Lower Extremity Functional Scale Research Articles

Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents.

Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses. To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain. Cross-sectional, secondary analysis. Inpatient acute rehabilitation. Children and adolescents with chronic pain (n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4-week inpatient IIPT program from November 2011 to January 2023. Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school-related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors. Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0-10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0-80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0-80), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition short form [BOT-2 SF]; scale: 0-70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0-10 for both). Overall, participants reported significant improvements (p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT-2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction (p < .05) in median pain intensity (MC = -3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds. Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.

Evaluation of Respiratory Function, Respiratory Muscle Strength, Physical Activity, and Functionality in Patients with Lower Extremity Lymphedema.

Background: Lymphedema is a chronic, progressive condition that has major physical and psychological consequences. It was aimed to examine the respiratory functions, respiratory muscle strength, physical activity level, and functionality of patients with lower extremity lymphedema and to compare them with healthy controls. Methods and Results: A total of 82 individuals (29.3% male, 70.7% female, with a mean age of 49.89 ± 15.07 years) with lower extremity lymphedema (Group 1) and healthy individuals (Group 2) were included. Respiratory functions of the participants were evaluated by spirometry, respiratory muscle strength by maximum oral pressure measurements, physical activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), functionality by Lower Extremity Functional Scale (LEFS) and Timed Up and Go test (TUG test). All respiratory function test measurements were lower in mean Group 1 than in Group 2 (p < 0.05). While inspiratory muscle strength did not differ between the groups (p > 0.05), expiratory muscle strength was lower in Group 1 than Group 2 (p < 0.05). Although spent time and energy for sitting were higher in Group 1 (p < 0.05), IPAQ vigorous-, moderate-, and light-intensity physical activity (MET-min/week) and IPAQ-total score did not differ between groups (p > 0.05). In Group 1, mean of LEFS score was lower and TUG test (seconds) in Group 1 was longer compared to Group 2 (p < 0.05). Conclusions: Respiratory functions, expiratory muscle strength, and functionality in patients with lower extremity lymphedema were adversely affected; however, inspiratory muscle strength and physical activity levels were similar to those of healthy controls.

Free Fasciocutaneous versus Muscle Flaps in Lower Extremity Reconstruction: Implications for Functionality and Quality of Life.

Free tissue transplantations are commonly used to treat complex lower extremity defects caused by trauma, vascular disease, or malignancy, particularly when vital structures are exposed. This study aimed to expand the knowledge on patient-reported outcomes by comparing fasciocutaneous and muscle flaps, with the goal of facilitating patient counseling. Additionally, patient-level risk factors associated with decreased functioning and health-related quality of life were identified. This retrospective, cross-sectional, multicenter study included patients who underwent microsurgical lower extremity reconstruction using free fasciocutaneous or muscle flaps between 2003 and 2021, with a minimum follow-up of 12 months. Data were collected from medical records, pain scores, Short-Form 36 (SF-36), and Lower Extremity Functional Scale (LEFS). Mean scores were compared between flap types and predictors of LEFS, SF-36 mental component summary (MCS), and SF-36 physical component summary (PCS) scores were determined using a backward stepwise regression model. Of the 206 patients eligible, 100 (49%) were included in the retrospective part. A total of 89 (43%) responded to the questionnaires, with 62 treated using a fasciocutaneous flap and 27 with a muscle flap. No significant differences in total LEFS, SF-36 PCS, or MCS scores were found between the two flap type. Pain was a significant predictor of decreased functional outcomes for both flap types and was also linked to poorer mental health in patients treated with fasciocutaneous flaps. Other predictors of low patient-reported outcome scores included obesity, diabetes, poorer mental health, and a follow-up of less than 2 years. Patients treated with fasciocutaneous and muscle flaps experience comparable levels of functionality and quality of life after surgery. Flap selection should be based on defect characteristics, along with the surgeon's individual skills and preferences. A comprehensive approach that considers physical comorbidities, pain, and mental health is essential, as these factors significantly impact patient functionality and quality of life.

Measurement Properties and Determinants of the 6-Minute Walk Test in Patients with Lower Limb Lymphedema.

Background: The aim of this study was to investigate the validity and reliability and identify determinants of the 6-minute walk test (6MWT) in patients with lower limb lymphedema (LLL). Methods and Results: The study included 28 patients with LLL and 28 healthy subjects. To investigate the convergent validity and determinants of the 6MWT, patients were assessed using the following measurements: circumference measurement for lymphedema severity, hand-held dynamometry for muscle strength, time up and go for functional mobility, five-time sit-to-stand test for functional lower extremity strength, Lower Extremity Functional Scale for lower extremity functionality, Lymphedema Life Impact Scale for quality of life, and International Physical Activity Questionnaire-Short Form for physical activity level. The test-retest reliability of the 6MWT was assessed using intraclass correlation coefficients (ICCs). 6MWT, a test-retest reliability analysis was carried out with 28 patients within 3-7 days. The receiver operating characteristic (ROC) curve was employed to determine the cut-off point of 6MWT. The test-retest reliability of 6MWT was detected as excellent (ICC [95%] 0.93 [0.87-0.97]). Significant correlations were found between the 6MWT health-related and disease-specific parameters, indicating sufficient convergent validity (r ≥ 0.3). The ROC curve indicated a cut-off point of 504 meters (area under the curve [AUC] 0.712 [95%CI: 0.575-0.849]). Multiple linear regression analysis demonstrated that lymphedema severity, hip abduction muscle strength, and lower limb functionality were the predictors of 6MWT. Conclusions: The 6MWT has been shown to be a reliable and valid tool for assessing the functional capacity of patients with LLL.

Treatment of High-Grade Chronic Osteomyelitis and Nonunions with PerOssal®: A Retrospective Analysis of Clinical Efficacy and Patient Perspectives.

Background/Objectives: Traditional autologous bone grafts as a treatment for bone defects have drawbacks like donor-site morbidity and limited supply. PerOssal®, a ceramic bone substitute, may overcome those drawbacks and could offer additional benefits like prolonged, local antibiotic release. This study investigates the clinical and radiological outcomes, including patient-reported outcomes, of using PerOssal® in nonunions (NU) and high-grade chronic osteomyelitis (COM). Methods: A single-center, retrospective study, investigating patients treated with PerOssal® between January 2020 and December 2023. Collected data include patient characteristics as well as various surgical and outcome parameters including the Lower Extremity Functional Scale (LEFS). Results: A total of 82 patients were analyzed. Reinfection occurred in 19.5% of cases. Osseous integration of PerOssal® was achieved in 89% of cases, higher in cavitary defects (91.5%) than segmental defects (72.7%). The revision rate was 32.9%, mainly due to wound healing disorders and reinfections. Mean LEFS score was 53.4 which was heavily influenced by sex (male: 50.7 vs. female: 63.4), revision surgery (no: 55.7 vs. yes: 49.1), reinfection (no: 56.6 vs. yes: 39.4), and osseous integration of PerOssal® (yes: 55.8 vs. no: 38.4). Conclusions: PerOssal® demonstrates promising outcomes in treating NUs and high-grade COM, especially in cavitary defects, with high osseous integration rates and acceptable functional results. However, reinfection remains a concern, particularly with difficult-to-treat pathogens and extensive surgical histories. Early, comprehensive surgical intervention and tailored antibiotic strategies are essential. Patient selection, defect characteristics, and comorbidities significantly influence success. Further research is needed to optimize treatment protocols.

Comprehensive Validation of the German Version of the LIMB-Q.

Lower extremity trauma significantly impacts patients' lives, requiring a nuanced approach to evaluate outcomes beyond clinical measures. The LIMB-Q, a patient-reported outcome measure (PROM), assesses the multifaceted impacts of lower extremity trauma, including physical and emotional dimensions, from the patient's perspective. This study validates the German version of the LIMB-Q. We relied on the translation of the LIMB-Q that had followed the International Society for Pharmacoeconomics and Outcomes Research best practice guidelines. Sixty patients who had undergone reconstructive surgery or amputation of the lower limb completed the LIMB-Q, Lower Extremity Functional Scale (LEFS), and Short Form Health Survey (SF-36). Internal consistency of the German LIMB-Q was determined by Cronbach's alpha, and reliability was assessed using the intraclass correlation coefficient. Construct validity was analyzed using Pearson correlation coefficients between the LIMB-Q, LEFS, and SF-36. Validation involved 60 patients. Internal consistency in a test-retest subset of 5 patients was good to excellent (α: 0.891 to 0.965). The intraclass correlation coefficient for these scales ranged from 0.821 to 1. The LIMB-Q domains significantly correlated with the corresponding domains of the SF-36 and LEFS, confirming excellent construct validity. The German version of the LIMB-Q is conceptually equivalent to the original English version. It is a reliable and valid PROM for assessing physical and psychological impairments in patients who have undergone lower extremity reconstructive surgery or amputation.

Clinical relevance of current patient-reported outcome measures for ankle fracture: surgeons' perspective.

Determine the relevance of the most frequently used patient-reported outcome measures (PROMs) for monitoring patient recovery after ankle fracture, from the clinical perspective of orthopaedic trauma surgeons, given lack of validated PROMs. Prospective cohort. Orthopaedic Trauma Association committee meetings, electronic correspondence. Orthopaedic trauma surgeons. Delphi method for consensus activities. IV. Most clinically relevant PROMs for ankle fracture recovery. Several English-language PROMs were identified based on use in literature and relevance to ankle fractures. 7 were selected by expert consensus. These are the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), Foot and Ankle Ability Measure (FAAM), American Academy of Orthopaedic Surgeons (AAOS), Foot and Ankle Disability Index (FADI) Score, Lower Extremity Functional Scale (LEFS), Olerud-Molander Ankle Score (OMAS), and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). The most clinically relevant PROM is the A-FORM, followed by the AAOS, LEFS, PROMIS PF, FADI, and OMAS, and the least clinically relevant overall, the FAAM. Understanding which PROM best matches physician expectations for tracking recovery is an important step toward a robust, evidence-based approach to patient care. The A-FORM was identified as the most clinically relevant among the most used PROMs. These results will aid surgeons, clinicians, and scientists to identify a uniformly, clinically relevant PROM for the treatment and study of outcomes and recovery after isolated ankle fracture.

Modified trochanteric triplane osteotomy for chronic moderate to severe slipped capital femoral epiphysis - a preliminary report.

Management of chronic moderate and severe slipped capital femoral epiphysis (SCFE) remains controversial. We propose that the modified trochanteric triplane osteotomy(MTTO) with a 1300 angled blade plate, without removal of bone wedge, is effective for addressing moderate and severe chronic SCFE. A retrospective review was performed on patients who underwent MTTO for moderate to severe chronic SCFE, with at least two years follow-up. Radiological outcomes assessed were osteotomy union, alpha angle, neck shaft angle, mechanical axis deviation and limb length discrepancy(LLD). Functional outcomes were assessed using modified Harris hip score, lower extremity functional scale (LEFS) and SF-36 questionnaire. A total of 11 patients (13 hips) underwent MTTO for chronic SCFE, with a mean age of 12.9 ± 2.1 years. The pre-operative median modified Harris Hip Score was 73. 12 had severe slip and one had moderate slip. All the osteotomies went on to unite by two months. At an average of 37 months follow up, the mean neck shaft angle was 1290, mean alpha angle was 69.70, and mean LLD was 1.05cm. There was significant improvement in the post-operative modified Harris hip score (p < 0.001), the median post-operative modified Harris hip score was 96, and the median LEFS was 78. One case had bone scan evidence of AVN, but did well with bisphosphonate therapy and one case had a superficial infection. MTTO is a safe and effective option for addressing deformities in chronic moderate and severe SCFE. However, a residual proximal femoral Cam deformity persists after this procedure which may need to be treated with a simultaneous or a staged osteochondroplasty.

Cross-cultural adaptation, reliability and validity of the persian version of the functional assessment scale for acute hamstring injuries

BackgroundThe Functional Assessment Scale for Acute Hamstring Injuries (FASH) which measure symptom’s severity and impact on physical activity and sports ability in individuals with acute hamstring muscle injury, is not available in Persian. The aim of this study was to translate and cross-culturally adapt the FASH questionnaire to Persian and to assess the psychometric properties of the translated version.MethodsThe Persian-translation and cross-cultural adaptation processes were based on World Health Organization method. A total of 160 participants compromising of four groups: (1) acute hamstring injury (N = 40), (2) other lower extremity injury (N = 40), (3) risk of acute injury (N = 40), and (4) healthy control (N = 40) were recruited to complete the Persian version of FASH (FASH-P) questionnaire twice with an interval of 48–60 h. The Short Form Health Survey (SF-36) and Lower Extremity Functional Scale (LEFS) were used to assess the criterion validity. Test-retest reliability, internal consistency, criterion validity, Dimensionality and floor/ceiling effects were evaluated to assess the FASH-P psychometric properties.ResultsThe FASH questionnaire were translated to Persian without any major problems. The FASH-P showed excellent power of differentiation because the scores were significantly different among the four groups. Regarding psychometric performances, excellent test–retest reliability (Intraclass correlation coefficient of 0.997) and a high level of internal consistency (Cronbach’s alpha of 0.966) were observed. The FASH-P total score was significantly correlated with SF-36 and LEFS questionnaires representing an excellent criterion validity. No floor or ceiling effect were found for total score in Hamstring muscle injury group.ConclusionsDue to the excellent psychometric performance, the FASH-P can be used as a reliable and valid tool for evaluating the severity of symptoms and sports ability in Persian-speaking patients with hamstring muscle injury.

Physical activity in patients with chronic venous insufficiency: Its relation with disease severity, pain, fatigue, and functionality

Purpose: Chronic venous insufficiency (CVI) is a progressive disease of the venous system caused by a variety of factors that impair the return of venous blood to the heart. The aim of the study was to evaluate the physical activity level in patients with CVI and its relation with disease severity, pain, fatigue, functionality. Methods: In all, 105 CVI patients (28.6% male, 71.4% female, mean age was 44.91±10.74 years) were enrolled in this study. Physical activity was evaluated with the International Physical Activity Questionnaire-Short Form (IPAQ-SF); disease severity, by Venous Clinical Severity Score (VCSS); the intensity of pain was determined by the Visual Analog Scale (VAS); fatigue level with the Fatigue Severity Scale (FSS); functionality was assessed with the Lower Extremity Function Scale (LEFS). Results: There was a significant negative correlation between IPAQ-SF-vigorous and VCSS, VASrest, VASactivity, VASnight (r: -0.818, p

Hindi version of the lower extremity functional scale: a study of translation, validation and cross-cultural adaptation

BACKGROUND: Lower Extremity Function Scale (LEFS) serves as a patient-reported outcome measure, used to evaluate the functional status of lower extremity in different musculoskeletal conditions. It was originally developed in English language (E-LEFS) and numerous translations in different languages are available to measure its usability among different cultures. OBJECTIVES: To translate the English version of the Lower Extremity Function Scale (E-LEFS) into Hindi language and to evaluate its content validity, cross-cultural adaptation along with the concurrent validity and reliability. METHOD: Process of forward and backward translation was carried out by two bilingual translators and a physiotherapist after obtaining developer’s approval, for which the Beaton guidelines were used. For the content validation, Delphi method of was employed in which 12 field experts of more than 5 years of experience participated. Cultural adaptation procedures were then carried out with 12 patients, who reported in out-patient department of the hospital through convenience sampling who were asked about whether the H-LEFS was well understood by the patients. Their responses were recorded as positive and negative responses. This process was followed by concurrent validation which was conducted by comparing the scores with the SF-36 scale, involving 30 patients with activity limitation in their daily life. Lastly, 50 patients were recruited for intra-rater reliability testing. RESULT: The scale was successfully translated and verified by the bi-lingual language experts. Content validity came out to be significant with each item scoring more than 0.92. Nearly all items, excluding item no. 8, 16, 17, 18, and 19 received universal agreement with a content validity ratio of 1. The average scale-level validity stood at 0.98, indicating excellent level of validity and the scale was found to be well adapted by the native people as out of 12 patients, 10 patients provided 100% positive response. Concurrent validation using Pearson’s correlation coefficient came out excellent with the values of 0.993 for E-LEFS and 0.890 for SF-36. Cronbach's alpha and ICC values were calculated as 1.00 for Intra-rater reliability. CONCLUSION: LEFS was well translated into Hindi language with an excellent content and concurrent validity and is found to be highly reliable. Hence, it is recommended for the usage of native Hindi speaking population.

Evaluation of Functional and Radiological Outcomes of Long Bone Fractures in Non-union Treated With Nail and Plate With Osteo-Periosteal Flaps.

To evaluate the functional and radiological outcomes of long bone fractures in non-union cases treated with nail and plate with osteo-periosteal flaps. This prospective study included 20 patients with non-union long bone fractures treated at Dr. DY Patil Medical College, Pimpri, Pune over a two-year period. Patients underwent surgical intervention using nail and plate with osteo-periosteal flaps. Outcomes were assessed using the Non-Union Scoring System (NUSS), Radiographic Union Scale in Tibial Fracture (RUST), and Lower Extremity Functional Scale (LEFS) at regular intervals over one year. Time to union and complications were also recorded. The mean age of patients was 41.5 ± 7.1 years, with 60% being male. Femur fractures were most common (40%), followed by tibia (35%) and humerus (25%). The mean duration of non-union before treatment was 4.15 ± 1.7 months. The average time to union was 19.8 ± 3.9 weeks. NUSS scores decreased from 40.9 ± 8.06 at one week to 16.6 ± 8.2 at one year. RUST scores improved from 4.0 ± 0 to 11.3 ± 0.92, and LEFS scores increased from 9.6 ± 1.9 to 69.2 ± 5.1 over the same period. Complications occurred in 40% of cases, with surgical site infection being the most common (20%). The use of nail and plate with osteo-periosteal flaps for non-union long bone fractures demonstrated improvements in both functional and radiological outcomes over a one-year follow-up period. However, careful monitoring for complications is necessary. Further studies with larger sample sizes are recommended to confirm these findings.

Translate and cross-culturally adapt the original English version of the lower extremity functional scale into the Sinhalese version

Objectives: Functional ability is critical for quality of life (QOF), and its evaluation is vital in a clinical context. However, there is a deficiency of a universally recognized grading scale in Sinhala for assessing functional capacity in athletes with lower extremity musculoskeletal conditions. This research aimed to validate the linguistic and cross-cultural adaptation of a translated Sinhala version of the lower extremity functional scale (S-LEFS). Materials and Methods: A two-stage observational study was conducted. The lower extremity functional scale was cross-culturally adapted to Sinhala through independent, double forward, and backward translation. An experienced clinical researcher tested the translated version to establish the linguistic validation of S-LEFS. The finalized version was validated for construct, convergent, and criterion validity. A total of 112 participants, comprising 57 healthy (50.89%) and 55 unhealthy (49.11%) lower limb athletes, completed S-LEFS. Results: S-LEFS demonstrated excellent reliability with a Cronbach’s alpha of 0.952. Exploratory factor analysis revealed good factor loadings (&gt;0.48) for all 20 items, with three components accounting for 70.63% of cumulative variance. Scale got a sensitivity of 87.5% and specificity of 81% at a cutoff point of 67.5. Kaiser-Meyer-Olkin (KMO) value was 0.918 (P &lt; 0.0001), and Bartlett’s Test of Sphericity was significant (P &lt; 0.01). No correlation was detected between S-LEFS and World Health Organization QOF-Bref (r = 0.281). Conclusion: S-LEFS is a reliable and valid tool for evaluating lower limb function in athletes.

Gender differences in effects of Graston technique, active release technique, and PNF stretching on hamstring flexibility in knee osteoarthritis

Aims. To seek gender differences among the effects of the Graston Technique (GT), Active Release Technique (ART), and Proprioceptive Neuromuscular Facilitation (PNF) stretching on hamstring flexibility, pain, lower extremity function, and physical function in patients with knee osteoarthritis. Materials and methods. A multicenter, single-blind randomized controlled trial was conducted involving 45 patients – aged above 30 years with knee osteoarthritis – randomly allocated to three equal groups: Group-A (GT), Group-B (ART), and Group C (PNF). Each group received 12 physiotherapy sessions over a four-week intervention period (3 visits per week). Data were collected before and after rehabilitation using the Numeric Pain Rating Scale, Active Knee Extension Test, Lower Extremity Function Scale, and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Results. A statistically significant interaction between the effects of gender and Active Release Technique on lower extremity function was present (p &lt; 0.001) with males (42.4 ± 2.2) showed more improvement than females (35.6 ± 6.6). On the contrary, females showed more improvement (p &lt; 0.001) than males when Graston Technique and PNF techniques were applied. Conclusion. There were no significant gender-based differences among GT, ART, and PNF regarding pain, hamstring flexibility and WOMAC score. However, males showed significantly more improvement in lower extremity function than females with ART, and females showed more improvement in lower extremity function as compared to males with GT and PNF.

Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma.

Background There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n = 33) or amputation ( n = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p = 0.021 and p = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p = 0.01), SF-36 physical functioning ( p = 0.031), physical role functioning ( p = 0.031), and emotional role functioning ( p = 0.047) scores than amputation patients. Conclusion Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.

Applying 3D-Printed Porous Ti6Al4V Prostheses to Repair Osteomyelitis-Induced Partial Bone Defects of Lower Limbs: Finite Element Analysis and Clinical Outcomes.

The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D-printed porous Ti6Al4V prostheses in addressing osteomyelitis-induced partial bone defects. We established a comprehensive protocol for utilizing 3D-printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre- and post-prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X-rays and the Lower Extremity Functional Scale (LEFS). FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow-up period was 24.5 months, with patients initiating weight-bearing activities on average 7.8 days post-surgery. Serial postoperative X-rays demonstrated long-term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow-up. 3D-printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice.

Translation, cross-cultural adaptation, validation, and reliability of the University of Wisconsin running injury and recovery index to Brazilian Portuguese (UWRI-BR)

ObjectiveTo translate and cross-culturally adapt the University of Wisconsin Running Injury and Recovery (UWRI) to Brazilian Portuguese (UWRI-BR) and assess its psychometric properties. MethodsThe Brazilian version of the UWRI questionnaire was based on the guideline proposed by Guillemin. The UWRI was translated, back-translated, and culturally adapted. Fifty runners responded to the pre-final version to validate the final version. Ninety-seven runners participated in the content validity of the UWRI-BR, and 58 runners in the assessment of reliability baseline 48–72 h after the first response. The Lower Extremity Functional Scale (LEFS) and 12-item Short Form Health Survey (SF-12) version 2 (SF-12_2) were applied to construct validity. ResultsThe final version of UWRI-BR showed a positive moderate correlation with LEFS (r = 0.65, p < 0.01) and weak with SF-12_2 (r = 0.31, p < 0.01). UWRI-BR showed excellent internal consistency (α = 0.92) and test-retest Reliability (ICC = 0.83; 95% CI (0,72–0,90). ConclusionThe Brazilian version of the UWRI was a valid and reliable tool for evaluating and monitoring the progression of runners with running-related injuries.

The effects of balance training in patients with total hip arthroplasty : Arandomized controlled pilot study.

Total hip arthroplasty (THA) causes damage to hip joint mechanoceptors, which in turn leads to decrease in proprioception and increase in balance disorders. Few research has focused on balance training in patients with arthroplasty and none investigated the long-term effect of balance training using objective balance assessment methods in THA patients. The purpose of our study was to investigate the effects of balance training in patients with THA until 26 weeks postoperatively. For this study 24 patients with hip osteoarthritis, who were candidates for THA were recruited. Of the patients with THA 16completed the study protocol and the patients were randomized to 2groups: conventional rehabilitation (CR, n = 8) or conventional rehabilitation plus balance training (CR + BT, n = 8). The CR group completed typical surgery-specific exercise programs, while the CR + BT group completed the CR plus balance exercises. The patients were evaluated by ahand-held dynamometer, single leg stance test (SLST), Tetrax balance system, Harris hip score, lower extremity function scale, 5times sit to stand test and 50-foot timed walk test preoperatively and 8, 14 and 26 weeks postoperatively. While the CR + BT group showed significant improvement for the right extremity eyes closed SLST score (p < 0.05), there was no significant difference for other assessment parameters between the CR and CR + BT groups (p > 0.05). There were significant improvements in both groups until 26 weeks following THA (p < 0.05). The results of our study indicate that there were similar improvements in the balance and functional parameters in the CR and CR + BT groups. There was no additional benefit after 26 weeks of controlled balance exercises following THA.

Differentiated Approach to Surgical ­Treatment of Gunshot Diaphyseal Shin Fractures

Background. The roots of problems in the treatment of gunshot fractures to extremities lay in the high-energetic character of these traumas, the frequency of infectious complications, high rate of slow consolidations, and occurrence of pseudoarthroses and bone tissue lesions. Objective. The objective of the study was to improve the treatment results of patients with gunshot fractures of the shin bones based on the development of a differentiated approach to the treatment of such injuries. Material and Methods. The study is based on the results of examination and treatment of 128 patients with dominant combat shin traumas. The patients were divided into two groups. The first group (control group) included 68 patients who underwent treatment with an external fixation device (EFD). The second group (study group) included 60 patients who underwent the extrafocal osteosynthesis replaced by an internal, mostly intramedullary one. To assess the functional outcomes of treatment, we applied the LEFS (Lower Extremity Functional Scale) in the dynamics of the therapy, namely in 3, 6, 12, and 18 months after the injury. Results. Mean values in both groups during the first two to three weeks showed no statistically significant difference, and their average score according to the LEFS scale was 15.75 points. The most significant differences were observed in the period from 6 to 12 months after the injury, 39.4±2.4 (EFD) and 57.3±2.1 (intramedullary nailing). After 18 months, excellent results showed 20.7% of patients from the study group and 15.8% of the control group (61 – 80 LEFS scores). Good results had 43.2% and 33.1%, respectively (41 – 60 LEFS scores). 28.1% and 39.3%, respectively, showed satisfactory results (21 – 40 LEFS scores). Poor results showed 8.0% of patients of the study group and 11.8% of the control group (p&lt;0.05). Conclusions. The analysis of treatment outcomes of patients with gunshot diaphyseal shin fractures demonstrates that conversion, when used according to indications and following criteria to the replacement of the method of fixation, reduces the incidence of complications in both the early and late postoperative periods, fastens consolidation of gunshot diaphyseal shin fractures by 4.5±2.3 weeks, reduces the frequency of fracture consolidation disorders by 10.6%, and improves the functional results of the patients by 15.0%.

Outpatient Physiotherapy for Immune-Mediated Necrotizing Myositis With a Positive Outcome: Must Pathology Equal Dysfunction? A Case Report

BACKGROUND: Necrotizing myositis (NM) is a rare autoimmune systemic condition leading to skeletal muscle destruction visualized on magnetic resonance imaging (MRI). The prognosis is severe progressive muscle weakness leading to functional mobility decline. This case study described outpatient physiotherapy management of NM, not hitherto reported, and the unanticipated outcomes given the diagnosis and MRI findings. CASE PRESENTATION: A 77-year-old female was diagnosed with NM, confirmed on MRI significant for abnormal T2 signal in all muscular compartments of both lower extremities, after 4 months of progressive limb weakness had prevented her from walking independently. Outpatient physiotherapy began 10 months after diagnosis. Examination revealed spinal and peripheral joint hypomobility, lower limb weakness (1 repetition, 30s sit to stand-30STS), functional limitation (14/80, Lower Extremity Functional Scale [LEFS]), and slow gait with rollator. The physiotherapy diagnosis was that musculoskeletal impairments contributed to movement dysfunction, leading to 18 manual therapy and exercise treatments over 19 weeks. OUTCOMES AND FOLLOW-UP: Strength (8 repetition 30STS) and function (49/80 LEFS) improved beyond minimal clinical important differences and gait speed at discharge approximated age-sex-matched normal. DISCUSSION: For this NM case, strength and function improved despite confirmed muscle necrosis and prognosis of progressive muscle degradation after addressing modifiable musculoskeletal impairments. JOSPT Cases 2024;4(4):205-211. Epub 7 October 2024. doi:10.2519/josptcases.2024.0064