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.
{"title":"Epidemiology and 12-Month Outcomes of Patients Managed in a Thoracolumbosacral Orthosis After Trauma","authors":"Darren Craig Webb, Lara Anne Kimmel, Jeff D’Souza, Susan Liew","doi":"10.1097/jpo.0000000000000484","DOIUrl":"https://doi.org/10.1097/jpo.0000000000000484","url":null,"abstract":"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.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135453949","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 : 2023-07-07DOI: 10.1097/JPO.0000000000000475
Rafael Isac Vieira, G. J. da Silva Honório, Kadine Priscila Bender dos Santos, Ruy Luiz Lorenzetti Branco, Joaquim Henrique Lorenzetti Branco, S. C. Tonon da Luz
ABSTRACT Introduction Prosthesis fixation is considered the central point for functionality, which promotes social reintegration of the individual with amputation. The deficits in the making of the prosthetic socket may trigger excessive friction on the residual limb and socket discomfort, possibly leading to a poor adaptation and consequent reduction of activity. Thermography is an evaluation and diagnostic method that may aid in the verification of the functionality of the prosthesis. The objective of the study was to analyze the superficial thermal distribution characteristics, the skin sensitivity of the residual limb, and the adaptation to the prosthesis of individuals with lower-limb amputation with prostheses provided by the Universal Health System. Materials and Methods Sixteen individuals of both genders with unilateral lower-limb amputation with ages between 18 and 64 years were recruited. The data collection protocol was composed of completing the physiotherapeutic evaluation form, assessment of residual limb skin sensitivity, application of the Prosthesis Evaluation Questionnaire (PEQ), treadmill walk for 10 minutes, thermographic evaluation immediately after the removal of the prosthesis, and lastly postacclimatization thermographic assessment. Results Before the acclimatization, the region of the L3 dermatome of those who had altered sensitivity, the maximum (31.43°C), mean (28.97°C), and minimum (28.27°C) temperatures were significantly lower compared with those who had normal sensitivity (32.81°C, 29.68°C, and 28.91°C, respectively) (P < 0.05). Regarding the period after the acclimatization, there was no significant difference in the comparison performed between temperature and sensitivity. The individuals with transtibial amputation obtained results above the overall median for the PEQ items, whereas the individuals with transfemoral amputation obtained results above the overall median for the “total score.” There is a strong negative relationship between the mean temperature of the residual limb extremity with item “utility” in the preacclimatization moment and a strong negative relationship between the mean and minimum temperatures at the residual limb extremity with the “residual limb health” item at the moment after the acclimatization. There is no association between the PEQ items and residual limb sensitivity. Conclusions One may conclude that high temperatures at the postacclimatization moment indicate areas of friction that trigger a poor adaptation of the residual limb with the prosthetic socket, in which case the development of new strategies for improving the quality of the prostheses supplied is suggested. Clinical Relevance Thermography helps in evaluating the residual limb and adapting the prosthesis, as it is a noninvasive clinical assessment tool. Thermography aids health professionals for management of the patient with amputation in the preprosthesis and postprosthesis phases.
{"title":"Thermographic Evaluation, Residual Limb Skin Sensitivity, and Adaptation to the Prosthesis of Individuals with Lower-Limb Amputation with Prosthesis Provided by the Universal Health System","authors":"Rafael Isac Vieira, G. J. da Silva Honório, Kadine Priscila Bender dos Santos, Ruy Luiz Lorenzetti Branco, Joaquim Henrique Lorenzetti Branco, S. C. Tonon da Luz","doi":"10.1097/JPO.0000000000000475","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000475","url":null,"abstract":"ABSTRACT Introduction Prosthesis fixation is considered the central point for functionality, which promotes social reintegration of the individual with amputation. The deficits in the making of the prosthetic socket may trigger excessive friction on the residual limb and socket discomfort, possibly leading to a poor adaptation and consequent reduction of activity. Thermography is an evaluation and diagnostic method that may aid in the verification of the functionality of the prosthesis. The objective of the study was to analyze the superficial thermal distribution characteristics, the skin sensitivity of the residual limb, and the adaptation to the prosthesis of individuals with lower-limb amputation with prostheses provided by the Universal Health System. Materials and Methods Sixteen individuals of both genders with unilateral lower-limb amputation with ages between 18 and 64 years were recruited. The data collection protocol was composed of completing the physiotherapeutic evaluation form, assessment of residual limb skin sensitivity, application of the Prosthesis Evaluation Questionnaire (PEQ), treadmill walk for 10 minutes, thermographic evaluation immediately after the removal of the prosthesis, and lastly postacclimatization thermographic assessment. Results Before the acclimatization, the region of the L3 dermatome of those who had altered sensitivity, the maximum (31.43°C), mean (28.97°C), and minimum (28.27°C) temperatures were significantly lower compared with those who had normal sensitivity (32.81°C, 29.68°C, and 28.91°C, respectively) (P < 0.05). Regarding the period after the acclimatization, there was no significant difference in the comparison performed between temperature and sensitivity. The individuals with transtibial amputation obtained results above the overall median for the PEQ items, whereas the individuals with transfemoral amputation obtained results above the overall median for the “total score.” There is a strong negative relationship between the mean temperature of the residual limb extremity with item “utility” in the preacclimatization moment and a strong negative relationship between the mean and minimum temperatures at the residual limb extremity with the “residual limb health” item at the moment after the acclimatization. There is no association between the PEQ items and residual limb sensitivity. Conclusions One may conclude that high temperatures at the postacclimatization moment indicate areas of friction that trigger a poor adaptation of the residual limb with the prosthetic socket, in which case the development of new strategies for improving the quality of the prostheses supplied is suggested. Clinical Relevance Thermography helps in evaluating the residual limb and adapting the prosthesis, as it is a noninvasive clinical assessment tool. Thermography aids health professionals for management of the patient with amputation in the preprosthesis and postprosthesis phases.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"272 - 282"},"PeriodicalIF":0.6,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46455423","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 : 2023-07-01DOI: 10.1097/JPO.0000000000000472
C. Ng, Kin Fong Wong, King-Pong Yu, K. Chan, Sin-Wa Ng
ABSTRACT Introduction Poliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance. Materials and Methods A case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants’ gait performance. Results Five participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer. Conclusions The knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower. Clinical Relevance The application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice.
{"title":"Application of Knee Robotic Orthosis to Improve the Walking Performance of People with Post-Polio Syndrome","authors":"C. Ng, Kin Fong Wong, King-Pong Yu, K. Chan, Sin-Wa Ng","doi":"10.1097/JPO.0000000000000472","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000472","url":null,"abstract":"ABSTRACT Introduction Poliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance. Materials and Methods A case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants’ gait performance. Results Five participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer. Conclusions The knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower. Clinical Relevance The application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"229 - 236"},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48690799","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 : 2023-05-11DOI: 10.1097/JPO.0000000000000471
S. Spaulding, Joshua B. Utay, Sheryl N. Sachs
ABSTRACT Introduction Prosthetic and orthotic (P&O) education summits and strategic planning meetings have been held periodically since 1970 to review the current state of practice and education and to advance the profession. These meetings typically included a panel of acknowledged experts from the ranks of educators, researchers, consumers, industry representatives, and practitioners. Materials and Methods A narrative review of education summit and strategic planning meeting reports was performed. The authors defined concrete aims and specific questions before conducting the review. The authors independently reviewed the reports to identify the purpose of each meeting and the perceived challenges of the time. Lastly, the authors performed a qualitative thematic analysis to clarify the findings. Results The recurring themes identified from the five education summit reports, joint task force report, and three National Commission on Orthotic and Prosthetic Education (NCOPE) strategic planning meeting reports include 1) workforce shortages, 2) continuous development and oversight of uniform, recognized, national academic standards, 3) sustainability of P&O academic programs, 4) development and oversight of uniform, recognized, national residency standards, 5) communication with stakeholders, including related health professionals, and 6) data collection and usage. Conclusions Recurring themes and challenges that existed previously in P&O education still exist today. Communication between academic programs and community partners (e.g., clinical practitioners, paraprofessionals, patients, payers, and interdisciplinary professionals) is a continuing priority to clarify the expectations of P&O professionals and to advance the profession. Use of a systematic approach could help map the patterns and needs of the profession to demonstrate progress over time and to facilitate future strategic planning. Clinical Relevance P&O education is designed to meet the needs of practitioners and paraprofessionals who implement P&O services (i.e., fitting, fabrication, and patient management). Maintaining communication between academia and its community partners is critical to advancing the profession.
{"title":"Recurring Themes in Prosthetic and Orthotic Education: A Narrative Review of Prosthetic and Orthotic Education Summit Meetings","authors":"S. Spaulding, Joshua B. Utay, Sheryl N. Sachs","doi":"10.1097/JPO.0000000000000471","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000471","url":null,"abstract":"ABSTRACT Introduction Prosthetic and orthotic (P&O) education summits and strategic planning meetings have been held periodically since 1970 to review the current state of practice and education and to advance the profession. These meetings typically included a panel of acknowledged experts from the ranks of educators, researchers, consumers, industry representatives, and practitioners. Materials and Methods A narrative review of education summit and strategic planning meeting reports was performed. The authors defined concrete aims and specific questions before conducting the review. The authors independently reviewed the reports to identify the purpose of each meeting and the perceived challenges of the time. Lastly, the authors performed a qualitative thematic analysis to clarify the findings. Results The recurring themes identified from the five education summit reports, joint task force report, and three National Commission on Orthotic and Prosthetic Education (NCOPE) strategic planning meeting reports include 1) workforce shortages, 2) continuous development and oversight of uniform, recognized, national academic standards, 3) sustainability of P&O academic programs, 4) development and oversight of uniform, recognized, national residency standards, 5) communication with stakeholders, including related health professionals, and 6) data collection and usage. Conclusions Recurring themes and challenges that existed previously in P&O education still exist today. Communication between academic programs and community partners (e.g., clinical practitioners, paraprofessionals, patients, payers, and interdisciplinary professionals) is a continuing priority to clarify the expectations of P&O professionals and to advance the profession. Use of a systematic approach could help map the patterns and needs of the profession to demonstrate progress over time and to facilitate future strategic planning. Clinical Relevance P&O education is designed to meet the needs of practitioners and paraprofessionals who implement P&O services (i.e., fitting, fabrication, and patient management). Maintaining communication between academia and its community partners is critical to advancing the profession.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"139 - 148"},"PeriodicalIF":0.6,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43537736","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}
{"title":"CRANIAL ORTHOSES","authors":"","doi":"10.1097/01.jpo.0000921044.36618.b4","DOIUrl":"https://doi.org/10.1097/01.jpo.0000921044.36618.b4","url":null,"abstract":"Journal of Prosthetics and Orthotics 35(2S):p 1-3, April 2023. | DOI: 10.1097/01.JPO.0000921044.36618.b4","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"336 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135017201","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}
{"title":"UPPER-LIMB PROSTHESES","authors":"","doi":"10.1097/01.jpo.0000921064.11529.b8","DOIUrl":"https://doi.org/10.1097/01.jpo.0000921064.11529.b8","url":null,"abstract":"Journal of Prosthetics and Orthotics 35(2S):p 53-61, April 2023. | DOI: 10.1097/01.JPO.0000921064.11529.b8","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135017203","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 : 2023-04-01DOI: 10.1097/JPO.0000000000000469
C. Faldini, A. Mazzotti, G. Geraci, S. Zielli, Simone Bonelli, A. Panciera
ABSTRACT Introduction Transtibial amputation represents a definitive treatment of several pathological conditions. Historically, immediate postoperative prosthetic protocols have been developed to improve recovery; however, concerns still limit their widespread application. Materials and Methods The aim of this article is to present a step-by-step approach to a revised, inexpensive, and easy technique that allows early postoperative prosthetic use and rehabilitation. Results The technique appears to provide optimal patient care levels at reasonable costs and could be applied also in low-resource settings. Conclusions Early ambulation allows to avoid postoperative complications (such as thromboembolism, pneumonia, etc.) and facilitates definitive prosthetic substitution and conservation of gait patterns as well as better psychological results. Clinical Relevance This technique can provide a solution for allowing early ambulation in persons with amputations, facilitating the postoperative management of these patients.
{"title":"Early Postoperative Prosthesis After Transtibial Amputation: Step-By-Step Approach","authors":"C. Faldini, A. Mazzotti, G. Geraci, S. Zielli, Simone Bonelli, A. Panciera","doi":"10.1097/JPO.0000000000000469","DOIUrl":"https://doi.org/10.1097/JPO.0000000000000469","url":null,"abstract":"ABSTRACT Introduction Transtibial amputation represents a definitive treatment of several pathological conditions. Historically, immediate postoperative prosthetic protocols have been developed to improve recovery; however, concerns still limit their widespread application. Materials and Methods The aim of this article is to present a step-by-step approach to a revised, inexpensive, and easy technique that allows early postoperative prosthetic use and rehabilitation. Results The technique appears to provide optimal patient care levels at reasonable costs and could be applied also in low-resource settings. Conclusions Early ambulation allows to avoid postoperative complications (such as thromboembolism, pneumonia, etc.) and facilitates definitive prosthetic substitution and conservation of gait patterns as well as better psychological results. Clinical Relevance This technique can provide a solution for allowing early ambulation in persons with amputations, facilitating the postoperative management of these patients.","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"35 1","pages":"219 - 223"},"PeriodicalIF":0.6,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43667457","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}
{"title":"2023 Annual Meeting Clinical Content Committee/Academy Board","authors":"","doi":"10.1097/01.jpo.0000921032.07583.d3","DOIUrl":"https://doi.org/10.1097/01.jpo.0000921032.07583.d3","url":null,"abstract":"Journal of Prosthetics and Orthotics 35(2S):10.1097/01.JPO.0000921032.07583.d3, April 2023. | DOI: 10.1097/01.JPO.0000921032.07583.d3","PeriodicalId":53702,"journal":{"name":"Journal of Prosthetics and Orthotics","volume":"337 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135017195","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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