Purpose: To examine the psychometric properties of selected field-based anaerobic capacity tests in children with and without DCD.
Methods: School-aged children (6–16 years) with and without DCD participated in the study. The children completed the shuttle run sub-item of the Bruninks-Oseretsky test of motor proficiency-second edition, the 10?×?5 m sprint tests (straight and slalom) and the muscle power sprint test (MPST).
Results: The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and 10?×?5?m sprint tests possess good construct validity and test–retest reliability in children with DCD. The 10?×?5?m sprint test-slalom was found to be the most responsive test among children with DCD. However, the MPST was less reliable in children with DCD compared to their typically developing peers, leading to a very large Smallest Detectable Difference.
Conclusions: The findings suggest that the selected anaerobic capacity measures have sound psychometric properties among children with DCD with the exception of the MPST. Clinicians working on children with DCD could use these tests in their practice, especially in situations where logistical resources are limited.
- Implications for Rehabilitation
Field-based anaerobic capacity tests are suitable measures for assessing anaerobic capacity in children with Developmental Coordination Disorder, particularly in situations where laboratory assessments are not feasible.
The shuttle run test item of the Bruninks-Oseretsky test of motor proficiency-second edition and the 10?×?5 sprint tests (straight and slalom) have good construct validity in this population.
The 10?×?5 sprint test (slalom) is the most sensitive anaerobic capacity test among children with Developmental Coordination Disorder.
Design: A prospective cohort study.
Setting: The cardiac ward at Aarhus University Hospital, Denmark.
Intervention: A socially differentiated CR intervention in addition to the standard CR program.
Subjects: Patients admitted with first-episode myocardial infarction between 2000 and 2004, N?=?379. Patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and extent of social network.
Main outcome measures: Primary outcome was medication adherence to antithrombotics, beta-blockers, statins and angiotensin-converting enzyme inhibitors. Secondary outcomes were biological and lifestyle risk factors defined as; total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glycated hemoglobin, blood pressure and smoking status.
Results: No significant long-term effect of the intervention was found.
Conclusions: The results indicate a non-significant effect of the intervention. However, it was found that equality in health was improved in the study population except concerning smoking. General practitioners manage to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
- Key points
The socially differentiated intervention did not significantly improve medication adherence or biological and lifestyle risk factors.
Despite the non-significant effect of the intervention, equality in health was improved except concerning smoking.
General practitioners managed to support the long-term secondary cardiovascular disease prevention in all patients regardless of social status.
Methods: Before and after 12?weeks of high-intense concurrent training (interval and strength training, 5 sessions per 2?weeks, n?=?16) body composition, resting blood pressure and heart rate, 2-h oral glucose tolerance (insulin sensitivity, glycosylated hemoglobin, blood glucose and insulin concentrations), blood lipids (high- and low-density lipoprotein, total cholesterol, triglyceride levels) and C-reactive protein were analyzed.
Results: Twelve weeks of high-intense concurrent training significantly improved resting heart rate (?6%), 2-h blood glucose concentrations (?13%) and insulin sensitivity (?24%). Blood pressure, body composition, blood lipids and C-reactive protein did not seem to be affected.
Conclusions: Under the conditions of this pilot study, 12?weeks of concurrent high-intense interval and strength training improved resting heart rate, 2-h glucose and insulin sensitivity in multiple sclerosis but did not affect blood C-reactive protein levels, blood pressure, body composition and blood lipid profiles. Further, larger and controlled research investigating the effects of high-intense concurrent training on cardiovascular risk factors in multiple sclerosis is warranted.
- Implications for rehabilitation
High-intensity concurrent training improves cardiovascular fitness.
This pilot study explores the impact of this training on cardiovascular risk factors in multiple sclerosis.
Despite the lack of a control group, high-intense concurrent training does not seem to improve cardiovascular risk factors in multiple sclerosis.
Materials and methods: This review was registered on PROSPERO (no: CRD42017063771) and was written according to the PRISMA guidelines. The search strategy included studies from the first indexed article until September 2017 and was performed in the electronical databases PubMed, Web of Science, Cochrane Library, Ovid Medline and PEDro. Two independent reviewers screened, assessed risk of bias by means of the PEDro scale and extracted data.
Results: Eight studies were included of which three investigated the effects of trunk training on muscle thickness, the remaining five investigated muscle activity. The following muscles were investigated: erector spinae, multifidi, paravertebralis, transversus abdominis, internal and external oblique abdominis, rectus abdominis, quadriceps femoris, hamstrings, soleus and tibialis anterior. Trunk exercises significantly improved the muscle activity of the internal oblique abdominis and increased muscle thickness of transversus abdominis.
Conclusions: Trunk training is effective in restoring symmetry in muscle thickness to improve muscle strength. The gain in muscle thickness is specific to the applied exercise program, suggesting that therapeutic goal setting is of great importance. However, no conclusion could be made concerning changes in muscle activity due to a high risk of bias.
- Implications for rehabilitation:
Trunk training seems to be effective in restoring symmetry in trunk muscle thickness.
Not all muscle groups benefit from specific trunk exercises.
Patients suffering from chronic stroke are still capable of restoring muscle function.
Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017.
Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p?=?.011) and from 4.1% to 1.8% for SAVR (p?=?.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p?<?.001) and from 87.2% to 91.6% for SAVR (p?=?.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4?±?8.4 to 3.7?±?3.4 days after TAVR (p?<?.001) and from 9.0?±?5.9 to 7.8?±?5.1 days after SAVR (p?<?.001).
Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.
Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915
- Key Messages
This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis.
Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade.
Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.
Design and setting: Cohort study in a Primary Health Care Center and a University Hospital.
Subjects: Somali women skin type V, n?=?114, aged 18–56 years, from latitude 0–10○ N, living in Sweden, latitude 57○ N?>?2 years were compared with women from a population sample, skin type II-III, n?=?69, aged 38–56 years, the WHO MONICA study, Gothenburg, Sweden.
Main outcome measures: Serum (S)-25(OH)D, S-parathyroid hormone (PTH), comorbidity and Health-Related Quality of Life (HRQoL) using the Short Form-36 (SF-36) and part of the EQ-5D questionnaires. All calculations were corrected for age.
Results: Vitamin D deficiency (S-25(OH)D?<?25?nmol/l) was found in 73% of the Somali women and in 1% of the controls (p?<?.0001). S-PTH was elevated (>6.9?pmol/l) in 26% and 9%, respectively (p?<?.004). Somali women used less medication, 16% vs. 55%, p?<?.0001) but more allergy medication, 11% vs. 7% (p?=?.006), had fewer fractures, 2% vs. 28% (p?<?.0001) and lower HRQoL in 7 out of 9 scales (p?<?.05–.001), than native controls. There were no differences in the prevalence of diabetes mellitus, hypothyroidism, positive thyroid peroxidase antibodies, vitamin B12 deficiency, celiac disease or hypertension.
Conclusions: Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity was low. Both mental, and especially physical HRQoL scores were lower in the Somali women. The effects of long-lasting deficiency are unknown.
- Key points
The aim was to explore the relationship between vitamin D deficiency (S-25(OH)D?<?25?nmol/l) and comorbidity in immigrants.
Vitamin D deficiency was common in Somali women living in Sweden, 73%, but comorbidity of hypothyroidism, diabetes mellitus, hypertension, fractures and use of medications was low.
Both mental, and especially physical, Health-Related Quality of Life were lower in the Somali women than in native Swedish women.
The effects of long-lasting deficiency are unknown.
Methods: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35?years at onset, duration ≥20?years, <67?years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples.
Results: Seven hundred and seventy-three patients (ages 50?±?10?years, diabetes duration 35?±?10?years) and 708 controls (ages 54?±?9?years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28–48%, which was 2–4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066–2.272), p?=?0.014), longer duration (1.046 (1.015–1.077), p?=?0.003), higher body mass index (1.08 (1.017–1.147), p?=?0.013) and HbA1c (1.029 (1.008–1.05), p?=?0.007) were associated with upper extremity impairments.
Conclusions: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed.
- Implications for rehabilitation
Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2–4-fold higher compared to non-diabetic persons.
Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments.
Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.
Methods: The study was conducted in two phases: phase I, a retrospective review to evaluate categories of goal set in routine clinical practice. Findings were used to design a goal classification system. Phase II, a multi-centre study to confirm the goal categories. Goals set (n?=?270) were analysed from data collected at three centres in the UK (one centre for phase I). Goal categories were mapped onto the domains of the World Health Organisation, International Classification of Functioning Disability and Health.
Results: One hundred and twenty seven participants were recruited in two cohorts: phase I: 63; phase II: 64. Goal categories using both cohorts were assigned to two domains, each subdivided into three key goal categories: Domain 1: body structure impairment 121 (44%): (a) pain/discomfort 34 (12%), (b) involuntary movements 20 (7%), and (c) range of movement/contracture prevention 67 (25%). Domain 2: activity function 149 (56%): (a) passive function (ease of caring for the affected limb) n?=?89 (33%), (b) active function (transfers) 26 (10%), and (c) active function (mobility) 27 (10%), other n?=?7 (3%).
Conclusions: Patients individual leg spasticity goals can be grouped into six categories and two domains, which will assist clinicians, patients and cares in setting and evaluating goals in practice.
- Implications for Rehabilitation
Six goal areas used in clinical goal setting for leg spasticity management were identified, under the two domains: (1) body structure impairment: pain, involuntary movements, and range of movement and (2) activities/function: passive function (ease of caring), active function – transfers or standing and active function – mobility.
Categorisation of goals is consistent on repeated evaluation and across different clinical services.
Using clinical goals for leg spasticity treatment is an effective method to identify treatment priorities.
Materials and methods: Studies reporting isolated lumbar extension strength changes were examined for inclusion criteria including: (1) participants with chronic low back pain, (2) intervention?≥?four?weeks including isolated lumbar extension exercise, (3) outcome measures including isolated lumbar extension strength, pain (Visual Analogue Scale), and disability (Oswestry Disability Index). Six studies encompassing 281 participants were included. Correlations among change in isolated lumbar extension strength, pain, and disability. Participants were grouped as “met” or “not met” based on minimal clinically important changes and between groups comparisons conducted.
Results: Isolated lumbar extension strength and Visual Analogue Scale pooled analysis showed significant weak to moderate correlations (r?=??0.391 to ?0.539, all p?<?0.001). Isolated lumbar extension strength and Oswestry Disability Index pooled analysis showed significant weak correlations (r?=??0.349 to ?0.470, all p?<?0.001). For pain and disability, isolated lumbar extension strength changes were greater for those “met” compared with those “not met” (p?<?0.001–0.008).
Conclusions: Improvements in isolated lumbar extension strength may be related to positive and meaningful clinical outcomes. As many other performance outcomes and clinical outcomes are not related, isolated lumbar extension strength change may be a mechanism of action affecting symptom improvement.
- Implications for Rehabilitation
Chronic low back pain is often associated with deconditioning of the lumbar extensor musculature.
Isolated lumbar extension exercise has been shown to condition this musculature and also reduce pain and disability.
This study shows significant correlations between increases in isolated lumbar extension strength and reductions in pain and disability.
Strengthening of the lumbar extensor musculature could be considered an important target for exercise interventions.
Materials and methods: We included 105 Obstructive Sleep Apnoea patients (70% male; mean age 46.62?±?9.79?years). All patients completed the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Beck Anxiety Inventory, and the Work Role Functioning Questionnaire-2.0.
Results: Obstructive Sleep Apnoea-severity, poor nighttime sleep quality, and anxiety were univariately associated with impaired work functioning. Multivariate analyzes revealed that poor perceived sleep quality was more strongly associated with work functioning than sleep efficiency and daily disturbances. Anxiety was strongly associated with impaired work functioning. After adding anxiety, the explained variance in work functioning increased from 20% to 25%. Anxiety moderated the association between low and medium levels of nighttime sleep quality problems and work functioning.
Conclusions: Poor perceived sleep quality and anxiety were strongly associated with impaired work functioning in Obstructive Sleep Apnoea patients. These findings may help to optimize management, standard treatment, and work functioning in people with Obstructive Sleep Apnoea when confirmed in longitudinal studies.
- Implications for Rehabilitation
Studies show an impairment of functional status, including work functioning, in obstructive sleep apnea patients.
Aside from physical disorders, obstructive sleep apnea patients often experience mental problems, such as anxiety.
As many people with obstructive sleep apnea are undiagnosed, our results demonstrate to employers and healthcare professionals the need to encourage patients for obstructive sleep apnea screening, especially in the situation of impaired work functioning, increased anxiety, and poor sleep quality.
The associations between obstructive sleep apnea, sleep and anxiety might increase the awareness of health professionals towards optimizing diagnostic accuracy and standard treatment.
Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score?≤??2.0. In addition, we focused on Z-score?≤??1.0 because this may indicate a tendency towards low bone mineral density.
Results: We included 16 studies, comprising 465 patients aged 1–65?years. Moderate and conflicting evidence for low bone mineral density (Z-score?≤??2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score?≤??1.0) for several body parts.
Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy.
- Implications for Rehabilitation
Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP.
Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view.
If indicated, medication and fall prevention training should be prescribed.
Purpose: To verify the effects of Kinesio taping in the performance of sit-to-stand movement in children with unilateral CP.
Methods and materials: A blinded, single placebo-controlled and repeated-measure design. The setting was the rehabilitation clinic of the university and care facilities. A total of 11 children from 6 to 12 years of age (mean: 10.5 years; standard deviation: 2.8 years) and classified as levels I and II by the Gross Motor Function Classification System were included. Kinesio taping was applied over the rectus femoris of the affected limb. Three taping conditions were used: Kinesio taping, without Kinesio taping and placebo. Three seat heights were used: neutral (100%), lowered (80%), and elevated (120%). Muscle activity (electromyography) and trunk and lower limb alignment (kinematics) were evaluated as body structures and function measures. The time required to perform sit-to-stand was used as a functionality measure. Mixed analysis of variation (ANOVA) measured angular variables of the hip, knee, ankle, and rectus femoris activity. Repeated ANOVA measured angular variables of trunk and pelvis and total duration. Significance was accepted for values of p?≤?0.05.
Results: Kinesio taping increased rectus femoris activity, decreased peak flexion of the trunk, knee, hip, and ankle, and increased trunk extension in the end of sit-to-stand when compared with without Kinesio taping and placebo. Total duration was decreased with lower effect sizes.
Conclusions: Immediate application of Kinesio taping modified body structures and function measures during sit-to-stand in children with unilateral CP, but it did not alter functionality.
- Implications for Rehabilitation
Evidence-based practice about the use of Kinesio taping in Cerebral Palsy.
Knowledge about alternative rehabilitation techniques in Cerebral Palsy.
Knowledge about sensory stimulation in Cerebral Palsy.
Effectiveness of Kinesio taping in muscle activation.
Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration’s definition, objective markers and impact on physiology and outcome.
Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; “dehydration” and “hypovolaemia” are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes.
Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours.
- Key messages
Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis.
Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice.
Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
Methods: Linking the questionnaires content and the ICF was performed by two independent reviewers, with an excellent concordance level (k?=?0.941), using the method described by Cieza et al.
Results: A total of 94 items were analyzed, in which 154 meaningful concepts were identified and linked to 48 ICF categories, of which 49% were from activities and participation component (d) and 36.8% from body functions (b).
Conclusions: The scales are linked with the classification at different levels. The International Consultation on Incontinence Questionnaire was the most limited instrument. Bristol Female Urinary Tract Symptoms Questionnaire and Incontinence Quality of Life Questionnaire presented greater agreement with the ICF, but the concepts in their items are mostly linked to body functions, denoting a biomedical vision. King’s Health Questionnaire demonstrated greater affinity with the ICF, and most concepts were related to the activities and participation categories, approaching more effectively the biopsychosocial model.
- Implications for Rehabilitation
Choosing the right instrument to assess the quality of life of women with urinary incontinence can be a difficult task, since the instruments have different approaches.
The use of International Classification of Functioning, Disability and Health as a reference among health professionals involved in rehabilitation of women with urinary incontinence will promote unification of the language about this group functioning.
The comparison among instruments presented here will help the professional to choose the one that provides the greatest amount of information in a consistent way, aiding the clinical decision-making process.
Design: Prospective cohort study using participants from a randomized controlled trial (RCT) designed to study the effect of exercise during pregnancy on pregnancy related diseases.
Setting: St. Olavs Hospital, Trondheim University Hospital and Stavanger University Hospital, April 2007 to December 2009.
Subjects: Healthy pregnant women.
Main outcome measures: Self-reported sick leave due to LPP in late pregnancy (gestation week 32–36).
Results: In total, 532/716 (74%) women reported LPP at 32–36 weeks of pregnancy, and 197/716 (28%) reported sick leave due to LPP. Not receiving job adjustments when needed (Odds ratio, OR with 95% confidence interval, CI, was 3.0 (1.7–5.4)) and having any pain in the pelvic girdle versus no pain (OR 2.7 (1.3–5.6), OR 2.7 (1.4–5.2) and OR 2.2 (1.04–4.8)) for anterior, posterior and combined anterior and posterior pain in the pelvis respectively, were associated with sick leave due to LPP in late pregnancy. Also higher disability, sick listed due to LPP at inclusion and lower education, were significant explanatory variables. There was a trend of reduced risk for sick leave due to LPP when allocated to the exercise group in the original RCT (OR 0.7 (0.4–1.0)).
Conclusion: Facilitating job adjustments when required might keep more pregnant women in employment. Furthermore, pain locations in pelvic area, disability, lower education and being sick listed due to LPP in mid pregnancy are important risk factors for sick leave in late pregnancy.
- Key points
Current awareness:
More than half of pregnant women are on sick leave during pregnancy and the most frequently reported cause is lumbopelvic pain.
This paper adds:
Inability to make job adjustments, pain locations in pelvic area, disability and lower education level were the most important risk factors for sick leave in late pregnancy. Facilitating early job adjustment might be a precaution to keep more pregnant women in work. Allocation to an exercise group tended to reduce the risk of sick leave in late pregnancy.Registration number: Clinical trial gov (NCT 00476567).
Methods: A retrospective pre-test/post-test quasi-experimental study design was used to compare admissions and days spent in hospital during the 24?months before and after attendance at the centre, using the hospital’s electronic records. Total population sampling yielded data for 44 mental health care users who made first contact with the service between July 2009 and June 2010. Data were compared using the Kruskal–Wallis test, Wilcoxon Signed Ranks test and Mann–Whitney U test.
Results: There was a significant decrease in the number of admissions (z?=??4.093, p?=?0.00) and the number of days spent in hospital (z?=??4.730, p?=?0.00). Participants were admitted to psychiatric care 33 times less in the 24?months’ post-intervention, indicating a medium effect (r?=?0.436). They also spend 2569?days less in hospital, indicating a large effect (r?=?0.504).
Conclusion: The findings suggest that an occupational therapy-led day treatment centre could be effective in reducing the use of inpatient mental health services in South Africa.
- Implications for Rehabilitation
Attendance at an occupational therapy-led community day treatment centre decreases the number of admissions and number of days spent in hospital and is therefore beneficial to mental health care users and service providers.
The study indicates that the successful implementation of a community day treatment centre for mental health care users on the grounds of a tertiary hospital by utilising existing resources is possible.
Methods: Twenty-two participants (14 female, 8 male) with a mean-age of 42 years (SD?=?10?years) were recruited to take part in two focus groups. The participants reported a range of lower-limb amputations (i.e., congenital, acquired, transfemoral, trantibial, unilateral, and bilateral) and on an average were 5 years post-surgery (SD?=?7 years). Each focus group comprised of 11 participants and was moderated by either the first or second author. The moderator asked participants to discuss their everyday experiences of life with an amputation using Charmaz’s good day/bad day approach. Focus groups were transcribed verbatim and analyzed using an inductive thematic analysis.
Results: Four themes were identified: pain, organization and planning, the embodied experience after amputation, and interactions with others.
Conclusions: These themes provide a key resource for understanding daily fluctuations in physical, social, and psychological functioning.
- Implications for Rehabilitation
Lower limb amputation can result in daily fluctuations in physical, social, and psychological functioning.
These fluctuations can be illustrated through experiences of pain, planning and organization, embodied experiences, and interactions with others.
At a policy level, evaluations of daily living after an amputation should be based on a longitudinal assessment.