Lower Extremity Function Research Articles

Prenatal surgery in fetal myelomeningocele with severe ventriculomegaly.

Prenatal myelomeningocele (MMC) repair is performed to decrease risk for treatment of hydrocephalus after birth and to preserve motor function. Some centers may not consider patients candidates for surgery if severe ventriculomegaly is present and there is no expected benefit in decreased risk for hydrocephalus treatment. This study sought to compare postnatal outcomes of fetuses with MMC and severe ventriculomegaly (>15mm) who underwent prenatal repair, with fetuses with severe ventriculomegaly who underwent postnatal repair and fetuses with ventriculomegaly (<15mm) who underwent prenatal repair. This was a retrospective study of fetuses with MMC that underwent prenatal or postnatal repair between 2012 and 2021 at a single institution. The cohort was divided based on preoperative fetal ventricular size into two groups, those with severe ventriculomegaly (≥15 mm) and those without severe ventriculomegaly (<15 mm). Fetal ventricular size was measured by MRI prior to surgery using the standardized approach and the mean of the left and right ventricle was used for analysis. Motor function of lower extremities was assessed at the time of referral by ultrasound and if flexion-extension movements of the ankle were seen, it was considered as preserved S1 motor function. Postnatal outcomes including motor function of lower extremities assessed at birth and need for diversion procedure for hydrocephalus treatment during the first year of life were collected and compared between groups. Data was presented as median and range or number and percentages as appropriate. P value >0.05 was considered statistically significant. Multivariate regression analysis was used to adjust for potential confounders. 154 patients were included in this study: 145 patients underwent fetal surgery (101 fetoscopic and 44 open hysterotomy) and 9 patients with severe ventriculomegaly underwent postnatal repair. Among the 145 patients who underwent fetal surgery, 22 presented with severe ventriculomegaly. Prenatally repaired fetuses with severe ventriculomegaly at referral were at a significantly higher need for hydrocephalus treatment by 12 months than those without severe ventriculomegaly (62% vs. 29%, p<0.01). However, motor function assessment at birth was similar between both prenatally repaired groups (OR=0.92, 95% CI [0.33-2.59], p=0.88) adjusted for the anatomical level of the lesion. The prenatally repaired group with severe ventriculomegaly had better preserved motor function levels at birth compared to the postnatal repair group with severe ventriculomegaly (L3 with 11.1% S1 motor function; p=<0.01 and p=<0.01). Prenatally repaired patients with severe ventriculomegaly had an 18.9 times chance of having an intact motor function at birth [95% CI (1.2 - 290.1)] adjusted for ethnicity, presence of clubfeet at referral, and gestational age at delivery compared to postnatal repair. There was not a significant difference in the need for hydrocephalus treatment in the first year of life between prenatal and postnatal repair of patients with severe ventriculomegaly (61.9% vs 87.5%, p=0.18). Although fetuses with MMC and severe ventriculomegaly do not seem to benefit from fetal surgery in terms of postnatal hydrocephalus treatment, they benefit from increased chance of preserved motor function at birth. Results from this study highlight the benefits of having prenatal MMC repair for cases with severe ventriculomegaly at referral to preserve motor function. This article is protected by copyright. All rights reserved.

Comparing complex decongestive therapy in patients with lymphedema of different causes by measuring: extremity volume, quality of life, and functionality.

This study aimed to investigate the effects of complex decongestive therapy (CDT) applied to the lower extremities of patients with lymphedema of different causes on the extremity volume, quality of life (QoL), and functionality. The study included 90 patients, of whom 28 had primary lymphedema, 30 had secondary lymphedema, 18 had phlebolymphedema, and 14 had lipolymphedema. A total of 137 extremities were treated with CDT. The patients who received CDT for 5 days a week for 3 weeks (15 sessions in total) were included in the sample. Extremity volume was measured using a tape measure. The lymphedema QoL-Leg Questionnaire was used to evaluate QoL, and the lower extremity functional scale (LEFS) was administered to assess lower extremity functionality. The changes in QoL before and after treatment significantly differed in the primary lymphedema, phlebolymphedema, and lipolymphedema groups (p < 0.05). The post-treatment LEFS scores indicated a significant decrease in the phlebolymphedema and lipolymphedema groups compared to the pre-treatment scores (p < 0.05). The difference in appearance, which is one of the sub-parameters of QoL, significantly decreased in the comparisons performed between the groups, whereas the changes in the remaining parameters were not significant.

The effect of transcranial direct current stimulation on balance, gait function and quality of life in patients with stroke

ABSTRACT Transcranial direct current stimulation (tDCS) has been used in various neurological diseases due to its positive effects on cortical excitability. The aim of our study is to examine the effects of tDCS in stroke and 28 patients with stroke were randomly divided into two groups as intervention and control groups. Balance was evaluated with the Timed Up and Go Test and Berg Balance Scale. Walking functions were evaluated using the 10-meter Walk Test and the 6 Minutes Walk Test, lower extremity function was evaluated by Fugl Meyer Lower Extremity Scale, quality of life by Stroke-Specific Quality of Life Scale (SS-QOL). A task-oriented physiotherapy and rehabilitation program was applied to both groups. In addition to the task-oriented program, anodal tDCS was applied in the intervention group and carried out with a current of 2 mA, 5 days a week, 20 min, for a total of 4 weeks. In the control group, after the flow was opened for 30 s and the patient felt a tingling sensation, it was turned off without the patient noticing. As a result, significant improvement was obtained in all parameters in both groups (p < 0.05). At the difference values of both groups, only SS-QOL mobility subgroup was significant and other parameters were not significant. Considering all these results, it can be seen that tDAS applied in addition to the task-oriented training program in individuals with stroke makes a positive contribution to the patients’ balance, walking function and quality of life. We think that tDAS may be a feasible and safe additional approach in this patient group.

Effects of neuromuscular electrical stimulation, light intensity walking and a seated exercise trainer on venous return in healthy young adults: a quasi-experimental crossover study

Background/Aims The growing prevalence of sedentary behaviour across the life course is linked to an increased risk of chronic venous disease and related mortality, warranting the need for non-invasive interventions to improve blood flow and lower extremity function. The aim of this study was to investigate the change in venous blood flow, heart rate and blood pressure after 8 minutes of using the Leeper device, Circulation Booster and light intensity walking. Methods A quasi-experimental crossover study involving 11 participants (eight women, three men, mean age 23.91 years, standard deviation 1.04 years) was conducted using Leeper and Circulation Booster devices and light intensity walking. During each intervention, participants exercised for 8 minutes, and blood flow was recorded at 0, 4 and 8 minutes. Heart rate and blood pressure were recorded at 0 and 8 minutes. Blood flow was the primary outcome measure, and heart rate and blood pressure were secondary outcomes. Participants rested for 10 minutes between exercise. A two-way repeated measures analysis of variance was used to analyse the effect of intervention and time on blood flow, blood pressure and heart rate. Results There was no significant interaction between intervention and time on blood flow (P=0.180) indicating that blood flow did not change over time depending on intervention. There was no significant main effect of time on blood flow (P=0.206), indicating that no intervention caused a significant increase or decrease in blood flow after 8 minutes of exercise. Conclusions The interventions involving the Leeper and Circulation Booster devices and light intensity walking did not appear to significantly increase blood flow in young adults. Further studies involving participants from older age groups and those with pathological interventions are warranted to examine the potential effectiveness of these interventions. Implications for practice The findings may assist with the advice that allied health professionals provide regarding the use of seated exercise trainers and EMS devices and their ability to influence changes in blood flow.

Physical independence and related factors among older adults: a systematic review and meta-analysis

Background: Adopting a physically active lifestyle is advocated as a strategy to prevent loss of physical independence and support healthy aging. This study aimed to evaluate the physical independence and related factors among older adults. Materials and methods: This systematic review and meta-analysis was conducted through electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database from the earliest to 1 April 2022. Two researchers independently extracted information from the studies and evaluated the quality of the studies. The analysis was conducted using CMA program version 3, and each study’s importance was determined based on its inverse variance. Results: Five thousand seven hundred thirty-three older adults participated in this review in six studies. All evaluated studies had high quality. The mean score of physical independence in older adults was 20.07 (SE=0.76) out of 24 (95% CI: 18.58–21.56; I2 =98.573%; P&lt;0.001). Physical activity is very important for physical independence and reduces the risk of physical dependence in older adults. Other factors, such as sex, BMI, age, abnormal performance, timed performance, sufficiently active, muscle function, handgrip strength, lower extremity function, lower body strength, maximal isometric knee extension power, lung function, aerobic endurance, sedentary time, agility, and the prevalence of arthritis, had a significant relationship with physical independence in older adults. Conclusion: Older adults demonstrate favourable levels of physical independence. Notably, physical activity emerges as a significant determinant positively associated with such independence. Thus, policymakers and administrators are encouraged to strategize the creation of conducive environments for walking and exercise among older adults.

Influence of yoga on pain, lower extremity kinetics, kinematics and function in patients with knee osteoarthritis

Influence of yoga on pain, lower extremity kinetics, kinematics and function in patients with knee osteoarthritis

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study.

Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage. We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament ossification, and surgical data. We enrolled 115 patients (78 men and 37 women) in the present study. Preoperatively, using the GLFS-25, 73.9% of patients had stage 3, 10.4% had stage 2, 9.6% had stage 1, 6.1% had no locomotive syndrome. The stage distribution of locomotive syndrome improved significantly at 6-months and 1-year postoperatively. The multivariable Poisson regression analysis revealed that better preoperative lower extremity function (relative risk: 3.0; 95% confidence interval: 1.01-8.8) was significantly associated with postoperative improvement in the locomotive syndrome stage. This is the first study to longitudinally assess the locomotive syndrome stage in patients with DCM using GLFS-25. Our results indicated that patients with DCM experienced significant improvement in the locomotive syndrome stage following cervical spine surgery. Particularly, the preoperative lower extremity function was significant in postoperative improvement in the locomotive syndrome stage.

ACUTE EFFECT OF ANKLE DYNAMIC TAPING AND KINESIO TAPING ON BALANCE AND LOWER EXTREMITY FUNCTIONAL PERFORMANCE IN HEALTHY INDIVIDUALS

Objective: The ankle-foot complex is integral to maintaining balance as it gathers proprioceptive data. Dynamic taping (DT) and Kinesio taping (KT) are special elastic therapeutic tape applied to the skin. This study aims to investigate the acute effect (2 hours) of DT and KT on dynamic balance and functional performance in healthy individuals. Method: A total of 15 adults (7 males and 8 females) were included in the study. Participants underwent testing under three conditions (No taping, DT, and KT). Balance was assessed with Y Balance Test, while functional performance was evaluated with Single Hop Test, Triple Hop Test, Cross Over Hop Test, and 6 Meter Timed Hop Test. Results: There was a significant difference in Y balance posteromedial test between three conditions (p0.05). Conclusion: The results of this study suggest that ankle KT enhances dynamic balance in healthy individuals.

Evaluating the Impact of Flossing Band Integration in Conventional Physiotherapy for Patellofemoral Pain Syndrome.

Background/Objectives: Patellofemoral Pain Syndrome (PFPS) is prevalent among physically active individuals, highlighting the need for innovative treatment strategies beyond conventional physiotherapy. This study investigates the effectiveness of integrating flossing band therapy with standard physiotherapy, anticipating improved outcomes in pain reduction, functional ability, and patient satisfaction. Methods: A double-blinded randomized controlled trial involved 50 PFPS-diagnosed participants. They were divided into two groups: Standard Physiotherapy Group (SPG) and Flossing Band and Physiotherapy Group (FBPG), each undergoing an 8-week intervention focusing on resistance training supplemented by respective therapies. Assessment metrics included pain (VAS), strength (Dynamometry), lower limb function (LEFS), and PFPS function (AKPS) measured before and after the intervention. Results: Significant enhancements in all outcome measures were noted for both groups, yet the FBPG exhibited notably superior improvements in pain, knee functionality, muscle strength, and lower extremity function. The FBPG demonstrated statistically significant greater efficacy in pain alleviation and strength enhancement. Conclusions: The addition of flossing band therapy to conventional physiotherapy presents a more effective treatment modality for PFPS, suggesting its potential to redefine therapeutic standards. Future studies should delve into the long-term impacts and mechanistic underpinnings of floss band therapy in PFPS management.

Impact of distinct cognitive domains on gait variability in individuals with mild cognitive impairment and dementia.

Gait variability is a common feature in neurodegenerative diseases and has been linked to cognitive impairment. Despite this link, the influence of specific cognitive domains, such as memory, visual spatial skills, executive function, and verbal function on gait variability is not well-understood. To investigate the predictive value of these specific cognitive domains on gait variability in people with mild cognitive impairment (MCI) and dementia during preferred and dual task walking. One hundred and two participants with either MCI or dementia underwent a comprehensive cognitive assessment and completed preferred and dual-task walking trials on a pressure-sensing walkway. Gait variability was assessed using the PKMAS software. Lower extremity function was evaluated with a self-reported validated scale. Our findings indicate that only visual spatial abilities had a moderate predictive value on gait variability [F (1, 78) = 17.30, p < 0.01, r = 0.43], both in preferred pace walking (70% direct effect) and dual-task walking (90% direct effect) (p's < 0.05). Additionally, lower extremity functional skills had a significant indirect effect (30%) on gait variability in preferred walking contexts. For individuals diagnosed with MCI or dementia, increased gait variability may be driven by deficits in visual spatial processing. An increased understanding of the role of visual spatial processing in gait variability can aid in the assessment and management of individuals with MCI or dementia, potentially leading to targeted interventions to improve mobility and safety.

Free-Living Sit-to-Stand Characteristics as Predictors of Lower Extremity Functional Decline among Older Adults.

Habitual strength and power-demanding activities of daily life may support the maintenance of adequate lower extremity functioning with aging, but this has been sparingly explored. Hence, we examined whether the characteristics of free-living sit-to-stand (STS) transitions predict a decline in lower extremity functioning over a 4-yr follow-up. A total of 340 community-dwelling older adults (60% women; age 75, 80, or 85 yr) participated in this prospective cohort study. At baseline, a thigh-worn accelerometer was used continuously (3-7 d) to monitor the number and intensity of free-living STS transitions. A decline in lower extremity functioning was defined as a drop of ≥2 points in the Short Physical Performance Battery (SPPB) from baseline to follow-up. Maximal isometric knee extension strength was measured in the laboratory. Eighty-five participants (75% women) declined in SPPB over 4 yr. After adjusting for age, sex, and baseline SPPB points, higher free-living peak STS angular velocity (odds ratio (OR), 0.70; 95% confidence interval (CI), 0.52-0.92, per 20°·s -1 increase) protected against a future decline. When adjusting the model for maximal isometric knee extension strength, the statistical significance was attenuated (OR = 0.72; 95% CI = 0.54-0.96, per 20°·s -1 increase). Performing STS transitions at higher velocities in the free-living environment can prevent a future decline in lower extremity function. This indicates that changes in daily STS behavior may be useful in the early identification of functional loss. Free-living peak STS angular velocity may be a factor underlying the longitudinal association of lower extremity strength and performance.

Effects of High-intensity Training and Electrical Stimulation on Pain, Disability, Knee Kinematic and Performance in Patellofemoral Pain: A Randomized Controlled Trial

Patellofemoral pain (PFP) is a widespread problem in athletes who participate in jumping, cutting, and pivoting sports. Forty-four players participated in this study. They were divided into two groups: exercise plus EMS (G1) and exercise without EMS (G2), both with 12 women and 10 men. The exercise performed was 8 weeks of a high-intensity strength program for 45-60 minutes, plus cooling and a warm-up phase. Visual analogue scale (VAS), disability (Kujala patellofemoral score), knee valgus angle (KVA) and single-leg hop (SLH) were tested before (pre-test) and after training (post-test at 8 weeks) using a within-between group analysis (ANOVA 2×2). At baseline, no differences between groups were found (p &gt; 0.05). After the intervention, both groups improved VAS, KVA, SLH (p &lt; 0.001), and disability (p = 0.042). G1 showed more improvements than G2 for VAS (- 63.4 vs - 51.5 %, p = 0.021, 𝜂p2 = 0.13), disability (+ 32.6 vs + 18.4 %, p = 0.001, 𝜂p2 = 0.52), KVA (+ 4.2 vs + 2.2 %, p = 0.016, 𝜂p2 = 0.214) and SLH (+ 12.3 vs + 6.0 %, p = 0.003, 𝜂p2 = 0.20) respectively. No differences were found between the sexes for each group. Despite both interventions being valid, high-intensity strength training combined with EMS improved pain, disability, knee kinematics, and lower extremity performance more than exercise alone in professional handball athletes with PFP. Keywords: Electrical muscle stimulation, Rehabilitation, Musculoskeletal, Knee, Handball players

3D-printed Multifunctional Guide Plate for Fenestration and Screws Drill in Proximal Femoral Benign Tumor.

The accurate fenestration, screw implantation and assisting stabilizing-plate placement in surgery of benign tumors in the proximal femur needs be defined easily. The aim of this study was to investigate the value of 3D printed multifunctional guides plate (3D-MGP) based on computer aided design. Between January 2020 and June 2022, 17 patients (nine females and eight males) with benign proximal femoral tumor had lesion curettage and allograft combined with internal plate fixation using 3D-MGP. In this study, the patients had CT scans and a technician reconstructed the 3D images of tumor and the femur, a doctor designed the location and margin of the fenestration and screws, and integrated different functions into MGP for benign proximal femoral lesions, which assisted in precise localization, fenestration and screw drilling. Musculoskeletal Tumor Society (MSTS) scoring was used to evaluate lower extremity function. Bone healing and the screws location was assessed with the radiographs. All patients underwent successful surgery with complete resection of the tumor and internal fixation with using the 3D-MGP. The mean follow-up was 16.4 months. The operative time was 126.47 ± 18.44 min, intraoperative bleeding was 198.23 ± 67.94 mL, intraoperative fluoroscopy was 6.47 ± 0.62, postoperative drainage was 223.82 ± 119.51 mL, and MSTS score was 27.29 ± 1.31 points. There were no unplanned fenestration and improper screw fixation. The 3D-MGP enabled personalized and accurate location of tumor, fenestration, screw placement and assisted stabilizing-plate placement for the treatment of benign tumor of the proximal femur. This technique has the potential to shorten operative times, decrease intraoperative bleeding, and reduce radiation exposure to patients.

Diagnosis concealment behaviors and disclosure beliefs are associated with health and quality of life in people with multiple sclerosis

BackgroundPeople with multiple sclerosis (pwMS) struggle with whether, how, and how much to disclose their diagnosis. They often expend resources to conceal their diagnosis, and hold beliefs that it may negatively affect their personal relationships and/or professional opportunities. To better understand these effects, we developed a measure to quantify concealment behaviors and disclosure beliefs. Our main objective is to evaluate relationships of DISCO-MS responses to health and quality of life in a multinational cohort. MethodsSurvey responses were obtained for DISCO-MS and PROMIS-MS scales: global health, communication, social roles participation, anxiety, depression, emotional / behavioral dyscontrol, fatigue, lower extremity function, positive affect / well-being, social roles satisfaction, sleep, stigma, upper extremity function, cognitive function, bladder control, bowel control, visual function. Simple linear regression assessed associations. Results263 pwMS were include. Higher concealment was associated with higher anxiety (beta= 0.15 [0.07, 0.23]), depression (beta = 0.13 [0.05, 0.21]), emotional dyscontrol (beta = 0.12 [0.04, 0.20]), lower affect / well-being (beta = -0.13 [-0.21, - 0.05]). Higher anticipation of negative consequences of disclosure was associated with lower self-reported physical (beta = -0.15) and mental health (beta = -0.14), lower positive affect / well-being, social roles satisfaction, higher anxiety, depression, emotional dyscontrol, sleep disturbance, and higher perceived stigma. DiscussionThese results reveal potential consequences of diagnosis concealment for physical and mental health and quality of life. Raising awareness and implementing interventions may mitigate negative repercussions of concealment.

The Effect of Closed Kinetic Chain Exercises on Lower Extremity Function in Male Football Players After Anterior Cruciate Ligament Reconstruction Surgery

Background and Aims : Anterior cruciate ligament (ACL) injury is the most common knee injuries in sports. This study aims to assess the effect of closed kinetic chain exercises on lower extremity function in football players with ACL reconstruction surgery. Methods This is a quasi-experimental study that was conducted on 22 male football players with a history of ACL injuruy referred to a hopspital from Ahvaz, Iran. They were randomly divided into two groups of 11, including exercise and control. The performance of the two groups was measured using shuttle run test, figure-of-eight hop test, hop test from side to side, and agility hop test in the pre-test and post-test phases. The exercise group performed closed kinetic chain exercises (side lunge, plie squat, hip bridge, walking backwards, front lunge, squat, and plank) for 6 weeks, 3 sessions per week, each for 35 minutes. No exercise was performed in the control group. For data analysis, repeated measures analysis of variance (ANOVA) and independent t-test were used. The significance level was set at 0.05. Results In the pre-test phase, no significant difference was observed between the two groups in the functional tests of shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P&gt;0.05). In the post-test phase, the ANOVA results showed that the exercise group performed better in shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P≤0.05). The results of Bonferroni post hoc test showed that the exercise group in the mentioned tests, both immediately after and one month after the exercises, their performance in the mentioned tests improved (P≤0.05). Conclusion The closed kinetic chain exercise can be used to increase the lower extremity performance of male football players with ACL injury.

Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort.

Retrospective analysis of a prospective, multicenter registry. To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients' upper and lower extremity treatment expectations. Level-III.

Abstract 3027: Home-based, High-pressure Intermittent Limb Compression Following Lower Extremity Revascularization In Patients With Severe Peripheral Artery Disease: A Pilot Trial

Objective: Many patients who undergo lower extremity revascularization (LER) for peripheral artery disease (PAD) continue to experience mobility impairment despite adequate revascularization. High-pressure intermittent limb compression (HPILC) has been shown to augment leg blood flow and improve walking endurance in symptomatic PAD patients. This pilot trial aimed to examine the feasibility of home-based HPILC for 2 hours daily over 3 consecutive months in patients who underwent LER for PAD. The primary outcome was the change in 6-minute walk distance from baseline to 3-month follow-up. Methods: Three months following LER, 9 participants were randomly assigned to either HPILC (n=5) or a sham (n=4) group. Participants were provided with a portable pneumatic air pump and inflatable cuffs that were wrapped around the feet, ankles, and calves (ArtAssist, ACI Medical). The inflation pressures were 120 mmHg and 30 mmHg in the HPILC and sham devices, respectively. A built-in timer, inaccessible to participants, provided one estimate of treatment compliance. Outcomes were assessed before and after the completion of the 3-month interventions. Results: Among the 9 randomized participants, one individual required reintervention and was withdrawn from the study. Adherence to treatment was 74% for HPILC and 92% for sham. As shown in Figure 1, the change in 6-minute walk distance from baseline tended to be higher in the HPILC group compared to the sham-treated group (HPILC: 35.2±38.7 m vs. Sham: -14.7±25 m, p=0.07). There were no group differences in the secondary outcomes, including the changes in the ankle-brachial index, the toe-brachial index, and the Vascular Quality of Life questionnaire scores. Conclusions: Home-based HPILC following LER for PAD is feasible, well-tolerated, and appears to improve walking performance. These preliminary findings indicate that HPILC may be a useful adjunct therapy to enhance lower extremity functioning in patients recovering from LER.

The association between lower extremity function and cardiovascular diseases risk in older Chinese adults: Longitudinal evidence from a nationwide cohort

BackgroundOlder adults in China are at a high risk of cardiovascular diseases (CVD), and impaired lower extremity function (LEF) is commonly observed in this demographic. This study aimed at assessing the association between LEF and CVD, thus providing valuable insights for clinical practice and public health policies. MethodsA sample of 4,636 individuals was included from the China Health and Retirement Longitudinal Study (CHARLS) dataset. Logistic regression and cox proportional hazard regression model was utilized to study the association between LEF and CVD incidence. Cross-lagged panel models were utilized to investigate the potential causal association between LEF and CVD over time. ResultsPoor LEF was significantly associated with a higher risk of CVD in the total population [OR (95 % CI): 1.62 (1.27–2.05), P < 0.001]. Individuals with poor LEF demonstrated an increased risk of developing CVD [HR (95 % CI): 1.11 (1.02–1.23), P < 0.05], particularly stroke, compared to those with good LEF. And those with poor LEF had higher risks for heart disease [1.21 (1.00–1.45), P < 0.05] and stroke [1.98 (1.47–2.67), P < 0.001]. ConclusionThe results suggest the potential usefulness of the Short Physical Performance Battery (SPPB) for classifying stroke risk in older Chinese adults, which also suggested that preventing and/or improving LEF may be beneficial for reducing stroke incidence and promoting healthy aging for older adults.

PATIENT-REPORTED OUTCOME MEASURES AFTER OPEN LOWER LIMB FRACTURE REPAIR

IntroductionOpen fractures are complex injuries associated with substantial morbidity. These injuries are associated with harm to both physical and emotional health as well as preclusion of work, social, and leisure activities. Patient reported outcome measures (PROMs) and health related quality of life are critical indicators of successful rehabilitation following open fracture treatment. This study aimed to measure the PROMs for patients with open lower limb fractures and investigate the relationship with injury severity.Materials &amp; MethodsA retrospective cohort study was performed at a single major trauma centre in the UK. All adult patients with an open lower limb fracture were eligible for inclusion. Patients were identified through a search of a local Open Fracture Database. Epidemiological, clinical, and fracture classification data were obtained by reviewing case notes. Lower Extremity Function Scale (LEFS) and EQ5-D were used as PROMs and measured by a postal questionnaire, alongside return to employment data.ResultsA total of 73 patients responded to the questionnaire. Median LEFS was 42 (IQR 26.5 – 59.5), and median EQ5-D was 0.69 (IQR 0.48 – 0.89). There was no significant association between open fracture classification and PROMs. Over 40% of patients reported a change in employment due to their injury. Those who changed jobs had a statistically significant reduction in the EQ5-D of 0.12 (p = 0.021); no significant difference existed in LEFS.ConclusionsThis study demonstrates the devastating functional impact of open fractures. This cohort of open injuries reported lower functional and quality-of-life measures compared to population norms. Injury classification was not a valuable predictor of PROMs. A substantial proportion of patients were forced to change employment due to their injury, and these patients reported a significantly lower quality of life. Further work is required to understand the factors contributing to open fracture PROMs.

Propeller vs. free fasciocutaneous flap in reconstruction of complex lower limb defects–A prospective study

BackgroundOf all body regions, lower extremity wounds have been and remain the greatest challenge. Free flaps have been accepted as a reasonable option to solve this dilemma, but they require the complexity of microsurgery. This study aimed to compare the postoperative and clinical outcomes of propeller flap and fasciocutaneous free flap in the reconstruction of complex lower limb defects. Materials and methodsThis randomized controlled trial was conducted from July 2021 to June 2023. Selected patients were randomized into two groups: the propeller flap group and fasciocutaneous free flap group. Demographic data, preoperative parameters, and postoperative parameter, including esthetic analysis, scar assessment, neurosensory analysis, psychosocial analysis, and lower extremity function, were estimated and statistically significant compared between the two study groups. ResultsRoad traffic accident (73.3%) was the most common etiology for lower limb defects in both groups. The foot and lower third of the leg were the most common site of defect, constituting 79.99%. The duration of surgery was significantly shorter in propeller flap as compared to fasciocutaneous free flaps. Flap size was smaller, with better neurosensory improvements in propeller flap group. Esthetic analysis, scar assessment, psychosocial analysis, and lower extremity functional analysis yielded similar results in both study groups. ConclusionPropeller flap has better outcomes compared to free flap in terms of smaller size of flap, shorter duration of surgery, and reduced length of hospital stay. Comparable results were obtained with respect to esthetic score, scar assessment score, psychosocial analysis, and neurosensory recovery and lower extremity functional score.