Prosthesis Evaluation Questionnaire Research Articles

Functional Outcomes After the Prosthetic Training Phase of Rehabilitation After Dysvascular Lower Extremity Amputation

ObjectiveTo describe physical function outcomes and modes of physical therapy intervention for a cohort of patients with dysvascular lower extremity amputation (LEA) during the prosthetic training phase of rehabilitation. DesignA retrospective cohort study. SettingPhysical rehabilitation clinics at a Veterans Affairs medical center and a university hospital. PatientsForty-two patients (38 men, 4 women, age 60.2 ± 8.4 years) who completed outpatient physical therapy rehabilitation with prosthetic training after dysvascular LEA. MethodsAll patients underwent a prosthetic training phase of rehabilitation, with standardized outcome measures performed at initiation and discharge. Main Outcome MeasuresPerformance-based physical function measures included Two-Minute Walk (2MW), Timed-Up and Go (TUG), and 5-meter gait speed. Self-report physical function measures included the Prosthesis Evaluation Questionnaire–Mobility Section (PEQ-MS) and the Patient-Specific Functional Scale. Rehabilitation dose was tracked as total number of clinic visits, rehabilitation duration, and specific intervention modes. ResultsThere were significant improvements between initial and discharge values (mean ± SD) for the Two-Minute Walk (67.5 ± 29.9 m and 103.3 ± 45.8 m, respectively, P < .001), gait speed (0.58 ± 0.27 m/s and 0.88 ± 0.39 m/s, respectively, P < .001), TUG (34.8 ± 21.3 seconds and 18.6 ± 13.9 seconds, respectively, P < .001), PEQ-MS (2.2 ± 0.9 and 2.8 ± 0.8, respectively, P < .001), and Patient-Specific Functional Scale (3.2 ± 2.0 and 5.9 ± 2.3, respectively, P < .001). Performance-based (TUG) and self-report (PEQ-MS) changes in functional mobility from initial exam to discharge had low or no correlations with rehabilitation dose measures. The number of clinic visits was 12.7 ± 13.1 and rehabilitation duration was 13.7 ± 16.8 weeks. ConclusionsSignificant improvements in performance-based and self-report measures of physical function occurred during the prosthetic training phase of physical rehabilitation after dysvascular major LEA. Despite improvements in function, gait speed, and TUG outcomes remained below clinically important thresholds, indicating patients were limited in community ambulation and at risk for falls. Lack of moderate or greater correlation between rehabilitation dose and outcome measures may indicate the need for more specific rehabilitation dose measures.

Understanding dynamic stability from pelvis accelerometer data and the relationship to balance and mobility in transtibial amputees

This study investigated whether pelvis acceleration-derived parameters can differentiate between dynamic stability states for transtibial amputees during level (LG) and uneven ground (UG) walking. Correlations between these parameters and clinical balance and mobility measures were also investigated. A convenience sample of eleven individuals with unilateral transtibial amputation walked on LG and simulated UG while pelvis acceleration data were collected at 100Hz. Descriptive statistics, Fast Fourier Transform, ratio of even to odd harmonics, and maximum Lyapunov exponent measures were derived from acceleration data. Of the 26 pelvis acceleration measures, seven had a significant difference (p≤0.05) between LG and UG walking conditions. Seven distinct, stability-relevant measures appeared in at least one of the six regression models that correlated accelerometer-derived measures to Berg Balance Scale (BBS), Community Balance and Mobility Scale (CBMS), and Prosthesis Evaluation Questionnaire (PEQ) scores, explaining up to 100% of the variability in these measures. Of these seven measures, medial–lateral acceleration range was the most frequent model variable, appearing in four models. Anterior–posterior acceleration standard deviation and stride time appeared in three models. Pelvis acceleration-derived parameters were able to differentiate between LG and UG walking for transtibial amputees. UG walking provided the most relevant data for balance and mobility assessment. These results could translate to point of patient contact assessments using a wearable system such as a smartbelt or accelerometer-equipped smartphone.

The prosthesis evaluation questionnaire: reliability and cross-validation of the Turkish version.

[Purpose] Currently, there are a limited number of amputee-specific instruments for measuring prosthesis-related quality of life with good psychometric properties in Turkey. This study translated the Prosthetic Evaluation Questionnaire to Turkish and analyzed as well as discussed its construct validity and internal consistency. [Subjects and Methods] The Prosthetic Evaluation Questionnaire was adapted for use in Turkish by forward/backward translation. The final Turkish version of this questionnaire was administered to 90 unilateral amputee patients. Second evaluation was possible in 83 participants within a median 28 day time period. [Results] Point estimates for the intraclass correlation coefficient ranged from 0.69 to 0.89 for all 9 Prosthetic Evaluation Questionnaire scales, indicating good correlation. Overall Cronbach’s alpha coefficients ranged from 0.64 to 0.92, except for the perceived response subscale of 0.39. The ambulation subscale was correlated with the physical functioning subscales of Short Form-36 (SF-36) (r=0.48). The social burden subscale score of the Prosthetic Evaluation Questionnaire was correlated with social functioning subscales of SF-36 (r= 0.63). [Conclusion] The Turkish version of the Prosthetic Evaluation Questionnaire is a valid and reliable tool for implementation in the Turkish unilateral amputee population.

The Conventional Non-Articulated SACH or a Multiaxial Prosthetic Foot for Hypomobile Transtibial Amputees? A Clinical Comparison on Mobility, Balance, and Quality of Life.

The effects of a non-articulated SACH and a multiaxial foot-ankle mechanism on the performance of low-activity users are of great interest for practitioners in amputee rehabilitation. The aim of this study is to compare these two prosthetic feet and assess possible improvements introduced by the increased degrees of freedom provided by the multiaxial foot. For this purpose, a group of 20 hypomobile transtibial amputees (TTAs) had their usual SACH replaced with a multiaxial foot. Participants' functional mobility, involving ambulatory skills in overground level walking, ramps, and stairs, was evaluated by performing Six-Minute Walking Test (6MWT), Locomotor Capability Index-5 (LCI-5), Hill Assessment Index (HAI), and Stair Assessment Index (SAI). Balance performances were assessed using Berg Balance Scale (BBS) and analysing upper body accelerations during gait. Moreover, the Prosthesis Evaluation Questionnaire (PEQ) was performed to indicate the prosthesis-related quality of life. Results showed that participants walked faster using the multiaxial foot (p < 0.05) maintaining the same upright gait stability. Significant improvements with the multiaxial foot were also observed in BBS, LCI-5, and SAI times and 4 of 9 subscales of the PEQ. Our findings demonstrate that a multiaxial foot represents a considerable alternative solution with respect to the conventional SACH in the prosthetic prescription for hypomobile TTAs.

Indices of physical activity, quality of life and psychological characteristics in patients with amputated lower limb

Aim. To study the physical activity in disabled patients who underwent an amputation of the lower limb in a late period of rehabilitation and prosthetics. Methods. The study included patients with structural and functional disorders of limbs. 308 patients aged 18 to 66 years were randomly selected to participate in the study as they were referred to Prosthetic and orthopedics center «Reabilitaciya invalidov», Kazan, Russia from 2008 to 2010. Patients were allocated to five age groups: 19 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years old and older than 60 years. Activity level, depending on the motor capacity was investigated in 308 patients who were offered prosthetics according to the classification subdividing locomotor activity on five levels. SF-36 questionnaire (quality of life), Spielberger-Hanin reactive and personal anxiety scales, Beck Depression Inventory, the Mehrabian Achieving Tendency Scale, Smisek-Leonhard characterological test were administered. Quality of lower limbs prostheses were assessed by «TWO LEGS» prosthesis evaluation questionnaire on a 5-point scale. Results. The majority of patients who were at the remote stage of rehabilitation after prosthesis had high level of physical activity - 141 (45.7%) patients, average activity level - 81 (26.2%) patients, reduced level of activity - 63 (20.5%) patients. High level of physical activity, depending on the locomotor activity, was more typical for the second (20-29) and third (30-39 years) age groups - 60 and 54%, respectively. Very high and high levels of physical activity was equally observed in patients with one and both amputated both lower legs: 8.4 and 7%, respectively. Conclusion. Level of amputation, age and psychological characteristics, as well as prosthesis quality and the term of prosthesis use were essential for motor activity, quality of life and functional independence of the disabled with structural and functional of the lower limb disorders.

Efficacy of Progressive Muscle Relaxation, Mental Imagery, and Phantom Exercise Training on Phantom Limb: A Randomized Controlled Trial

ObjectiveTo evaluate the reduction in phantom pain and sensation with combined training of progressive muscle relaxation, mental imagery, and phantom exercises. DesignRandomized controlled prospective trial with 2 parallel groups. SettingAmputee unit of a rehabilitation hospital. ParticipantsSubjects with unilateral lower limb amputation (N=51) with phantom limb pain (PLP) and/or phantom limb sensation (PLS). InterventionsThe experimental group performed combined training of progressive muscle relaxation, mental imagery, and phantom exercises 2 times/wk for 4 weeks, whereas the control group had the same amount of physical therapy dedicated to the residual limb. No pharmacological intervention was initiated during the trial period. Main Outcome MeasuresThe Prosthesis Evaluation Questionnaire and the Brief Pain Inventory were used to evaluate changes over time in different aspects (intensity, rate, duration, and bother) of PLS and PLP. Blind evaluations were performed before and after treatment and after 1-month follow-up. ResultsThe experimental group showed a significant decrease over time in all the Prosthesis Evaluation Questionnaire domains (in terms of both PLS and PLP; P<.04 for both) and the Brief Pain Inventory (P<.03). No statistically significant changes were observed in the control group. Between-group analyses showed a significant reduction in intensity (average and worst pain) and bother of PLP and rate and bother of PLS at follow-up evaluation, 1 month after the end of the treatment. ConclusionsCombined training of progressive muscle relaxation, mental imagery, and modified phantom exercises should be taken into account as a valuable technique to reduce phantom limb pain and sensation.

Influence of a user-adaptive prosthetic knee on quality of life, balance confidence, and measures of mobility: a randomised cross-over trial

Objective: To study the influence of a transition from a non-microprocessor controlled to the Rheo Knee® II on quality of life, balance confidence and measures of mobility. Design: Randomised crossover trial. Setting: Research department of a rehabilitation centre. Subjects: Persons with a transfemoral amputation or knee disarticulation (n=10). Interventions: Participants were assessed with their own non-microprocessor controlled knee and with the Rheo Knee® II. The low-profile Vari-Flex with EVO foot was installed in both knee conditions, followed by eight weeks of acclimatisation. The order in which knees were tested was randomised. Main measures: Prosthesis Evaluation Questionnaire with addendum, Activities-specific Balance Confidence scale, Timed “up & go” test, Timed up and down stairs test, Hill Assessment Index, Stairs Assessment Index, Standardized Walking Obstacle Course and One Leg Balance test. Results: Significant higher scores were found for the Rheo Knee® II on the Residual Limb Health subscale of the Prosthesis Evaluation Questionnaire when compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 86.67 [62.21-93.08] and 68.71 [46.15-94.83]; P=0.047) In addition, participants needed significantly more steps to complete an obstacle course when walking with the Rheo Knee® II compared to the non-microprocessor controlled prosthetic knee (median [interquartile range] resp. 23.50 [19.92-26.25] and 22.17 [19.50-25.75]; P=0.041). On other outcome measures, no significant differences were found. Conclusions: Transition towards the Rheo Knee® II had little effect on the studied outcome measures.

Evaluation of Mobility in Persons with Limb Loss Using the Amputee Mobility Predictor and the Prosthesis Evaluation Questionnaire–Mobility Subscale

This study is a retrospective chart review of standardized outcome measure data assessing mobility in persons with lower-limb loss. Patient charts were reviewed after the recent adoption of outcome measures as standard practice at a multiregion prosthetic practice. The study investigated the effects of amputation level and assigned activity level (K-level) on patient-perceived potential for mobility and functional ambulatory potential. The Amputee Mobility Predictor (AMP) and Prosthesis Evaluation Questionnaire–Mobility Subscale (PEQ-MS) scores were obtained and compared between transtibial and transfemoral patients and stratified by K-level. An analysis of variance (ANOVA) of AMP and PEQ-MS scores yielded significant variation (a = 0.05) for amputation K-levels. A Fisher protected least significant difference post hoc test found that the K3 and K4 groups had significantly higher AMP with prosthesis (AMPPRO) and PEQ-MS scores than those of the K2 group. The AMP and PEQ-MS scores were not found to be significantly different among transtibial and transfemoral amputation levels in the population studied. These two outcome measures have shown promise for differentiating K-level when adopted as standard practice in the clinical setting.

PERCEIVED DIFFERENCES BETWEEN THE GENIUM AND THE C-LEG MICROPROCESSOR PROSTHETIC KNEES IN PROSTHETIC-RELATED FUNCTION AND QUALITY OF LIFE

Microprocessor knees (MPKs) are a viable option for persons with transfemoral amputation (TFA). Studies have assessed biomechanics and physical function to quantify MPK functional performance. However, it is also essential to assess patient perception as part of evidence-based practice using valid and reliable measures. The Prosthesis Evaluation Questionnaire (PEQ) evaluates prosthetic-related function and quality of life. The PEQ has been used in MPK literature to compare perceptive response between C-Leg and non-microprocessor-controlled knee mechanisms. The Genium, a new MPK, has not been assessed for differences in perceived function. The purpose of this project was to report perceived differences in prosthetic function and quality of life following accommodation with a Genium compared with a C-Leg. Twenty people with TFA participated in this randomized crossover study. C-Leg users randomized to test first with their own C-Leg or a Genium then crossed over into the other condition for repeated testing. Nonknee prosthetic attributes were held constant. Participants completed the PEQ for each knee condition to compare perceived differences in prosthetic function and quality of life. Genium use resulted in significant improvements (p ≤ 0.05) in the following scales — Perceived Response, Social Burden, Utility, and WellBeing — as well as in individual items related to improved standing comfort, satisfaction with walking ability, and improved gait in tight spaces, hills, and slippery surfaces (p < 0.025). As a result of using the Genium, patients perceive improvements in prosthetic-related quality of life and function. Further, patients perceive improvements in very specific mobility functions related to ambulation on complex settings.

Ankle Dorsiflexion Arthrodesis to Salvage Chopart’s Amputation With Anterior Skin Insufficiency

In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients. Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale. Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months). Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing. Level IV, retrospective case series.

Comparison of Functional Outcomes Following Bridge Synostosis with Non-Bone-Bridging Transtibial Combat-Related Amputations

The prevalence of penetrating wartime trauma to the extremities has increased in recent military conflicts. Substantial controversy remains in the orthopaedic and prosthetic literature regarding which surgical technique should be performed to obtain the most functional transtibial amputation. We compared self-reported functional outcomes associated with two surgical techniques for transtibial amputation: bridge synostosis (modified Ertl) and non-bone-bridging (modified Burgess). A review of the prospective military amputee database was performed to identify patients who had undergone transtibial amputation between June 2003 and December 2010 at three military institutions receiving the majority of casualties from the most recent military conflicts; two of those institutions, Walter Reed Army Medical Center and National Naval Medical Center, have since been consolidated. Short Form-36, Prosthesis Evaluation Questionnaire, and functional data questions were completed by twenty-seven modified Ertl and thirty-eight modified Burgess isolated transtibial amputees. The average duration of follow-up after amputation (and standard deviation) was 32 ± 22.7 months, which was similar between groups. Residual limb length was significantly longer in the modified Ertl cohort by 2.5 cm (p < 0.005), and significantly more modified Ertl patients had delayed amputations (p < 0.005). There were no significant differences between groups with regard to any of the Short Form-36 domains or Prosthesis Evaluation Questionnaire subsections. The modified Ertl and Burgess techniques offer similar functional outcomes in the young, active-duty military population managed with transtibial amputation.

A comparison between the suction suspension system and the hypobaric Iceross Seal-In® X5 in transtibial amputees

The two passive vacuum suspension systems currently available in total surface-bearing sockets are the hypobaric Iceross Seal-In(®) and the suction suspension system. The purpose of this study was to compare the effect of the hypobaric Iceross Seal-In(®) liner with that of the suction suspension system for quality of life, pistoning, and prosthesis efficiency in unilateral transtibial amputees. Single-group repeated measures. Ten amputees were enrolled. The pistoning test, used to compare vertical movement of the stump within the socket, and the energy cost of walking test were carried out when the amputees were wearing the suction suspension system and after 2, 5, and 7 weeks of Seal-In® X5 use. The Prosthesis Evaluation Questionnaire and the Houghton Scale Questionnaire of perceived mobility and quality of life with the prosthesis, and the Timed Up&Go Test and the Locomotor Capability Index for functional mobility were also administered at the beginning and end of the study. The hypobaric Iceross Seal-In® X5 led to significant pistoning reduction and improvement on the Houghton Scale Questionnaire and 3 of 9 domains of the Prosthesis Evaluation Questionnaire. No statistical changes were observed in functional mobility or the energy cost of walking tests. Replacing the suction suspension system with the hypobaric Iceross Seal-In® X5 improves quality of life in transtibial amputees.

Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations

This study examined the longitudinal changes in generic health-related quality of life (QOL), prosthesis-related QOL, falls efficacy, and walking speed in men with lower-limb amputations up to 6 months following discharge from rehabilitation. Seven male unilateral transtibial amputees completed the Medical Outcomes Study 36-Item Short Form Health Survey, the Prosthesis Evaluation Questionnaire, and the Modified Falls Efficacy Scale at 1, 3, and 6 months postdischarge from rehabilitation. Walking speed was also recorded to objectively assess participants' mobility. Health-related QOL measures displayed increases, resulting in large effect sizes though not reaching statistical significance. Prosthesis-related QOL measures indicated that scales relating to the participants' prostheses improved and the support of significant others was the most positively scored variable. Walking speed increased by 0.12 m/s, although it was not significantly related to indices of QOL or falls efficacy. Falls efficacy did not improve significantly during the study period, although it was strongly related to QOL (p < 0.05). These results provide a novel insight into how QOL and falls efficacy develop in people with lower-limb amputations, alongside changes in mobility, after discharge from rehabilitation. Further improvements in physical health following discharge may be required to elicit subsequent increases in overall QOL and concurrent improvements in falls efficacy.

Quantitative and Qualitative Comparison of a New Prosthetic Suspension System with Two Existing Suspension Systems for Lower Limb Amputees

The objectives of this study were to compare the effects of a newly designed magnetic suspension system with that of two existing suspension methods on pistoning inside the prosthetic socket and to compare satisfaction and perceived problems among transtibial amputees. In this prospective study, three lower limb prostheses with three different suspension systems were fabricated for ten transtibial amputees. The participants used each of the three prostheses for 1 mo in random order. Pistoning inside the prosthetic socket was measured by motion analysis system. The Prosthesis Evaluation Questionnaire was used to evaluate satisfaction and perceived problems with each suspension system. The lowest pistoning motion was found with the suction system compared with the other two suspension systems (P < 0.05). The new suspension system showed peak pistoning values similar to that of the pin lock system (P = 0.086). The results of the questionnaire survey revealed significantly higher satisfaction rates with the new system than with the other two systems in donning and doffing, walking, uneven walking, stair negotiation, and overall satisfaction (P < 0.05). The new suspension system has the potential to be used as an alternative to the available suspension systems. The pistoning motion was comparable to that of the other two systems. The new system showed compatible prosthetic suspension with the other two systems (suction and pin lock). The satisfaction with donning and doffing was high with the magnetic system. Moreover, the subjects reported fewer problems with the new system.

Patient evaluation of the Echelon foot using the Seattle Prosthesis Evaluation Questionnaire

The introduction of the Echelon prosthetic foot with a hydraulic self-aligning ankle adds improved adaptability to varied terrains and uneven walking surfaces. However, the specific indications for prescribing such components and the potential benefits are yet to be fully established. Nine amputees including three bilateral amputees evaluated their standard prostheses using the Seattle Prosthesis Evaluation Questionnaire. They were then provided with Echelon feet, and they evaluated them after 4 weeks of use. Improved satisfaction in all categories of use in relation to the Echelon foot with the greatest increase reported by bilateral amputees. The use of prosthetic feet with hydraulic self-aligning ankle improves prosthetic users' satisfaction in general with a particular benefit in bilateral amputees. Establish the clinical impact and user satisfaction after using Echelon feet in prosthetic users with different levels of amputations.

EDITORIAL

The author explores the idea of creating an Orthotic Evaluation Questionnaire (OEQ) modeled on the Prosthesis Evaluation Questionnaire (PEQ), developed by Prosthetics Research Study in the 1990s.

Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation

To assess the effects of two types of microprocessor-controlled prosthetic knee joints (MPKs) on perceived performance and everyday life activity level. Randomized cross-over trial. Thirty persons with a unilateral above-knee amputation or knee disarticulation classified as Medicare Functional Classification Level-2. Participants were measured in 3 conditions, i.e. using a mechanically controlled prosthesis, an MPK featuring a microprocessor-controlled stance and swing phase (MPKA), and an MPK featuring a microprocessor-controlled stance phase (MPKB). Subjects' perceived performance regarding prosthesis use was measured with the Prosthesis Evaluation Questionnaire. Subjects' activity level was quantified using accelerometry. As high within-group variability regarding subjects' functional performance was expected to impede detection of possible effects of an MPK, data were analysed for the total group and for 3 subgroups of participants. Participants' perception regarding ambulation, residual limb health, utility, and satisfaction with walking were significantly higher in the MPKA condition compared with the mechanical knee joint condition. Participants' activity level was similar in all knee joint conditions. Although Medicare Functional Classification Level-2 amputees report benefitting in terms of their performance from using an MPK, this is not reflected in their actual daily activity level after one week of using an MPK.

Transtibial prosthetic suspension: Less pistoning versus easy donning and doffing

Poor suspension increases slippage of the residual limb inside the socket during ambulation. The main purpose of this article is to evaluate the pistoning at the prosthetic liner-socket interface during gait and assess patients' satisfaction with two different liners. Two prostheses with seal-in and locking liners were fabricated for each of the 10 subjects with transtibial amputation. The Vicon motion system was used to measure the pistoning during gait. The subjects were also asked to complete a Prosthesis Evaluation Questionnaire. The results revealed higher pistoning inside the socket during gait with the locking liner than with the seal-in liner (p < 0.05). The overall satisfaction with the locking liner was higher (p < 0.05) because of the relative ease with which the patients could don and doff the device. As such, pistoning may not be the main factor that determines patients' overall satisfaction with the prosthesis and other factors may also contribute to comfort and satisfaction with prostheses. The article also verifies the feasibility of the Vicon motion system for measuring pistoning during gait.

Vacuum-Assisted Socket Suspension Compared With Pin Suspension for Lower Extremity Amputees: Effect on Fit, Activity, and Limb Volume

Klute GK, Berge JS, Biggs W, Pongnumkul S, Popovic Z, Curless B. Vacuum-assisted socket suspension compared with pin suspension for lower extremity amputees: effect on fit, activity, and limb volume. Objective To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees. Design Randomized crossover with 3-week acclimation. Setting Household, community, and laboratory environments. Participants Unilateral, transtibial amputees (N=20 enrolled, N=5 completed). Interventions (1) Total surface–bearing socket with a vacuum-assisted suspension system (VASS), and (2) modified patellar tendon–bearing socket with a pin lock suspension system. Main Outcome Measures Activity level, residual limb volume before and after a 30-minute treadmill walk, residual limb pistoning, and Prosthesis Evaluation Questionnaire. Results Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension ( P=.0056; 38,000±9,000 steps per 2wk vs 73,000±18,000 steps per 2wk, respectively). Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension ( P=.0021; 1±3mm vs 6±4mm, respectively). Treadmill walking had no effect on residual limb volume. In general, participants ranked their residual limb health higher, were less frustrated, and claimed it was easier to ambulate while wearing a pin suspension compared with the VASS. Conclusions The VASS resulted in a better fitting socket as measured by limb movement relative to the prosthetic socket (pistoning), although the clinical relevance of the small but statistically significant difference is difficult to discern. Treadmill walking had no effect, suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional, nonvacuum systems. Participants took approximately half as many steps while wearing the VASS which, when coupled with their subjective responses, suggests a preference for the pin suspension system.

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.