Prosthesis Evaluation Questionnaire Research Articles

Transtibial Ertl amputation for children and adolescents: A case series and literature review

Despite advances in limb reconstruction, there are still a number of young patients who require trans-tibial amputation. Amputation osteoplasty is a technique first described by Ertl to enhance rehabilitation after trans-tibial amputation. The purpose of the study reported here was to evaluate the results of the original Ertl procedure in skeletally immature patients and to assess whether use of this procedure would result in a diminished incidence of bony overgrowth. The cases of four consecutive patients (five amputations) treated between January 2005 and June 2008 were reviewed. Clinical evaluation consisted of the completion of the prosthesis evaluation questionnaire (PEQ) and physical examination. Radiographic analysis was performed to evaluate bone-bridge healing, bone overgrowth, and the development of genu varum as measured by the medial proximal tibial angle (MPTA). The best mean PEQ score in the question section was 91.8 (range 74-100) for 'well being' and the worst mean score was 66.6 (range 50-78) for 'residual limb health'. Examination of the residual limbs revealed no bursae, and all knees were stable with full range of movement. All bony bridges united at an average age of 1.7 (range 1-2)months. One case required stump revision for bony overgrowth, and one case developed asymptomatic mild genu varum. The original Ertl osteomyoplasty may serve as one of the options for treatment of trans-tibial amputation in older children. Our results suggest that the Ertl osteomyoplasty is a feasible option in this challenging patient population.

Patient satisfaction following lower-limb amputation

Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients. This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription. A cross-sectional study was done. Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfaction-related questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS). Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (-0.35 ≤ r ≤ 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden (r ≥ 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (-0.45 ≤ r ≤ 0.43), and the GPS did not correlate with any satisfaction measures (-0.23 ≤ r ≤ 0.15). In this study of high functioning amputees, gait deviation was unimportant to the amputee, while self-reported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation. For the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. RESULTS suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.

Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices. Objective To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees. Design Intervention study with crossover design. Setting University research center. Participants Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation. Intervention Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d). Main Outcome Measures Physical function, gait, dynamic balance. Results The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices. Conclusions Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.

Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference

This study compared subjects' performance with a nonmicroprocessor knee mechanism (NMKM) versus a C-Leg on nine clinically repeatable evaluative measures. We recorded data on subjects' performance while they used an accommodated NMKM and, following a 90-day accommodation period, the C-Leg in a convenience sample of 19 transfemoral (TF) amputees (mean age 51 +/- 19) from an outpatient prosthetic clinic. We found that use of the C-Leg improved function in all outcomes: (1) Prosthesis Evaluation Questionnaire scores increased 20% (p = 0.007), (2) stumbles decreased 59% (p = 0.006), (3) falls decreased 64% (p = 0.03), (4) 75 m self-selected walking speed on even terrain improved 15% (p = 0.03), (5) 75 m fastest possible walking speed (FPWS) on even terrain improved 12% (p = 0.005), (6) 38 m FPWS on uneven terrain improved 21% (p < 0.001), (7) 6 m FPWS on even terrain improved 17% (p = 0.001), (8) Montreal Rehabilitation Performance Profile Performance Composite Scores for stair descent increased for 12 subjects, and (9) the C-Leg was preferred over the NMKM by 14 subjects. Four limited community ambulators (Medicare Functional Classification Level [MFCL] K2) increased their ambulatory functional level to unlimited community ambulation (MFCL K3). Objective evaluative clinical measures are vital for justifying the medical necessity of knee mechanisms for TF amputees. Use of the C-Leg improves performance and quality of life and can increase MFCL and community ambulation level.

Distal Tibiofibular Bone-Bridging in Transtibial Amputation

The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation. Twenty consecutive patients who underwent a unilateral transtibial amputation, as a consequence of traumatic injury, had distal tibiofibular bone-bridging performed by a single surgeon. Eight completed the Prosthesis Evaluation Questionnaire (PEQ), a validated outcomes instrument designed to measure patient self-reported health-related quality of life after a lower-extremity amputation. Their responses were compared with those of a previously reported control group of nondiabetic patients who had undergone transtibial amputation with the use of a traditional technique and with those of a previously reported consecutive group of Brazilian patients, including twelve who were diabetic, who had undergone a similar bone-bridge procedure. The scores in the American bone-bridge group were similar to those in the control group and not as good as those in the Brazilian bone-bridge group. The American bone-bridge and control groups scored lower in the Social Burden, Ambulation, Frustration, Sounds, Utility, and Well-Being domains of the PEQ. While many experts in the care of amputees believe that the distal tibiofibular bone-bridge technique improves patient functional outcomes, our small group of patients treated with this procedure did not appear to have better outcomes than a group of patients treated successfully with a standard surgical technique. More information is needed before the bone-bridge technique can be recommended as an important component of standard transtibial amputation surgery.

Rasch analysis of the Locomotor Capabilities Index-5 in people with lower limb amputation

The aim of this study was to perform a Rasch analysis on the 5-level ordinal scale version of the Locomotor Capabilities Index (LCI-5), in order to investigate rating scale quality and conduct reliability and validity assessments. A questionnaire was mailed to 144 subjects who had undergone lower limb amputation (LLA) in the previous five years and completed a rehabilitation and prosthetic training programme. A total of 123 persons (85%) responded to the questionnaire, a self-report assessment of prosthetic capability and performance which included the LCI-5, the Mobility Section of the Prosthesis Evaluation Questionnaire (PEQ-MS) and other variables associated to prosthetic wear and use. Following Rasch analysis and expert review, the LCI-5 response categories level 1 ('yes, if someone helps me') and 2 ('yes, if someone is near me') were combined into a single category and 4 items were deleted (due to misfitting). The remaining 10 items fitted the Rasch model (LCI10-4) and demonstrated good reliability (person separation reliability = 0.94, item separation reliability = 0.98) and internal construct validity. Moreover, the good correlation with the PEQ-MS (r(s) = 0.77) and with prosthetic wear and use (r(s) range 0.34 - 0.51) supported the convergent validity of the scale. In conclusion, Rasch analysis provided the rationale for improving the measurement qualities of the LCI-5, refining its rating scale (through category diagnostics), identifying those items most useful for measuring the intended construct (as per the indexes of unidimensionality and internal construct validity) and showing that one can place high confidence in the consistency of both the person-ability and item-difficulty estimates obtained (reliability).

Evaluation of Function, Performance, and Preference as Transfemoral Amputees Transition From Mechanical to Microprocessor Control of the Prosthetic Knee

Hafner BJ, Willingham LL, Buell NC, Allyn KJ, Smith DG. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Objective To evaluate differences in function, performance, and preference between mechanical and microprocessor prosthetic knee control technologies. Design A-B-A-B reversal design. Setting Home, community, and laboratory environments. Participants Twenty-one unilateral, transfemoral amputees. Intervention Mechanical control prosthetic knee versus microprocessor control prosthetic knee (Otto Bock C-Leg). Main Outcome Measures Stair rating, hill rating and time, obstacle course time, divided attention task accuracy and time, Amputee Mobility Predictor score, step activity, Prosthesis Evaluation Questionnaire score, Medical Outcomes Study 36-Item Short-Form Health Survey score, self-reported frequency of stumbles and falls, and self-reported concentration required for ambulation. Results Stair descent score, hill descent time, and hill sound-side step length showed significant ( P<.01) improvement with the C-Leg. Users reported a significant ( P<.05) decrease in frequency of stumbles and falls, frustration with falling, and difficulty in multitasking while using the microprocessor knee. Subject satisfaction with the C-Leg was significantly ( P<.001) greater than the mechanical control prosthesis. Conclusions The study population showed improved performance when negotiating stairs and hills, reduced frequency of stumbling and falling, and a preference for the microprocessor control C-Leg as compared with the mechanical control prosthetic knee.

Residual-limb quality and functional mobility 1 year after transtibial amputation caused by vascular insufficiency

This study identified which residual-limb quality factors are related to functional mobility 1 year after transtibial (TT) amputation. A group of 28 TT amputees were evaluated with respect to their functional mobility (Prosthesis Evaluation Questionnaire [PEQ], Locomotor Index, Timed Up and Go test). The general (Chakrabarty score) and bony (tibial length, relative fibular length) residual-limb quality factors were assessed. An increase in general residual-limb quality (Chakrabarty >60) was correlated with greater functional mobility in one of the outcome measures (PEQ). For bony residual-limb quality, a tibial length of 12-15 cm distal from the knee joint line was correlated with greater functional outcome for all three outcome measures and the relative fibular length was not correlated with functional mobility for any of the outcome measures. This study showed that specific aspects of residual-limb quality are related to increased functional mobility. The amputation technique and resulting residual-limb factors may be important for patients to achieve functional prosthetic use.

Measuring mobility in people with lower limb amputation: Rasch analysis of the mobility section of the prosthesis evaluation questionnaire

To assess the psychometric properties of the Mobility Section of the Prosthesis Evaluation Questionnaire (PEQ-MS). A postal survey, including self-report assessment of prosthetic capability and performance with the PEQ-MS and the Locomotor Capabilities Index, and of other variables associated with prosthetic wear and use. The PEQ-MS data underwent Rasch analysis for rating scale diagnostics and a reliability and validity study. A total of 123 subjects (mean age 54 years) who had undergone lower limb amputation in the previous 5 years and who had completed rehabilitation and a prosthetic training programme. According to Rasch analysis and expert review, some response categories of the PEQ-MS (13 items, 11-level numeric rating scale) were collapsed and one item was deleted. The remaining 12 items fitted to the Rasch model and created a revised scale with a 5-level response format, the PEQ-MS12/5. The PEQ-MS12/5 demonstrated good reliability (person-separation reliability = 0.95, item-separation reliability = 0.98) and internal construct validity. Moreover, the correlation with the Locomotor Capabilities Index (rs = 0.78) and with prosthetic wear and use (rs range 0.41-0.59) supported the convergent validity of the PEQ-MS12/5. The new PEQ-MS12/5 presents good psychometric characteristics for measuring mobility in people with lower limb amputations. These preliminary results provide an already applicable instrument and a solid basis for further validation studies.

Summary and Conclusions From the Academy??s Sixth State-of-the-Science Conference on Lower Limb Prosthetic Outcome Measures

Summary and Conclusions From the Academy??s Sixth State-of-the-Science Conference on Lower Limb Prosthetic Outcome Measures

Use of the Prosthesis Evaluation Questionnaire (PEQ)

ABSTRACTThe Prosthesis Evaluation Questionnaire (PEQ) was developed specifically to provide functional outcome measures in prosthetics that are more tuned to prosthesis-related changes in quality of life. It is a self-report questionnaire containing 54 questions organized into nine functional domain

Comparison of Rectified and Unrectified Sockets for Transtibial Amputees

The current method for fabricating prosthetic sockets is to modify a positive mold to account for the non-homogeneity of the residual limb to tolerate load (i.e., rectified socket). We tested unrectified sockets by retaining the shape of the residual limb, except for a distal end pad, using an alginate gel process instead of casting. This investigation compared rectified and unrectified sockets. Forty-three adults with unilateral transtibial amputations were tested after randomly wearing both rectified and unrectified sockets for at least 4 weeks. Testing included a gait analysis, energy expenditure and Prosthesis Evaluation Questionnaire (PEQ). Results indicated no differences between sockets for gait speed and timing, gait kinematics and kinetics, and gait energy expenditure. There were also no differences in the Prosthetic Evaluation Questionnaire and 16 subjects selected the rectified socket, 25 selected the unrectified socket, and 2 subjects selected to use both sockets as their exit socket. Results seemed to indicate that more than one paradigm exists for shaping prosthetic sockets, and this paradigm may be helpful in understanding the mechanisms of socket fit. The alginate gel fabrication method was simpler than the traditional method. The method could be helpful in other countries where prosthetic care is lacking, may be helpful with new amputees, and may be helpful in typical clinics to reduce costs and free the prosthetist to focus more time on patient needs.

A questionnaire survey of the effect of different interface types on patient satisfaction and perceived problems among trans-tibial amputees

The objectives were to investigate the effect of three different interface types on consumer satisfaction and perceived problems among trans-tibial amputees in the Netherlands. A postal questionnaire (based on the Prosthesis Evaluation Questionnaire) was sent to 353 patients. Responders were classified in three groups of interface types: polyethylene foam (PEF) inserts, silicone liners (SIL), and polyurethane liners (PUL). Differences concerning satisfaction and problems between interface types were computed and adjusted for potential confounding by age, gender, reason for amputation and time since first prosthesis. A total of 220 patients responded (62%). Patients wearing liners reported a significantly poorer durability and higher maintenance time compared with patients using PEF inserts. Sum-scores for satisfaction or problems did not show any significant differences between groups. Analysis of individual items showed a significant difference only for satisfaction with sitting and with walking on uneven terrain in favour of PEF inserts. In contrast to most studies, interface type was included as a possible determinant of customer use, satisfaction, and perceived problems. The perceived differences between the three suspension types are to a large extent small and non-significant. The findings do not support liner prescription as a matter of course for all trans-tibial amputees. A careful analysis of patients' preferences should be made to determine the best course of action. Further studies, preferably prospective, need to be conducted to determine which systems are most comfortable and offer least complaints.

Quantification of prosthetic outcomes: Elastomeric gel liner with locking pin suspension versus polyethylene foam liner with neoprene sleeve suspension

For this randomized crossover trial, we compared two common transtibial socket suspension systems: the Alpha liner with distal locking pin and the Pe-Lite liner with neoprene suspension sleeve. Our original hypotheses asserted that increased ambulatory activity, wear time, comfort, and satisfaction would be found with the elastomeric suspension system. Thirteen subjects completed the study. Following 2.5-month accommodation to each condition, ambulatory activity was recorded (steps/minute for 2 weeks), and subjects completed three questionnaires specific to prosthesis use and pain: the Prosthesis Evaluation Questionnaire (PEQ), a Brief Pain Inventory (BPI) excerpt, and the Socket Comfort Score (SCS). Upon completion, subjects selected their favored system for continued use. Ten subjects preferred the Pe-Lite and three the Alpha. Subjects spent 82% more time wearing the Pe-Lite and took 83% more steps per day. Ambulatory intensity distribution did not differ between systems. No statistically significant differences were found in questionnaire results. Subject feedback for each system was both positive and negative.

Preliminary Investigation Comparing Rectified and Unrectified Sockets for Transtibial Amputees

In Brief The current method for fabricating prosthetic sockets is to modify a positive mold to account for the nonhomogeneity of the residual limb to tolerate load (i.e., rectified socket). We tested unrectified sockets by retaining the shape of the residual limb, except for a distal end pad, using an alginate gel process during casting. This investigation compared rectified and unrectified sockets. Ten adults with unilateral transtibial amputations were tested after randomly wearing both rectified and unrectified sockets for 4 weeks. Testing included a gait analysis, energy expenditure, and Prosthesis Evaluation Questionnaire (PEQ). Results indicated no differences between sockets for gait speed and timing, gait kinematics and kinetics, gait energy expenditure, and rate of perceived exertion. There were no differences in the PEQ. Four subjects selected the rectified socket, and six selected the unrectified socket as exit sockets. The alginate gel method of fabricating the socket was simpler and less time-consuming than the traditional method. This method could be helpful in countries in which prosthetic care is lacking and may be helpful in typical clinics to reduce costs and free the prosthetist to focus more time on patient needs. Preliminary results indicate that more than one paradigm may exist for shaping sockets. Understanding the mechanisms for these paradigms could lead to customizing the socket to better meet the varying needs of individual patients. This article compares test results for two types of prosthetic sockets; rectified and unrectified. The rectified method is the traditional and currently favored mode of socket fabrication. However, user test results indicated no differences between the two methods in several key areas of evaluation.

Phantom limb, residual limb, and back pain after lower extremity amputations.

This study describes the sensations and pain reported by persons with unilateral lower extremity amputations. Participants (n = 92) were recruited from two hospitals to complete the Prosthesis Evaluation Questionnaire which included questions about amputation related sensations and pain. Using a visual analog scale, participants reported the frequency, intensity, and bothersomeness of phantom limb, residual limb, and back pain and nonpainful phantom limb sensations. A survey of medication use for each category of sensations also was included. Statistical analyses revealed that nonpainful phantom limb sensations were common and more frequent than phantom limb pain. Residual limb pain and back pain were also common after amputation. Back pain surprisingly was rated as more bothersome than phantom limb pain or residual limb pain. Back pain was significantly more common in persons with above knee amputations. These results support the importance of looking at pain as a multidimensional rather than a unidimensional construct. They also suggest that back pain after lower extremity amputation may be an overlooked but very important pain problem warranting additional clinical attention and study.

Prosthesis evaluation questionnaire for persons with lower limb amputations: Assessing prosthesis-related quality of life

Objective: To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life. Design: Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. Source of Sample: Records from two Seattle hospitals. Patients: Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level. Main Outcome Measures: The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form. Results: Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables. Conclusions: The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.