Lower Extremity Functional Scale Questionnaire Research Articles

Extremity Dysfunction After Large-Bore Radial and Femoral Arterial Access.

BackgroundThe use of large‐bore (LB) arterial access and guiding catheters has been advocated for complex percutaneous coronary intervention. However, the impact of LB transradial access (TRA) and transfemoral access (TFA) on extremity dysfunction is currently unknown.Methods and ResultsThe predefined substudy of the COLOR (Complex Large‐Bore Radial PCI) trial aimed to assess upper and lower‐extremity dysfunction after LB radial and femoral access. Upper‐extremity function was assessed in LB TRA‐treated patients by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and lower‐extremity function in LB TFA‐treated patients by the Lower Extremity Functional Scale questionnaire. Extremity pain and effect of access site complications and risk factors on extremity dysfunction was also analyzed. There were 343 patients who completed analyzable questionnaires. Overall, upper and lower‐extremity function did not decrease over time when LB TRA and TFA were used for complex percutaneous coronary intervention, as represented by the median Quick Disabilities of the Arm, Shoulder, and Hand score (6.8 at baseline and 2.1 at follow‐up, higher is worse) and Lower Extremity Functional Scale score (56 at baseline and 58 at follow‐up, lower is worse). Clinically relevant extremity dysfunction occurred in 6% after TRA and 9% after TFA. A trend for more pronounced upper‐limb dysfunction was present in female patients after LB TRA (P=0.05). Lower‐extremity pain at discharge was significantly higher in patients with femoral access site complications (P=0.02).ConclusionsFollowing LB TRA and TFA, self‐reported upper and lower‐limb function did not decrease over time in the majority of patients. Clinically relevant limb dysfunction occurs in a small minority of patients regardless of radial or femoral access.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03846752.

The profunda artery perforator free flap for lower extremity reconstruction.

The profunda artery perforator (PAP) flap has been reported in several types of reconstructions. This report aims to evaluate the usefulness and the clinical outcome of patients who underwent the PAP free flap for lower limb reconstruction. Between February 2018 and February 2020, nine patients with injury at lower third of the leg, foot dorsum or foot plant (eight acute injuries and one chronic ulcer) were selected. Mean wound size was 12.5 × 6.3cm (9 × 5-14.5 × 6.5). Inclusion criteria consisted in patient's request to hide the donor site scar and the absence of previous traumas or surgery in the donor site. Patients considered unable to bear prolonged surgery were excluded. Patients underwent preoperative CT angiography and peri-operative Doopler, for perforator selection. All flaps were designed with pinch test, in elliptical shape. Microvascular anastomosis was performed to the tibialis anterior/posterior or medial plantar vessels. Outcomes were evaluated in terms of wound coverage success and patient's quality of life through Lower Extremity Functional Scale (LEFS) questionnaire. The mean size of the harvested skin paddle was 13.5 × 7.4cm (9 × 6-15 × 8) and mean pedicle length was 8.5cm. Mean flap harvest time was 43.5min (35-55). Flap survival rate was 100%, with one re-exploration with minimal partial flap loss. Mean follow-up was 13.5months . Reconstructive results were successful in wound coverage and function. All patients reported satisfaction with their result by LEFS questionnaire (score:64.7). With proper patient selection, there was 100% flap survival rate with no major complication. According to our data, the PAP free flap could be a valuable option for lower extremity reconstruction.

Comparisons of fascio‐cutaneous anterolateral thigh and sandwich fascial ALT free flap in the distal extremity reconstruction

The anterolateral thigh (ALT) flap is considered a workhorse reconstructive option; however, it is encumbered by its bulkiness that can result in poor final outcome and need for revision surgery. The aim of the present study was to compare the standard cutaneous ALT free flap and sandwich fascial ALT (SALT) free flap, raised harvesting between the Scarpa's fascia and the crural fascia, for distal extremity soft tissue reconstruction, including pre- intra- and post-operative considerations and outcomes. A retrospective review of medical records from 2013 to 2018 of 24 patients who underwent distal extremity reconstruction with standard fascio-cutaneous ALT flap (13 patients) and SALT flap (11 patients) was performed. The mean defect dimensions were 12 × 6.5 cm in group 1 and 12 × 6 in group 2. Surgical outcomes and quality of life were assessed (through the upper extremity functional scale and the lower extremity functional scale questionnaires. The mean flap dimensions were 13.1 × 7.1 in group 1 and 14.1 × 7.8 in group 2, the overall flap success rate was 100% (one microvascular venous thrombosis occurred in group 1), no statistically significant difference was recorded regarding microvascular thrombosis (one patient in group p = .369) and infections (one patient in group 1, p = .36) while a statistically significant difference was presence regarding the number of secondary/debulking procedures (6 patients vs. 0) (p = .0076) and the quality of life perception showed an overall better perception in group 2 with statistical significant difference (p = .03). The SALT flap represents a valid option, as showed through our preliminary data, when a thin and robust reconstruction is required when dealing with distal extremities soft tissue reconstruction.

Donor-Site Morbidity and Functional Status following Medial Femoral Condyle Flap Harvest.

The medial femoral condyle free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor-site morbidity and functional outcomes after flap harvest have not been fully appreciated. The authors report the postoperative outcomes and analyze the impact of increasing the size of the flap on knee donor-site morbidity. A retrospective chart review of patients who underwent medial femoral condyle flap surgery between 2001 and 2012 at their institution was performed. The size of the flap was stratified, based on the largest dimension, into three groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure. A univariate logistic regression analysis was performed, and results were analyzed. A total of 75 patients were identified. Average age was 29.5 ± 15.2 years. Average follow-up time was 13 months. The overall complication rate was 18.6 percent. Paresthesia in the saphenous nerve distribution was the most common complication. Increasing the size of the flap resulted in a significant elevation in complication risk (p < 0.05). A total of 47 patients completed the Lower Extremity Functional Scale questionnaire. The average Lower Extremity Functional Scale score was 72.12 ± 14.18. Fifty-one percent (n = 24) scored 80 points, indicating a normal level of function on average. The medial femoral condyle flap has overall acceptable donor-site morbidity, with a good level of function postoperatively. Larger flaps are associated with a greater number of complications. Therapeutic, III.

Amputation: Not a failure for severe lower extremity combat injury

IntroductionThe use of improvised explosive devices is a frequent method of insurgents to inflict harm on deployed military personnel. Consequently, lower extremity injuries make up the majority of combat related trauma. The wounding pattern of an explosion is not often encountered in a civilian population and can lead to substantial disability. It is therefore important to study the impact of these lower extremity injuries and their treatment (limb salvage versus amputation) on functional outcome and quality of life. Patients and methodsAll Dutch repatriated service members receiving treatment for wounds on the lower extremity sustained in the Afghan theater between august 2005 and August 2014, were invited to participate in this observational cohort study. We conducted a survey regarding their physical and mental health using the Short Form health survey 36, EuroQoL 6 dimensions and Lower Extremity Functional Scale questionnaires. Results were collated in a specifically designed electronic database combined with epidemiology and hospital statistics gathered from the archive of the Central Military Hospital. Statistical analyses were performed to identify differences between combat and non-combat related injuries and between limb salvage treatment and amputation. ResultsIn comparison with non-battle injury patients, battle casualties were significantly younger of age, sustained more severe injuries, needed more frequent operations and clinical rehabilitation. Their long-term outcome scores in areas concerning well-being, social and cognitive functioning, were significantly lower. Regarding treatment, amputees experienced higher physical well-being and less pain compared to those treated with limb salvage surgery. ConclusionSustaining a combat injury to the lower extremity can lead to partial or permanent dysfunction. However, wounded service members, amputees included, are able to achieve high levels of activity and participation in society, proving a remarkable resilience. These long-term results demonstrate that amputation is not a failure for casualty and surgeon, and strengthen a life before limb (damage control surgery) mindset in the initial phase. For future research, we recommend the use of adequate coding and injury scoring systems to predict outcome and give insight in the attributes that are supportive for the resilience that is needed to cope with a serious battle injury.

Functional Outcomes of Service Members With Bilateral Transfemoral and Knee Disarticulation Amputations Resulting From Trauma.

As longitudinal studies for those with bilateral transfemoral amputation (BTFA) or knee disarticulation (KD) are lacking, it is important to quantify performance measures during rehabilitation in an effort to determine reasonable expectations and trends that may influence the rehabilitation process. At initial evaluation (date of first independent ambulation) and follow up (median 135 [range = 47-300] days later), 10 participants with BTFA/KD completed 6 minute walk testing and Activity Specific Balance Confidence and Lower Extremity Functional Scale questionnaires. Of these, six participants also completed stair ambulation; ascent time and stair assessment index (SAI) scores were calculated. Patients utilized their prescribed prostheses at each visit. Participants were able to cover a significantly greater distance (135.3 [70.1] m) in 6 minutes at the follow-up visit (*p = 0.005). The change in SAI scores for stair ascent and descent was not statistically significant (p = 0.247). Stair ambulation confidence scores were significantly greater at the final visit (*p = 0.034). Stair negotiation appears to plateau early; however, confidence builds despite absence of functional gains over time. Service members with BTFAs/KDs are able to achieve functional community ambulation skills. Thus, this investigation suggests that clinicians can realign rehabilitation paradigms to shift focus towards community distance ambulation once safe stair ascent and descent is achieved.

Cemented Total Hip Arthroplasty With Retrograde Ischioacetabular Steinmann Pin Reconstruction for Periacetabular Metastatic Carcinoma

BackgroundSurgical management of advanced periacetabular lesions is challenging because of extensive bone loss, particularly for Modified American Academy of Orthopaedic Surgeons Classification defects type IV (pelvic discontinuity with posterior column involvement). Multiple methods for rebuilding the acetabulum have been described; all involve passing Steinmann pins in a retrograde or an antegrade fashion from the anterior iliac wing or iliac crest around the acetabulum in an attempt to recreate the normal bony anatomy. However, these techniques fail to engage the ischium in its entirety. The ischial contribution to the posterior column is a critical element in a stable acetabular construct. MethodsAfter curettage of the acetabular lesion, Steinmann pins are passed through the ischial tuberosity and posterior column into the sciatic buttress in a retrograde manner. The number of pins depends on the size of the defect and involvement of the posterior column. Patients and MethodsMedical records of 11 patients with a Modified American Academy of Orthopaedic Surgeons Classification defect type IV treated with retrograde ischioacetabular Steinmann pin reconstruction at our institution between 2007 and 2012 were reviewed. European Quality of Life-5 dimensions and Lower Extremity Functional Scale questionnaires were used to assess patient functional outcomes. ResultsThe 6 patients (4 females and 2 males; age range, 56-81 years) surviving 12 months postoperatively reported improved mobility and good quality-of-life scores. ConclusionWe described a new method for posterior acetabular column reconstruction that uses the ischial tuberosity and body as additional points of stabilization during the reconstruction of the posterior column.

Activity Scale for Arthroplasty Patients After Total Hip Arthroplasty

The purpose of the Activity Scale for Arthroplasty Patients (ASAP) is to develop and validate a self-report questionnaire that demonstrated discrimination of functional gains, low burden, appropriate concurrent validity, and was not limited by ceiling effects. We identified 128 high-functioning hip arthroplasty patients from our database who completed a 25-item ASAP and Lower Extremity Functional Scale questionnaires and a set of anchor questions. Factor analysis identified 10 items associated with 2 distinct factors: (1) activities and (2) running and running-related environments. These 10 items were retained and were identified as the ASAP. The ASAP may be useful in high-level hip arthroplasty patients where other scales fail to capture activities secondary to ceiling effects. In addition, the scale burden is minimized by inclusion of only 10 items.

Physical Outcomes of Patients With Burn Injuries—A 12 Month Follow-Up

There is only limited research documenting functional ability, physical fitness, and health related quality of life after burn injury. The objective of this study was to measure a comprehensive range of physiotherapy-related outcomes over a 12-month period for patients with significant burn injuries. A prospective study was performed on consecutive patients admitted to the Royal Adelaide Hospital over a 12-month period. Outcomes were measured at admission and discharge from hospital and at 1, 3, 6, and 12 months, and comprised the: Medical Outcomes Study 36-Item Short Form Health Survey, Quick Disabilities of the Arm, Shoulder and Hand questionnaire, Lower Extremity Functional Scale questionnaire, shuttle walk test, grip strength and scar appearance using the Matching Assessment with Photographs of Scars. A total of 86 patients (74 male, mean age 38 years) participated. There was a significant deterioration in all outcomes in the first few months after burn injury, with most outcomes improving towards baseline levels by 6 months. However, lower limb function (Lower Extremity Functional Scale) remained significantly reduced at 12 months and functional exercise capacity (shuttle walk test) was still markedly reduced at 6 months compared with predicted normal values. The total burn surface area significantly affected many of the outcomes. In conclusion, for this sample of patients after burn injury, there was an acceptable rate of recovery for physiotherapy-related outcomes, in that most measures had returned to near baseline levels by 6 months postinjury, with the exception of lower limb function and functional exercise capacity.

Comparison of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS) Questionnaires in Patients Awaiting or Having Undergone Total Knee Arthroplasty

Purpose: The purpose of this study was to determine the relationship between two functionally oriented health status measures, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS), in patients awaiting or having undergone total knee arthroplasty (TKA). Methods: Patients who were on the waiting list for TKA (n = 150) or who had undergone TKA (n = 150) received a mailed questionnaire. Results: Responses were tabulated for 187 completed questionnaires. Although correlations of r = .87 to .89 were observed between scores on the WOMAC physical function and the LEFS questionnaires, the standard error of estimate associated with using one questionnaire to predict scores on the other was large (F6 to F8). The relative efficiency of the WOMAC and the LEFS was similar, as were their relationships with the patients' ability to walk and ascend or descend stairs. Respondents indicated no clear preference for either questionnaire. Conclusions: Although related, scores from the WOMAC and the LEFS were not directly interchangeable. Both the WOMAC and the LEFS have advantages. Clinicians' use of one or both of these health status measures in patients with TKA depends on their anticipated use of the information.