Pub Date : 2021-04-21DOI: 10.1097/JPO.0000000000000367
Zachary A. Block, John T. Brinkmann, S. Gard
ABSTRACT Study Design This is a narrative review. Introduction Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.
{"title":"The Utilization of Consensus Techniques in Education and Research in Medical Professions","authors":"Zachary A. Block, John T. Brinkmann, S. Gard","doi":"10.1097/JPO.0000000000000367","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000367","url":null,"abstract":"ABSTRACT Study Design This is a narrative review. Introduction Consensus techniques are an increasingly common research tool used to define levels of expert agreement on a topic where evidence is inconsistent or lacking. An assessment of commonly used consensus techniques can inform future education and research. Objective The aim of this study was to describe the use of various consensus techniques used in education and research in orthotics and prosthetics and closely related medical professions, to aid in choosing the most appropriate consensus technique for future research. Methods A systematic search of the literature was conducted using specific terms and keywords related to various consensus techniques, applications of consensus techniques in research and education, and medical disciplines related to orthotics and prosthetics. Studies were included if they described the use of a consensus technique for medical education or research and explained why the specific technique was used. Results Common consensus techniques were identified in the literature. To allow comparison of the techniques, the advantages, disadvantages, limitations, and previous applications of each were extracted from the literature. Conclusion Using the information from the literature, the most prevalent consensus techniques can be compared, aiding educators and researchers in choosing the technique most suitable for their topic of inquiry.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"175 - 183"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47385741","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 : 2021-04-21DOI: 10.1097/JPO.0000000000000365
Nicole A. Hoffman, Joanna R. Dallum, S. Hinshon, M. Finch
ABSTRACT Introduction Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture. Materials and Methods Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment. Results There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observational Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist. Conclusions Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes.
{"title":"Carbon Fiber Two-Pull Solid Ankle-Foot Orthoses versus Serial Casting in the Treatment of Idiopathic Toe Walking with Ankle Equinus Contracture","authors":"Nicole A. Hoffman, Joanna R. Dallum, S. Hinshon, M. Finch","doi":"10.1097/JPO.0000000000000365","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000365","url":null,"abstract":"ABSTRACT Introduction Idiopathic toe walking (ITW) is a common pediatric diagnosis. Serial casting, a common treatment used for an ankle equinus contracture, may not be appropriate for all children. This pilot study investigated whether carbon fiber two-pull solid ankle-foot orthoses (CTP-AFOs) would have similar outcomes as serial casting in the treatment of children with a diagnosis of ITW and ankle equinus contracture. Materials and Methods Children with ITW (n = 35) were randomized to receive CTP-AFOs or serial casting. Assessments were at initial, posttreatment, and 4-month follow-up with therapy protocols until posttreatment. Results There was no statistical difference in active (<0.001) and passive (<0.001) dorsiflexion range of motion, the Observational Gait Scale (<0.001), the Pediatric Reach Test (<0.01) popliteal range of motion (<0.001), strength in dorsiflexion (<0.001) and plantarflexion (0.21), and the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (0.31). Both groups demonstrated significant improvement over time with therapeutic intervention performed by a physical therapist. Conclusions Carbon fiber two-pull solid ankle-foot orthoses are a noninferior alternative to serial casting in a population with ITW and ankle equinus contracture. Therapeutic interventions for treatment of ITW and ankle equinus contracture have demonstrated improvements in motor outcomes.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"140 - 151"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44870021","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 : 2021-04-21DOI: 10.1097/JPO.0000000000000368
William Sloth, J. Fabricius, A. Pedersen
ABSTRACT Introduction Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ. Materials and Methods This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane. Results The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ. Conclusions A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ.
{"title":"Compensatory Gait Strategies in Persons with Transfemoral Amputations Walking with a Locked Prosthetic Knee Joint Compared with an Unlocked Knee Joint: A Crossover Trial","authors":"William Sloth, J. Fabricius, A. Pedersen","doi":"10.1097/JPO.0000000000000368","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000368","url":null,"abstract":"ABSTRACT Introduction Individuals with transfemoral amputation walking with a locked prosthetic knee joint (LPKJ) have compromised degree of freedom in leg movement compared with walking with an unlocked prosthetic knee joint (UPKJ), thus presenting a risk for compensatory gait strategies, with risk of lower back pain. The objective was to compare gait strategies in individuals with transfemoral amputation walking with an LPKJ and a UPKJ. Materials and Methods This was a crossover trial. Nine individuals with transfemoral amputation habitually walking with a UPKJ completed an intervention of 1 to 2 weeks of walking with a UPKJ followed by 1 to 2 weeks of walking with an LPKJ. Gait strategies were analyzed after each intervention using three-dimensional gait analysis. The outcome was pelvic and lumbar spinal movement from terminal stance to initial swing in the sagittal and transversal plane. Results The maximum anterior tilt of the pelvis in the sagittal plane and the pelvic rotation shifted from preswing to initial swing in the gait cycle when walking with an LPKJ compared with the UPKJ. Conclusions A compensatory gait strategy was observed among individuals with transfemoral amputation walking with an LPKJ compared with a UPKJ. Studies should investigate the incidence of low back pain in individuals with transfemoral amputation walking with LPKJ compared with those walking with UPKJ.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"159 - 164"},"PeriodicalIF":0.6,"publicationDate":"2021-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46157529","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 : 2021-04-20DOI: 10.1097/JPO.0000000000000369
Brian Kaluf, Courtney Cox, Eric M. Shoemaker
ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.
{"title":"Hydraulic- and Microprocessor-Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study","authors":"Brian Kaluf, Courtney Cox, Eric M. Shoemaker","doi":"10.1097/JPO.0000000000000369","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000369","url":null,"abstract":"ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"294 - 303"},"PeriodicalIF":0.6,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42151924","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 : 2021-04-02DOI: 10.1097/JPO.0000000000000364
Hanieh Seyyedzadeh, M. Arazpour, H. Saeedi, M. Mousavi, Navid Golchin
ABSTRACT Introduction This study evaluated the efficacy of two different medial linkage mechanisms (sliding mechanism [SM] and medial linkage mechanism associated with reciprocating gait motion (MLRGM), used within otherwise identical knee-ankle-foot orthoses (KAFOs) on patients with spinal cord injury (SCI). Methods Three volunteer subjects with SCI were fitted with a KAFO equipped with 1) an SM and 2) a medial linkage mechanism (MLRGM). Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance, and the resulting physiological cost index to be performed. Results The use of a KAFO fitted with the MLRGM resulted in improvements in walking speed, distance walked, and energy costs when compared with the more standard SM. However, the time required to don the KAFO increased with use of the MLRGM, but doffing time was approximately equal for both types. Conclusions This study demonstrated that the use of a KAFO with an MLRGM could provide significant benefits for patients with SCI when compared with a KAFO with a standard SM.
{"title":"Comparison of the Efficacy of Two Different Medial Linkage Mechanisms in Knee-Ankle-Foot Orthoses on Walking Ability in Subjects with Spinal Cord Injury","authors":"Hanieh Seyyedzadeh, M. Arazpour, H. Saeedi, M. Mousavi, Navid Golchin","doi":"10.1097/JPO.0000000000000364","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000364","url":null,"abstract":"ABSTRACT Introduction This study evaluated the efficacy of two different medial linkage mechanisms (sliding mechanism [SM] and medial linkage mechanism associated with reciprocating gait motion (MLRGM), used within otherwise identical knee-ankle-foot orthoses (KAFOs) on patients with spinal cord injury (SCI). Methods Three volunteer subjects with SCI were fitted with a KAFO equipped with 1) an SM and 2) a medial linkage mechanism (MLRGM). Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance, and the resulting physiological cost index to be performed. Results The use of a KAFO fitted with the MLRGM resulted in improvements in walking speed, distance walked, and energy costs when compared with the more standard SM. However, the time required to don the KAFO increased with use of the MLRGM, but doffing time was approximately equal for both types. Conclusions This study demonstrated that the use of a KAFO with an MLRGM could provide significant benefits for patients with SCI when compared with a KAFO with a standard SM.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"311 - 314"},"PeriodicalIF":0.6,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44777932","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 : 2021-04-02DOI: 10.1097/JPO.0000000000000362
W. Glasoe, M. K. Allen, J. R. Harris, Madeline M. Higgins, Susan M. Jewett, Michael J. Rucker
ABSTRACT Introduction No recent review of the literature has investigated the effects of dynamic weight-bearing interventions for hallux valgus (HV) deformity, nor has research identified a preferred conservative treatment. This review studied the effectiveness of functional foot orthoses or taping in adults seeking care for HV. The outcomes examined were pain, function, and change in plantar pressures. Materials and Methods The literature was searched up to February 1, 2019, to identify relevant studies that treated adult HV with functional foot orthoses or taping and reported outcomes of pain, function, or the redistribution of plantar pressures. Pain and function were evaluated with a standardized mean difference effect size calculation; change in plantar pressures attributed to interventions was reported descriptively. Results Seven studies were identified for review. Five studies reported improved (pooled effect size, ≥0.89) pain or function outcomes for up to 6 months. Two studies that reported only plantar pressure measurements identified reduced loading under the first metatarsophalangeal joint. Conclusions Treatment with functional foot orthoses and taping reduced pain and function impairments in patients with HV over the short term (6 months), with no adverse outcomes reported. Although the actual mechanism is unknown, studies reporting plantar pressures indicate that load is transferred away from the area of deformity. Foot orthoses were identified as the preferred treatment, with tape considered an option for clinical assessment or temporary pain relief. Because of the progressive nature of deformity, the impairments, although improved with treatment (pooled effect size, ≥0.89), may not necessarily be lasting.
{"title":"Effects of Functional Foot Orthoses and Taping Interventions on Pain, Function, and Plantar Pressure for Adult Hallux Valgus: A Literature Review","authors":"W. Glasoe, M. K. Allen, J. R. Harris, Madeline M. Higgins, Susan M. Jewett, Michael J. Rucker","doi":"10.1097/JPO.0000000000000362","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000362","url":null,"abstract":"ABSTRACT Introduction No recent review of the literature has investigated the effects of dynamic weight-bearing interventions for hallux valgus (HV) deformity, nor has research identified a preferred conservative treatment. This review studied the effectiveness of functional foot orthoses or taping in adults seeking care for HV. The outcomes examined were pain, function, and change in plantar pressures. Materials and Methods The literature was searched up to February 1, 2019, to identify relevant studies that treated adult HV with functional foot orthoses or taping and reported outcomes of pain, function, or the redistribution of plantar pressures. Pain and function were evaluated with a standardized mean difference effect size calculation; change in plantar pressures attributed to interventions was reported descriptively. Results Seven studies were identified for review. Five studies reported improved (pooled effect size, ≥0.89) pain or function outcomes for up to 6 months. Two studies that reported only plantar pressure measurements identified reduced loading under the first metatarsophalangeal joint. Conclusions Treatment with functional foot orthoses and taping reduced pain and function impairments in patients with HV over the short term (6 months), with no adverse outcomes reported. Although the actual mechanism is unknown, studies reporting plantar pressures indicate that load is transferred away from the area of deformity. Foot orthoses were identified as the preferred treatment, with tape considered an option for clinical assessment or temporary pain relief. Because of the progressive nature of deformity, the impairments, although improved with treatment (pooled effect size, ≥0.89), may not necessarily be lasting.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e1 - e8"},"PeriodicalIF":0.6,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46968377","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 : 2021-04-01DOI: 10.1097/JPO.0000000000000358
S. Stauffer, Corin Shirley, B. Fortson, N. Henry, Chrysta R Irolla, Benjamin E Padilla
Supplemental digital content is available in the text. ABSTRACT Introduction Pectus carinatum is a bony deformity of the anterior chest wall and has a strong negative impact on patient self-esteem and quality of life. During adolescence, the deformity is often flexible and can be treated with a compressive orthosis. Compliance with orthoses yields deformity correction and self-esteem improvement (J Pediatr Surg. 2013;48:1055-1059). The purpose of this study is to evaluate the compliance to and patient satisfaction with the custom University of California, San Francisco (UCSF), Pectus Carinatum Orthosis (PCO) design. Materials and Methods This was a cross-sectional survey of the patients who received orthotic treatment for pectus carinatum at UCSF between August 2012 and June 2018. Potential subjects were contacted and asked to complete the Pectus Carinatum Evaluation Questionnaire (PCEQ), which was administered online via Research Electronic Data Capture. The PCEQ measures compliance as well as the physical and psychosocial impact of orthotic treatment for pectus carinatum. Results were compiled and summarized using nonparametric descriptive statistics. Results Of the 35 consented subjects, 12 (11 male patients and 1 female patient aged 12–17 years) completed the survey. Subjects reported an average wear time of 12.7 hours per day, 5 days a week. Seven reported no symptoms, three experienced chest pain, two reported difficulty breathing, and one had back pain. Eight reported happiness with the results of their orthotic treatment. Conclusion Wear times reported by the subjects were comparable with those reported in other studies looking at prefabricated pectus orthoses. However, there were lower reports of pain associated with the UCSF treatment than in other studies. Further research is necessary to determine the benefit of custom fabricated versus prefabricated PCOs.
文本中提供了补充数字内容。摘要简介隆凸胸是胸前壁的一种骨性畸形，对患者的自尊和生活质量有很大的负面影响。在青春期，畸形通常是灵活的，可以用压缩矫形器治疗。对矫形器的依从性产生畸形矫正和自尊改善（J Pediatr Surg.2013；48:1055-1059）。本研究的目的是评估定制的加利福尼亚大学旧金山分校（UCSF）Pectus Carinatum Orthosis（PCO）设计的依从性和患者满意度。材料和方法这是对2012年8月至2018年6月在加州大学旧金山分校接受隆突矫正治疗的患者的横断面调查。联系潜在受试者，并要求其填写通过Research Electronic Data Capture在线管理的胸肉评估问卷（PCEQ）。PCEQ测量隆胸矫正治疗的依从性以及身体和心理社会影响。使用非参数描述性统计对结果进行了汇编和总结。结果在35名同意的受试者中，12名（11名男性患者和1名女性患者，年龄12-17岁）完成了调查。受试者报告每周5天，平均每天佩戴12.7小时。7人报告没有症状，3人胸痛，2人报告呼吸困难，1人背痛。8人对他们的矫正治疗结果表示满意。结论受试者报告的佩戴时间与其他研究中报告的预制胸矫形器的佩戴时间相当。然而，与其他研究相比，与UCSF治疗相关的疼痛报告较少。有必要进行进一步的研究，以确定定制和预制PCO的益处。
{"title":"Patient-Reported Efficacy of the University of California, San Francisco, Custom Pectus Carinatum Orthosis","authors":"S. Stauffer, Corin Shirley, B. Fortson, N. Henry, Chrysta R Irolla, Benjamin E Padilla","doi":"10.1097/JPO.0000000000000358","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000358","url":null,"abstract":"Supplemental digital content is available in the text. ABSTRACT Introduction Pectus carinatum is a bony deformity of the anterior chest wall and has a strong negative impact on patient self-esteem and quality of life. During adolescence, the deformity is often flexible and can be treated with a compressive orthosis. Compliance with orthoses yields deformity correction and self-esteem improvement (J Pediatr Surg. 2013;48:1055-1059). The purpose of this study is to evaluate the compliance to and patient satisfaction with the custom University of California, San Francisco (UCSF), Pectus Carinatum Orthosis (PCO) design. Materials and Methods This was a cross-sectional survey of the patients who received orthotic treatment for pectus carinatum at UCSF between August 2012 and June 2018. Potential subjects were contacted and asked to complete the Pectus Carinatum Evaluation Questionnaire (PCEQ), which was administered online via Research Electronic Data Capture. The PCEQ measures compliance as well as the physical and psychosocial impact of orthotic treatment for pectus carinatum. Results were compiled and summarized using nonparametric descriptive statistics. Results Of the 35 consented subjects, 12 (11 male patients and 1 female patient aged 12–17 years) completed the survey. Subjects reported an average wear time of 12.7 hours per day, 5 days a week. Seven reported no symptoms, three experienced chest pain, two reported difficulty breathing, and one had back pain. Eight reported happiness with the results of their orthotic treatment. Conclusion Wear times reported by the subjects were comparable with those reported in other studies looking at prefabricated pectus orthoses. However, there were lower reports of pain associated with the UCSF treatment than in other studies. Further research is necessary to determine the benefit of custom fabricated versus prefabricated PCOs.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"96 - 100"},"PeriodicalIF":0.6,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47991869","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 : 2021-04-01DOI: 10.1097/JPO.0000000000000361
Phillip M. Stevens
Supplemental digital content is available in the text.
文本中提供了补充数字内容。
{"title":"Prioritizing Primary Outcomes in Prosthetic Rehabilitation: Observations from Recent Evidence","authors":"Phillip M. Stevens","doi":"10.1097/JPO.0000000000000361","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000361","url":null,"abstract":"Supplemental digital content is available in the text.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"82 - 87"},"PeriodicalIF":0.6,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42860358","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 : 2021-04-01DOI: 10.1097/JPO.0000000000000359
Tylan N. Templin, G. Klute, R. Neptune
ABSTRACT Introduction For able-bodied individuals, the mechanical output from the ankle muscles is modulated to meet the altered demands of load carriage. However, for individuals with a lower-limb amputation, the stiffness properties of standard-of-care prosthetic feet do not change with varying load conditions. Thus, individuals with amputation often develop gait asymmetries during load carriage that increase their risk for developing overuse injuries such as in the intact knee and increase the metabolic cost of walking relative to able-bodied individuals. The purpose of this preliminary study was to assess the influence of load carriage technique on knee joint loading and metabolic cost during gait of an individual with a below-knee amputation using a forward dynamics simulation framework. Methods Simulations were generated to track the experimental walking data of individuals with amputation for 3 loading conditions (unloaded, front load, and back load). Results These simulations showed that individuals with amputation rely on their intact limb as a compensatory strategy to meet the increased demands of carrying a load. Carrying a back load was found to increase intact knee joint loading relative to carrying a front load but reduced metabolic cost. Conclusion The tradeoff between joint loading and metabolic cost should be considered when determining the appropriate load carriage technique. Future work should focus on improving prosthetic foot designs to help reduce joint loading asymmetry and elevated metabolic cost during different loading conditions for individuals with lower-limb amputation.
{"title":"The Influence of Load Carriage on Knee Joint Loading and Metabolic Cost on Walking with Lower-Limb Amputation: A Preliminary Modeling Study","authors":"Tylan N. Templin, G. Klute, R. Neptune","doi":"10.1097/JPO.0000000000000359","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000359","url":null,"abstract":"ABSTRACT Introduction For able-bodied individuals, the mechanical output from the ankle muscles is modulated to meet the altered demands of load carriage. However, for individuals with a lower-limb amputation, the stiffness properties of standard-of-care prosthetic feet do not change with varying load conditions. Thus, individuals with amputation often develop gait asymmetries during load carriage that increase their risk for developing overuse injuries such as in the intact knee and increase the metabolic cost of walking relative to able-bodied individuals. The purpose of this preliminary study was to assess the influence of load carriage technique on knee joint loading and metabolic cost during gait of an individual with a below-knee amputation using a forward dynamics simulation framework. Methods Simulations were generated to track the experimental walking data of individuals with amputation for 3 loading conditions (unloaded, front load, and back load). Results These simulations showed that individuals with amputation rely on their intact limb as a compensatory strategy to meet the increased demands of carrying a load. Carrying a back load was found to increase intact knee joint loading relative to carrying a front load but reduced metabolic cost. Conclusion The tradeoff between joint loading and metabolic cost should be considered when determining the appropriate load carriage technique. Future work should focus on improving prosthetic foot designs to help reduce joint loading asymmetry and elevated metabolic cost during different loading conditions for individuals with lower-limb amputation.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"33 1","pages":"118 - 124"},"PeriodicalIF":0.6,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43797385","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 : 2021-03-12DOI: 10.1097/JPO.0000000000000356
Elizabeth M. Bell, Jessica Carrignan, Douglas Kurt Collier, Ji Seung Yang, J. Shim
ABSTRACT Introduction Although the physical abilities associated with activity, exercise, and fitness within the general population of individuals without disabilities have been well established, it is unclear if these abilities define the physical function of individuals with lower-limb amputations (LLAs) who use a prosthesis. A multidimensional definition of the physical function of people with LLA must consider what abilities are necessary and relevant. Objectives This literature review aimed to identify common abilities used to evaluate the physical function of people with LLA. A secondary aim was to evaluate if each identified ability had been indirectly addressed by existing questionnaires and performance-based tests. Study Design Literature Review. Methods Ten common physical abilities associated with measuring the physical function of LLA were identified through literature review. These identified abilities were used to assess what aspects had been indirectly addressed by existing questionnaires and performance-based evaluations of LLA physical function. Results and Conclusions Abilities identified through literature review included agility, balance, comfort, endurance, flexibility, load, maneuverability, power, strength, and symmetry. These 10 abilities are important and commonly used as outcome measures associated with the physical function of people with LLA. Although each ability was addressed by multiple assessments, no assessment addressed all 10 identified abilities. The Prosthetic Limb Users Survey of Mobility, Prosthetic Profile of the Amputee, Rivermead Mobility Index, and the Amputee Mobility Predictor addressed most (8–9 of 10) of the identified abilities. There were clear differences and gaps in the abilities addressed by current assessments, possibly because they rely on an incomplete definition of what is required for LLA physical function. We propose that these 10 abilities are unique and underlie the definition of LLA physical function. However, future work must assess the validity of this proposed framework. Clinical Relevance A multidimensional definition of LLA physical function is necessary to enable more appropriate prosthetic design, prescription, and use. Promoting greater mobility and physical activity levels within this population will improve health of people with LLA.
{"title":"Identifying Prosthetic Capabilities That Define Functionality of Individuals With Amputation","authors":"Elizabeth M. Bell, Jessica Carrignan, Douglas Kurt Collier, Ji Seung Yang, J. Shim","doi":"10.1097/JPO.0000000000000356","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000356","url":null,"abstract":"ABSTRACT Introduction Although the physical abilities associated with activity, exercise, and fitness within the general population of individuals without disabilities have been well established, it is unclear if these abilities define the physical function of individuals with lower-limb amputations (LLAs) who use a prosthesis. A multidimensional definition of the physical function of people with LLA must consider what abilities are necessary and relevant. Objectives This literature review aimed to identify common abilities used to evaluate the physical function of people with LLA. A secondary aim was to evaluate if each identified ability had been indirectly addressed by existing questionnaires and performance-based tests. Study Design Literature Review. Methods Ten common physical abilities associated with measuring the physical function of LLA were identified through literature review. These identified abilities were used to assess what aspects had been indirectly addressed by existing questionnaires and performance-based evaluations of LLA physical function. Results and Conclusions Abilities identified through literature review included agility, balance, comfort, endurance, flexibility, load, maneuverability, power, strength, and symmetry. These 10 abilities are important and commonly used as outcome measures associated with the physical function of people with LLA. Although each ability was addressed by multiple assessments, no assessment addressed all 10 identified abilities. The Prosthetic Limb Users Survey of Mobility, Prosthetic Profile of the Amputee, Rivermead Mobility Index, and the Amputee Mobility Predictor addressed most (8–9 of 10) of the identified abilities. There were clear differences and gaps in the abilities addressed by current assessments, possibly because they rely on an incomplete definition of what is required for LLA physical function. We propose that these 10 abilities are unique and underlie the definition of LLA physical function. However, future work must assess the validity of this proposed framework. Clinical Relevance A multidimensional definition of LLA physical function is necessary to enable more appropriate prosthetic design, prescription, and use. Promoting greater mobility and physical activity levels within this population will improve health of people with LLA.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"34 1","pages":"e9 - e19"},"PeriodicalIF":0.6,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45108585","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}
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