Validation of a patient activity monitor to quantify ambulatory activity in an amputee population

The ability to objectively measure an amputee's walking activity over prolonged periods can provide clinicians with a useful means of evaluating their patients' outcomes. The present study aimed to validate the temporospatial data output from a commercially available ambulatory activity monitor (PAM, Ossur) fitted to trans-tibial and trans-femoral amputees, against data that was simultaneously captured from a three dimensional motion analysis system (Qualisys Medical AB, Gothenburg, Sweden). Results indicate that the PAM monitor provides accurate measures of temporospatial aspects of amputee gait for walking speeds above 0.75 m/s.     

Considerations for developing an evidenced-based practice in orthotics and prosthetics

Evidence-based practice has become somewhat of a catchphrase over the past ten years. In this paper evidence-based practice is defined and its importance for the development of the prosthetics and orthotics profession is highlighted. The authors suggest that evidence-based practice needs to be prioritized within the profession and that a cultural change needs to be initiated which supports clinicians in incorporating research findings into their daily practice. In addition, the authors highlight the need for prosthetists/orthotists to become more active in generating research rather than relying on other professional groups to contribute to their professional body of knowledge.     

Sagittal plane position of the functional joint centre of prosthetic foot/ankle mechanisms

Background

The use of motion analysis techniques in amputee rehabilitation often utilizes kinematic data from the prosthetic limb. A problem with methods currently used is that the joint positions of the prosthetic ankle are assumed to be in the same position as that of an intact ankle. The aim of this study was to identify both traditional anatomical joint centres as well as functional joint centres in a selection of commonly used prosthetic feet. These coordinates were then compared across feet and compared to the contralateral intact ankle joint.

Methods

Six prosthetic feet were fit to a unilateral trans-tibial amputee on two separate occasions. The subject's intact limb was used as a control. Three-dimensional kinematics were collected to determine the sagittal position of the functional joint centre for the feet investigated.

Findings

None of the prosthetic feet had a functional joint centre that was within the 95% CI for that of an intact ankle (both x- and y-coordinate position), nor any of the other prosthetic feet investigated. The repeatability of the method was found to be adequate, with 95% CI of the difference (test–retest) of the prosthetic feet similar to that for the intact ankle and within clinically accepted levels of variability.

Interpretation

The motion of the prosthetic feet tested is clearly different from that of an intact ankle. Kinematic methods that assume ankle constraints based on an intact ankle are subject to systematic error as this does not reflect the real motion of the prosthetic foot.     

The lived experience of people who require prostheses or orthoses in the Kingdom of Cambodia: A qualitative study

BackgroundThere is an assumption that provision of assistive technologies, such as prostheses and orthoses, will improve the life situation of people with disabilities; however, this issue has been poorly addressed in low- and middle-income country settings.ObjectiveThe objective of this qualitative study was to explore the life experience of people who use lower-limb prosthetic or orthotic devices in Cambodia, with a view to identifying areas in which developments can be made to improve the life experiences for prosthesis and orthosis users.MethodsParticipants were recruited from 1/urban and 2/rural prosthetic and orthotic clinics, run by the same non-governmental organisation. Individual interviews were conducted in 2019 with 15 users of prosthetic or orthotic devices. Interviews were transcribed and analysed using a thematic analysis approach.ResultsThree themes were identified: 1) A more positive outlook with an assistive device; 2) assistive devices reduce barriers but do not eliminate them and 3) disability creates social exclusion while assistive devices facilitate inclusion. For participants in this study, life without a prosthesis or orthosis was characterised by financial insecurity and a sense of hopelessness. After receiving an assistive device, participants experienced a greater sense of self-worth and empowerment as well as improved functional performance and social interactions.ConclusionsDisability was found to affect multiple facets of participants’ lives including physical and psychosocial factors. Prosthetic and orthotic devices were experienced as being enablers of social inclusion and generally improved the life situation for individuals with disabilities in The Kingdom of Cambodia. Attention should be directed towards improving knowledge of, and access to prosthetic and orthotic services, securing a stable income for users and addressing device related problems.     

Effects of an unstable shoe construction on standing balance in children with developmental disabilities: a pilot study

This study aimed to investigate if prolonged use of shoes incorporating an unstable sole construction could facilitate improvements of balance in a sample of developmentally disabled children. Ten children (six male and four female) aged between 10 and 17 years participated in the study. Children were fitted with shoes incorporating an unstable sole (Masai Barefoot Technology) and instructed to wear them for a minimum of two hours per day for eight weeks. A within subjects repeated measures design was used. Children were tested prior to receiving the shoes, four weeks after receiving the shoes and eight weeks after receiving the shoes. A force plate capable of rotating about a single axis (NeuroCom International Inc, Oregon) was used to test static balance, reactive balance and directional control. Static balance was not found to be influenced by prolonged use of the footwear; however, significant improvements were noted in children's reactive balance both with the shoes and barefoot. Results suggest that reactive balance can be improved by prolonged and regular use of shoes incorporating an unstable sole construction.     

Perceived self-efficacy and specific self-reported outcomes in persons with lower-limb amputation using a non-microprocessor-controlled versus a microprocessor-controlled prosthetic knee

Purpose: To measure self-efficacy in a group of individuals who have undergone a lower-limb amputation and investigate the relationship between self-efficacy and prosthetic-specific outcomes including prosthetic use, mobility, amputation-related problems and global health. A second purpose was to examine if differences exist in outcomes based upon the type of prosthetic knee unit being used.

Method: Cross-sectional study using the General Self-Efficacy (GSE) Scale and the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA). Forty-two individuals participated in the study. Twenty-three used a non-microprocessor-controlled prosthetic knee joint (non-MPK) and 19 used a microprocessor-controlled prosthetic knee joint (MPK).

Results: The study sample had quite high GSE scores (32/40). GSE scores were significantly correlated to the Q-TFA prosthetic use, mobility and problem scores. High GSE scores were related to higher levels of prosthetic use, mobility, global scores and negatively related to problem score. No significant difference was observed between individuals using a non-MPK versus MPK joints.

Conclusions: Individuals with high self-efficacy used their prosthesis to a higher degree and high self-efficacy was related to higher level of mobility, global scores and fewer problems related to the amputation in individuals who have undergone a lower-limb amputation and were using a non-MPK or MPK knee.

• Implications for rehabilitation

• Perceived self-efficacy has has been shown to be related to quality of life, prosthetic mobility and capability as well as social activities in daily life.

• Prosthetic rehabilitation is primary focusing on physical improvement rather than psychological interventions.

• More attention should be directed towards the relationship between self-efficacy and prosthetic related outcomes during prosthetic rehabilitation after a lower-limb amputation.

     

Incidence of Lower-Limb Amputation in the Diabetic and Nondiabetic General Population: A 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations

OBJECTIVE—The purpose of this study was to compare the incidence of vascular lower-limb amputation (LLA) in the diabetic and nondiabetic general population.RESEARCH DESIGN AND METHODS—A population-based cohort study was conducted in a representative Swedish region. All vascular LLAs (at or proximal to the transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation, or reamputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged ≥45 years.RESULTS—During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years was 192 (95% CI 145–241) for diabetic women, 197 (152–244) for diabetic men, 22 (17–26) for nondiabetic women, and 24 (19–29) for nondiabetic men. The incidence increased from the age of 75 years. Of all amputations, 74% were transtibial. The incidences of contralateral amputation and of reamputation per 100 amputee-years in diabetic women amputees were 15 (7–27) and 16 (8–28), respectively; in diabetic men amputees 18 (10–29) and 21 (12–32); in nondiabetic women amputees 14 (7–24) and 18 (10–28); and in nondiabetic men amputees 13 (6–22) and 24 (15–35).CONCLUSIONS—In the general population aged ≥45 years, the incidence of vascular LLA at or proximal to the transmetatarsal level is eight times higher in diabetic than in nondiabetic individuals. One in four amputees may require contralateral amputation and/or reamputation.Severe peripheral arterial disease indicating critical ischemia has been found in 1.2% of a general population aged ≥60 years (1) and in almost 5% of primary care patients aged ≥65 years (2). It has been reported that one in four diabetic individuals develops peripheral vascular disease that, when severe, may require amputation (3). Estimating the incidence of vascular lower-limb amputation (LLA) in diabetic and nondiabetic individuals can provide important information regarding changes in the incidence over time. This can assist in the planning of preventative care and rehabilitation and facilitate assessment of the effects of interventions, such as arterial reconstruction and amputation at specific levels, and the success of prosthetic rehabilitation (4,5).The reported annual incidence of LLA related to peripheral vascular disease has ranged from approximately 20 to 35 per 100,000 inhabitants (5,6). These incidence rates were usually based on the total population rather than on age-groups of the diabetic or the nondiabetic general population in which severe peripheral vascular disease usually occurs (7). Furthermore, different definitions and incidence estimation methods have been used, and problems of incorrectly registered diagnoses and missing data have been described (3,8). Individuals with diabetes have accounted for less than half of all patients with LLA in studies from Finland and Sweden (5,9) but for as much as two-thirds of patients with LLA in a German general population study (6).Compared with amputations in nondiabetic individuals, amputations due to diabetes have more often involved younger individuals and lower amputation levels (10). Because vascular LLA in diabetic and nondiabetic individuals may differ with regard to patient characteristics, initial amputation level, clinical management, and prognosis (including mortality rates), it is important to study the epidemiology of LLA related to peripheral vascular disease with and without diabetes independently (10). Few population-based studies have estimated the incidence of LLA in the diabetic general population based on validated data concerning the age- and sex-specific prevalence of diabetes at the time of study. Despite the availability of data on amputations (11), the utility of these data to accurately determine the incidence of LLA in the general population may be limited because the data are usually based on hospital discharges, which do not accurately detail procedures performed and concurrent diagnosis of diabetes. Moreover, accurate incidence rates cannot be derived unless the data are related to validated estimates of the sex- and age-specific prevalence of diabetes in the general population.The aim of this population-based cohort study was to estimate the incidence of LLA (at or proximal to the transmetatarsal level) performed for peripheral vascular disease among the diabetic and the nondiabetic general population over a 10-year period, with particular consideration of the rate of reamputation and contralateral amputation.     

Effects of an unstable shoe construction on balance in women aged over 50 years

Background

Shoes with an unstable sole construction are commonly used as a therapeutic tool by physiotherapists and are widely available from shoe and sporting goods retailers. The aim of this study was to investigate the effects of using an unstable shoe (Masai Barefoot Technology) on standing balance, reactive balance and stability limits.

Methods

Thirty-one subjects agreed to participate in the study and underwent balance tests on three different occasions. After test occasion one (baseline) 20 subjects received Masai Barefoot Technology shoes and were requested to wear them as much as possible for the remaining eight weeks of the study. Three specific balance tests were administered on each test occasion using a Pro Balance Master (NeuroCom International Inc., Oregon, USA). Tests included; a modified sensory organization test, reactive balance test and limits of stability test.

Findings

Subjects in the intervention group significantly improved their performance on elements of all three tests however results on these variables were not demonstrated to be significantly better than the control group. No significant differences were observed across testing occasions in the control group.

Interpretation

Results from the present study suggest that, for this group of individuals, use of unstable footwear may improve certain aspects of balance.