximately 75% of Medicare patients sustain vascular-related major lower-limb amputations and die within 5 years postamputation. Studies have examined factors influencing mortality rates at 1 and 5 years postamputation. Lower-limb prosthesis users are assigned Medicare Functional Classification Levels (i.e., K-levels) at prosthetic evaluations. Higher K-level patients tend to ambulate faster and have lower comorbidity index scores. To date, no known studies have examined K-level classification as a mortality indicator. The study objective was to examine mortality rates and major nontraumatic lower-limb amputation Medicare patient demographics in the Chicago metropolitan area. A secondary goal was to explore how K-level classification coincides with mortality rates. Materials and Methods A total of 2833 lower-limb prosthetic patient evaluation records ranging from June 2014 to February 2019 were exported from Futura Practice Management. Only Medicare patients with major-lower limb amputations and information related to vascular etiologies were considered. Type and comorbidity quantity were assessed per record. K-levels used were those recorded; raw Amputee Mobility Predictor scores were not considered. The patients' living status was based on the dates of death found in the MYCGS database; living patients were assigned dates of database access. The number of days the patient survived postamputation was calculated as the difference between their living status and date of death. Descriptive statistics, binary logistic regression models with a confidence interval of 95%, and 5-year Kaplan-Meier plot were generated in SPSS. A truth table was created to determine eligible records for use in plots and mortality calculations at 5 years postamputation. Results A total of 502 patients were included after inclusion criteria application. Overall mortality rates at 1 year and 5 years postamputation were 33.6% and 73.59%, respectively. Transtibial and transfemoral mortality rates for 1 year and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. Comorbidity quantity had no statistical significance or influence on mortality rates at 1 year and 5 years postamputation. End-stage renal disease (ESRD) and heart condition had greater mortality association and increased mortality by a factor of 2.3 and 2.4, respectively. Kaplan-Meier results suggest that as K-level classification increases, so too does cumulative survival. Conclusions One-year and 5-year overall mortality rates fell within the ranges reported in the literature (33.6%, 73.59%). Transtibial and transfemoral mortality at 1 and 5 years postamputation were 33.07%, 72.32%, 35.59%, and 77.78%, respectively. ESRD and heart condition were indicators of mortality relative to other comorbid conditions. Higher K-level was associated with greater survival probability per Kaplan-Meier results. Clinical Relevance ESRD demonstrated greater association with mortality","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135273791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-26DOI: 10.1097/jpo.0000000000000483
Priya Karakkattil, Bonnie Lewis, Mayra Zamora, Elaine Trudelle-Jackson, Ann Medley
ABSTRACT Introduction Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aim of this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function.
踝足矫形(AFO)和功能性电刺激(FES)是治疗由中枢神经系统原因引起的足下垂患者常用的干预措施。本系统综述的目的是在比较AFO和FES的有效性时，分析现有证据，以改善由中枢神经起源引起的足下垂患者的步态耐力。第二个目的是评估使用FES和AFO对行走功能感知的差异。方法采用MEDLINE/PubMed、Cochrane、JBI、CINAHL、Nursing and Allied Health、Ovid Emcare、PsycInfo、Scopus、Web of Science进行文献检索。截至2020年7月发表的所有文章均纳入本综述。评估随机对照试验或交叉试验，比较AFO和FES对中枢神经来源的足下垂患者的步态耐力和步行功能改善的感知。采用PEDro量表评估方法学质量。两名独立审稿人筛选标题、摘要和全文，第三名审稿人解决任何分歧。结果筛选了25条记录，其中16篇全文文章使用PEDro评分评估其合格性。11项期末研究(PEDro评分5 - 7分)纳入定性分析。在9项评估步态耐力的研究中，只有2项报告了FES对步态耐力的显著改善。8项研究中有7项评估了参与者对各种行走功能设备的偏好，结果显示FES的使用具有显著性。结论:我们的综述显示，与AFO相比，支持使用FES改善步态耐力的证据并不确凿。然而，对参与者行走设备偏好的定性分析显示，与AFO相比，FES是该人群中首选的设备。临床意义对于中枢神经系统病理的足下垂患者，FES或AFO可用于改善步态耐力。然而，FES可能是参与者行走功能的首选设备。
{"title":"Comparative Effects of Ankle-Foot Orthosis and Functional Electrical Stimulation on Gait Endurance and Participant Preference in Individuals with Foot Drop of Central Pathology: Systematic Review","authors":"Priya Karakkattil, Bonnie Lewis, Mayra Zamora, Elaine Trudelle-Jackson, Ann Medley","doi":"10.1097/jpo.0000000000000483","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000483","url":null,"abstract":"ABSTRACT Introduction Ankle-foot orthosis (AFO) and functional electrical stimulation (FES) are commonly used interventions for patients with foot drop caused by a central neurological origin. The aim of this systematic review is to analyze the available evidence on the improvement of gait endurance in people with foot drop caused by a central neurological origin when comparing effectiveness of AFO and FES. The secondary aim is to evaluate the available evidence for the difference between the use of FES and AFO on perception of walking function. Methods A literature search was conducted using MEDLINE/PubMed, Cochrane, JBI, CINAHL, Nursing and Allied Health, Ovid Emcare, PsycInfo, Scopus, and Web of Science. All articles published through July 2020 were included in this review. Randomized control trials or crossover trials addressing the comparison of AFO to FES in people with foot drop of central neurological origin on gait endurance and perception of improvement in walking function were assessed. PEDro scale was used to assess methodological quality. Two independent reviewers screened titles, abstracts, and full articles, and a third reviewer resolved any disagreements. Results Twenty-five records were screened with 16 full-text articles assessed for eligibility using the PEDro score. Eleven final studies (PEDro scores range from 5 to 7) were included in qualitative analysis. Only two of the nine studies that evaluated gait endurance reported significant improvement in gait endurance in favor of FES. Seven of the eight studies evaluated the participant preference of device for various walking functions, which showed significance in favor of the use of FES. Conclusions Our review reveals inconclusive evidence to support the use of FES compared with AFO for improving gait endurance. However, qualitative analysis of device preference for walking by participants reveals that FES was the preferred device in this population compared with AFO. Clinical Relevance For patients with foot drop of central nervous system pathology, FES or AFO can be used to improve gait endurance. However, FES may be the preferred device by participants for their walking function.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134885429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-04DOI: 10.1097/jpo.0000000000000484
Darren Craig Webb, Lara Anne Kimmel, Jeff D’Souza, Susan Liew
ABSTRACT Introduction Traumatic fractures of the thoracolumbar junction (T10–L3) are the most common fractures of the spinal column. The management of these injuries can be operative or nonoperative, and braces are often used, including the Boston Overlap Brace (BOB), a type of thoracolumbosacral orthosis (TSLO). Methods All patients admitted to the Alfred Hospital in 2015 and managed in a BOB for 2- or 3-column thoracolumbar burst fractures (without neurology) were included in the study. In-hospital and 6- and 12-month patient-reported outcome measures were collected. A random-effects regression model analysis for each outcome (self-reported) pain and functional outcome measures by the Glasgow Outcomes Scale–Extended (GOS-E) was undertaken. Results A total of 115 patients (62 male) were included with a median age of 53 years. Using a random-effects model, having a lower-limb fracture or a regional kyphosis angle >8° was associated with not having a good recovery after taking into account all other factors with a univariate relationship with this outcome. In terms of the outcome of self-reported pain, only female sex was associated with reporting pain. Conclusions This study included a large cohort of patients with management of a traumatic fracture with a BOB-type TLSO and provided information that should guide a larger study to review whether the factors associated with poorer outcome, including female sex and local kyphotic angle, need to be considered before deciding on the management of these fractures. Clinical Relevance The association between degree of deformity of fracture (>8°) and associated lower-limb injury with poorer patient outcomes may need to be taken into account before deciding to manage thoracolumbar fractures with a BOB-type TLSO although further longitudinal studies are required.
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