Prosthetic Evaluation Questionnaire Research Articles

Evaluating the Usability and Equivalence of Electronic Patient-Reported Outcome Measures for Individuals with a Lower-Limb Amputation.

ABSTRACT Introduction Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss. Methods In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively. Results Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures. Conclusions This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation. Clinical Relevance Except for the PEQ, electronic versions of the PROMs in this study can likely be used interchangeably with paper versions among individuals with lower-limb loss.

Longitudinale piloot studie van het effect van mechatronische knieën bij amputaties onderste lidmaat naar functie, activiteiten dagelijks leven en kwaliteit van leven

Longitudinal pilot study of the effect of mechatronic knees in lower limb amputations on function, activities of daily living and quality of life Introduction: Individuals with an above the knee amputation have difficulties with mobility, increased risk of falling, limitations in activities of daily living (ADL) and reduced quality of life. A prosthetic knee is an essential part of the equipment. There are mechanical and mechatronic (MPK) prosthetic knees. The effect of an MPK on function, ADL and quality of life is investigated. Methodology: This is a longitudinal follow-up design comparing results between an initial test with a non-MPK (T0), an MPK (T1) and after six months with MPK (T2). Inclusion criteria is recently obtaining reimbursement for an MCK. At all measurement time points, a walking test and timed up and go (TUG) test were performed and the PEQ-MS (prosthetic evaluation questionnaire, mobility scale) and ABC (activities-specific balance confidence) questionnaires were completed. These tests are administered at the 3 measurement time points (T0, T1 and T2). Data are modelled with a linear mixed model. Results: Eight subjects are included in the study. In the comparison between T1 and T2, we see the following. Walking distance and speed are better on T2 than T1. There is no significant difference between the two groups regarding the TUG and the ABC questionnaire. At T2, a lower score is seen on the PEQ-MS questionnaire. In the comparison between T0 and T2, we see the following. The TUG, walk test and ABC questionnaire are significantly better at T2. Regarding the PEQ-MS questionnaire, there is a tendency toward a better score at T2. The number of falls is significantly lower on T1 and T2 compared to T0. Discussion: Overall, the previously described positive effects and trends of mechatronic prosthetic knees are confirmed in this small study, both on function and activities of daily living. Both performance-based measurements and patient-reported outcome parameters were used. No strong and definitive statements can be made based on a small sample size such as this one. Nevertheless, there are interesting results that may be useful for further research.

Measuring residual limb health in persons with upper limb amputation: Modifications of the Prosthetic Evaluation Questionnaire residual limb health scale.

Assessing the user perspective on residual limb health problems is particularly important for amputation care, given the relationship between residual limb health and prosthetic satisfaction. Only 1 measure, the Residual Limb Health scale of the Prosthetic Evaluation Questionnaire (PEQ) has been validated for use in lower limb amputation, but not examined in persons with upper limb amputation (ULA). The objective of this study was to examine the psychometric properties of a modified PEQ Residual Limb Health scale in a sample of persons with ULA. The study involved a telephone survey of 392 prosthesis users with ULA, with a 40-person retest sample. The PEQ item response scale was modified to a Likert scale. The item set and instructions were refined in cognitive and pilot testing. Descriptive analyses characterized the prevalence of residual limb issues. Factor analyses and Rasch analyses evaluated unidimensionality, monotonicity, item fit, differential item functioning, and reliability. Test-retest reliability was assessed by an intraclass correlation coefficient. Sweating and prosthesis odor were prevalent at 90.7% and 72.5%, respectively; blisters/sores (12.1%) and ingrown hairs (7.7%) were the least prevalent problems. Response categories were dichotomized for 3 items and trichotomized for 3 items to improve monotonicity. After adjusting for residual correlations, confirmatory factor analyses showed acceptable fit (comparative fit index = 0.984, Tucker-Lewis index = 0.970, and root mean square error approximation = 0.032). Person reliability was 0.65. No items had moderate-to-severe differential item functioning by age or sex. Intraclass correlation coefficient for test-retest reliability was 0.87 (95% CI, 0.76-0.93). The modified scale had excellent structural validity, fair person reliability, very good test-retest reliability, and no floor or ceiling effects. The scale is recommended for use with persons with wrist disarticulation, transradial amputation, elbow disarticulation, and above-elbow amputation.

Impacts of Microprocessor-Controlled Versus Non-microprocessor-Controlled Prosthetic Knee Joints Among Transfemoral Amputees on Functional Outcomes: A Comparative Study.

Introduction: Selecting a prosthetic knee mechanism is an important part of transfemoral (TF) amputee rehabilitation. Prosthetic knee joint selection depends on the users' gait and their energy consumption. This study compares the feedback of transfemoral prosthesis users based on the prosthetic knee design self-reporting responses using the Prosthetic Evaluation Questionnaire (PEQ) outcome measure.Objective: This study aims to assess the impact of using a microprocessor-controlled prosthetic knee (MCPK) compared with a non-microprocessor-controlled prosthetic knee (NMCPK); feedback on the amputee usage can improve the clinical decision for proper prosthetic knee joint selection.Methods: This is a cross-sectional study with a total of 76 adult unilateral transfemoral amputees classified into two groups. The participants in the first group (38) used the MCPK (Genium, Otto Bock, Minneapolis, MN, USA), and the participants in the second group (38) used the NMCPK (hydraulic and total knee joints). Enrolment was based on a sequence of appointments where all participants answered the PEQ, with different subscale questions including utility (UT), sounds (SO), appearance (AP), residual limb health (RL), frustration (FR), perceived response (PR), social burden (SB), ambulation (AM), and quality of life (QoL). PEQ was filled out during the follow-up appointments at the prosthetic clinic through a visual analog scale (VAS). All data entered into a database were analyzed.Result: The MCPK participants have significantly improved utility, appearance, ambulation, and total PEQ score, the same results as the male participants. Middle-adulthood (25-40 years) MCPK participants have a significant p-value in the score of utility, frustration, ambulation, and total PEQ score compared to early-adulthood (18-24 years) and late-adulthood (41-60 years) participants. Also, there was a significant improvement in the p-value in ambulation scores in participants using MCPK with amputations caused by diseases compared to amputations caused by trauma and congenital cause.Conclusion: Transfemoral amputee prosthesis utility, natural gait, and ambulation improved when using MCPK compared to when using NMCPK during prosthetic rehabilitation.

Biomechanical accommodation to walking with an ankle-foot prosthesis: An exploratory analysis of novice users with transtibial limb loss within the first year of ambulation.

The way in which a person with limb loss interacts with a prosthesis changes over time; however, there remains a lack of guidance for defining accommodation to walking with a prosthesis, limiting consistency and generalizability of research. To evaluate accommodations to walking with dynamic elastic response prosthetic ankle-foot devices among novice users with unilateral transtibial limb loss during the first year of ambulation. This is a retrospective cohort study. Prosthetic and intact ankle-foot mechanical power profiles and mechanical work during step-to-step transitions were calculated using the Unified Deformable model for 22 male individuals with limb loss at five time points within the first year of independent ambulation (0, 2, 4, 6, and 12 months). Subjects walked at a self-selected walking velocity and controlled walking velocity (CWV). Subjective measures included the Prosthetic Evaluation Questionnaire and the 36-Item Short-Form Health Survey. Self-selected walking velocity ranged from 1.24 ± 0.06 m/s at 0 month to 1.38 ± 0.04 m/s at 12 months, whereas CWV was 1.20 ± 0.02 m/s. At both velocities, positive work/peak power during prosthetic push-off trended upward until the 4-month time point. In addition, negative peak power during intact foot-strike seemed to qualitatively become less negative until 4 months. Positive work during intact push-off trended downward until 4 months at CWV, whereas positive peak power during intact push-off qualitatively became more positive at self-selected walking velocity. These trends may partially indicate (biomechanical) accommodation to walking by appearance of a "plateau" at 4 months after initial ambulation with a prosthesis.

Quality of Life in Lower-Limb Amputees 10 Years After the 2008 Sichuan Earthquake: A Cross-Sectional Study.

The aim of this study was to investigate the long-term outcome of quality of life (QOL) in the lower-limb amputees 10 years after the 2008 Sichuan earthquake. In the cross-sectional study, 66 lower-limb amputees were recruited. The prosthetics-related QOL was assessed using the Prosthetic Evaluation Questionnaire (PEQ) in terms of the scales of utility, appearance, sounds, residual limb health, perceived response, frustration, social burden, ambulation, and well-being. The score of each PEQ subscale was calculated and compared among the cohorts with different demographic characteristics. The PEQ scores showed that the scales of sounds, residual limb health, and frustration were still low in the lower-limb amputees 10 years after the 2008 Sichuan earthquake. The comparison of PEQ scales among cohorts with different demographic characteristics indicated that the potential demographic risk factors, namely, age, marital status, educational level, living independence, and comorbidity, were associated with prosthesis-related QOL. The prosthesis-related QOL of the lower-limb amputees 10 years after the 2008 Sichuan earthquake has been partly documented in this study. The potential demographic risk factors associated with QOL of amputees were also identified. These findings could enhance the understanding of prosthesis-related QOL of lower-limb amputees sustained in an earthquake and facilitate the optimization of post-disaster rehabilitation strategies.

Chronic pain in lower limb amputees: Is there a correlation with the use of perioperative epidural or perineural analgesia?

Chronic pain is common in patients who undergo lower limb amputation. The use of epidural or perineural catheters seems to reduce acute pain after surgery but their effects in a longer follow up are unknown. To evaluate the long-term prevalence of phantom limb sensation (PLS), phantom limb pain (PLP), and residual limb pain (RLP) and their correlation with perioperative use of epidural or perineural catheters. Postal survey. Patients with trans-femoral, trans-tibial or hemi-pelvectomy amputation were asked to partake in the study. The Prosthetic Evaluation Questionnaire was used for the presence of chronic post-surgical pain. Use of catheters was retrieved from medical notes. 57 patients at a mean of 4.4 years follow up were included. PLS was reported in 68.4%, PLP in 63.2 % and RLP in 54.4% of amputees. No correlation was identified between pain syndromes and the presence of individual catheters and the duration of their permanence. The simultaneous use of 2 catheters was related to a lesser presence of PLP. Data on prevalence of PLP, PLS and RLP are consistent with the literature. Favourable effects in PLP reduction in the long term follow up was related to the simultaneous use of two catheters.

LEVEL OF MOBILITY AND ITS ASSOCIATION WITH QUALITY OF LIFE IN LOWER LIMB AMPUTEES

Objectives: The objective of the study was to explore the levels of mobility and its association with quality of life in lower limb amputees. Methodology: A cross-sectional correlational study was conducted at Chal foundation, Fauji Foundation Hospital and PIPOS on the sample of 230 patients for time duration of six months from January–July 2019. The lower limb amputees aged between 18-57 years, and using prosthesis from more than four months were included in the study. The level of mobility was measured through Self-reporting Prosthetic Limb User Survey of Mobility (SF-PLUS-M) questionnaire, while Prosthetic Evaluation Questionnaire (PEQ) was used to determine the Quality of Life (QOL) among prosthesis users. This data was analyzed by SPSS version 21. Results: The mean age of study participants was 43±14.89 years. The mean PLUS-M score was 39.48±14.33. The results showed a positive significant association between level of mobility and quality of life in lower limb amputees (p<0.001). Conclusion: The study concluded that in Pakistan lower limb amputees has high level of mobility that contributes in improved quality of life.

User Satisfaction with Conventional Lower-Limb Orthotic Devices: A Cross-Sectional Survey in Pakistan

Purpose: Persons with disabilities affecting lower-limb function use ankle-foot-orthoses (AFO) and knee-ankle-foot-orthoses (KAFO) on a regular basis. However, the effectiveness of these devices in daily use is seldom evaluated, especially in the developing world. This study aimed to evaluate user satisfaction with lower-limb orthotic devices while performing a broad spectrum of daily life activities in Pakistan, and to document the desired outcomes. Method: A survey was conducted among orthotic device users in the out-patient departments of three hospitals in Lahore, Pakistan. The survey questionnaire was devised by adapting the Prosthetic Evaluation Questionnaire to suit orthotics evaluation. Fifty-four AFO and KAFO users participated in the study. Results: Most users felt comfortable while walking on even surfaces with their orthoses. However, donning/doffing these, climbing stairs and performing certain routine activities were considered problematic for most people. Energy conservation was the most desired AFO feature, while the KAFO users wanted automatic knee-joint function. Conclusion and Implications: Overall satisfaction with the existing lower-limb orthoses is adequate. Yet, significant improvements are needed in terms of energy efficiency and comfort while walking on different terrains. Further research is required in order to improve the functioning of the existing orthotic devices.

SURİYELİ MÜLTECİ ALT EKSTREMİTE AMPUTELERİNDE PROTEZE BAĞLI YAŞAM KALİTESİNİN ARAŞTIRILMASI

Purpose: The use of prosthesis and an individual's perception of the prosthesis are associated with the quality of life. The study aimed to evaluate the quality of life related to prosthesis in Syrian refugees with lower extremity amputees. Methods: The study was conducted at three different prosthetic-orthotic centers managed by the Alliance of International Doctors. Seventy-six male (age=37.76±12.83 years) and 12 females (age=37.16±16.07 years) Syrian refugees with unilateral lower extremity (transtibial and transfemoral/knee disarticulation) amputation were evaluated. Demographic and amputation and prostheses-related characteristics were recorded. Quality of life related to the prosthesis was evaluated using the Prosthetic Evaluation Questionnaire (PEQ). Results: All PEQ scores of the transtibial and transfemoral/knee disarticulation amputees were similar (p>0.05). The PEQ-Appearance score of the single amputees was observed to be significantly lower than the married amputees (p=0.013). The PEQ-Ambulation score of participants using prosthesis over one year was significantly higher (p=0.038). The PEQ-Sound score of participants using prosthesis less than one year was found significantly higher (p=0.048). The PEQ-sound scores of chronic disease group were significantly higher than those of accident and war associated amputees (p=0.020). Conclusion: Quality of life of the refugee amputees regarding prosthesis and living with a prosthesis were similar regardless of the level of amputation. Expectations change with the increase in the duration of prosthesis use, and in single amputees, the expectation of cosmetic appearance becomes a concern.

Improved Self-Reported Comfort, Stability, and Limb Temperature Regulation With an Immediate Fit, Adjustable Transtibial Prosthesis

ObjectiveThe purpose of this investigation was to assess participants’ self-reported satisfaction with an adjustable, immediate fit transtibial prosthetic system as compared to their conventionally fabricated prosthetic device. DesignA prospective study involving a 2-week single-group pre-post intervention design. SettingPhysical medicine and rehabilitation clinic of a university hospital. ParticipantsAdults (N=27) with transtibial limb loss. InterventionParticipants were fit with the iFIT prosthetic system and instructed to wear it for a 2-week evaluation period. Main Outcome MeasureA modified Prosthetic Evaluation Questionnaire (PEQ) scale was completed on the participant’s conventional prosthetic during the initial visit and the iFIT system after 2 weeks. ResultsTwenty-seven persons with lower limb loss were enrolled. Three were lost to follow-up leaving 24 participants with completed data. Three participants had recent amputations with no conventional device for comparison. The modified PEQ scores were significantly higher for the iFIT prosthetic in comparison to their conventional device (29.18±4.63 vs 23.82±6.38, P<.01). Participants were also found to perceive significantly better temperature control with the iFIT prosthetic system (4.19±0.68 vs 2.97±1.02, P<.001). Participants did not report any skin breakdown, prosthetic issues, or falls. ConclusionThis immediate fit, adjustable transtibial prosthesis demonstrated significantly better patient satisfaction and temperature perception compared to conventional devices. These results are consistent with previous findings and further support the efficacy of an immediate fit adjustable transtibial prosthetic system. Longer-term studies in the United States and internationally are underway to assess the durability and efficacy of this new prosthesis in different populations and settings.

Ergonomic evaluation of low-cost prosthetic products: comparison between rigid and flexible ankle joint design

Disability due to an amputated leg affect people in Indonesia, including those with low to middle income categories. To facilitate them, Yayasan Difabel Mandiri manufactures a low-cost flexible ankle prosthetic to fix the shortcomings of the rigid ankle prosthetics available in the market. This experimental study aimed to evaluate the use of flexible ankle prosthetic for daily activities. Seven disabled people simulated a walking task with or without a backpack loaded with 10% of body mass using two prosthetic types (i.e., flexible and rigid ankle). Measures were obtained to evaluate the performance of the prosthetic including the center of pressure (COP) indicating static and dynamic stability and subjective ratings of prosthetic evaluation questionnaire (PEQ). Results showed a significant difference in dynamic stability between the rigid and flexible ankle prosthetic foot with a better performance indicated by the flexible ankle joint design. No differences were shown for the use of backpack. Flexible ankle further improves the quality of life of disabled people specified by 12.76% higher average rating of PEQ. In conclusion, flexible ankle joint potentially improves the design of the prosthetic foot to meet the need and comfort of disables.

Relevance of medical comorbidities for functional mobility in people with limb loss: retrospective explanatory models for a clinical walking measure and a patient-reported functional outcome

ObjectivesVarious modifiable and non-modifiable factors affect functional mobility, but subjective patient-reported and objective performance-based measures are rarely combined in explanatory analyses of functional mobility in people with limb loss. This study determined separate explanatory models for patient-reported function using the Prosthetic Evaluation Questionnaire Mobility Subscale (PEQ-MS), and performance-based 2-Minute Walk Test (2MWT). DesignRetrospective cross-sectional observational analysis. SettingWellness-walking program. ParticipantsThree hundred five volunteers with lower limb loss participated. Sixty nine percent were men, mean age 56 (15) years. Fifty two percent had vascular amputation causes, 42% had surgical levels above the knee, and 82% had medical comorbidities. Walking levels included limited-household (21%), limited-community (30%), and independent-community (49%). Outcome measures included patient-reported PEQ-MS, Activities-specific Balance Confidence (ABC) and Houghton scales; and performance-based balance and walking. Main outcomesSeparate PEQ-MS and 2MWT multiple regression models fit using backward deletion. ResultsModifiable (balance ability, ABC, Houghton score; P<0.05) and non-modifiable factors (sex, amputation cause, surgical level; P<0.05) explained the variance in 2MWT (adjusted R2=0.685). Patient-reported and performance-based modifiable factors (Houghton score, 2MWT; P<0.001) explained PEQ-MS variance (adjusted R2=0.660). Integumentary (P=0.022) and cardiopulmonary (P<0.001) comorbidities explained an additional 4% of PEQ-MS variance, while surgical level was insignificant. ConclusionsBoth modifiable and non-modifiable factors explained prosthetic functional mobility. Performance-based walking was explained by modifiable factors including balance ability and confidence, prosthesis and walking aid use. Patient-reported function was also explained by prosthesis and walking aid use, walking speed and medical comorbidities. Modifiable factors for objective and subjective prosthetic mobility may provide a clinical roadmap for rehabilitation.

Differences in Physical Performance Measures Among Patients With Unilateral Lower-Limb Amputations Classified as Functional Level K3 Versus K4

ObjectiveTo determine whether differences in physical function, assessed via self-report questionnaires and physical performance tests, exist between individuals with lower-limb loss using a prosthetic device classified as a K3 versus a K4 functional level. DesignCross-sectional study. SettingA university physical therapy amputee clinic. ParticipantsParticipants (N=55) were included if they (1) were aged ≥18 years with a unilateral transfemoral or transtibial amputation; (2) were classified as K3 or K4 functional level; (3) completed all relevant outcome measures; and (4) were currently using a prosthesis. InterventionsNot applicable. Main Outcome MeasuresLocomotor Capabilities Index (LCI), Prosthetic Evaluation Questionnaire–Mobility Section (PEQ-MS), Timed Up and Go (TUG), 10-Meter Walk Test (10MWT), Amputee Mobility Predictor (AMPPRO), and 6-Minute Walk Test (6MWT). K level was determined by group consensus based on a standardized clinical evaluation. ResultsAfter controlling for covariates, patients classified as K3 had slower TUG times (P=.002) and self-selected and fast gait speeds (P<.001), lower AMPPRO scores (P<.001), and walked shorter distances during the 6MWT (P=.003) when compared with patients classified as K4. No significant between-group differences for the LCI or PEQ-MS were found. ConclusionsClinicians involved in prosthetic prescription may consider including the TUG, 10MWT, AMPPRO, and 6MWT during their clinical evaluations to help differentiate between individuals of higher functional mobility. The LCI and PEQ-MS may be less useful in classifying individuals as K3 versus K4 because of a ceiling effect.

Limb Laterality Recognition Score: A Reliable Clinical Measure Related to Phantom Limb Pain.

To explore the usefulness of the limb laterality recognition score as a clinical measure of phantom limb pain, regarding test-retest reliability and association of limb laterality recognition scores with phantom limb pain measures. Retrospective cohort. Community support group. Eleven adults who averaged 4.8 years since lower limb amputation due to vascular pathologies (N = 9), trauma (N = 1), and cancer (N = 1). Subjects self-reported amputated limb pain using the sensation subsection of the Prosthetic Evaluation Questionnaire and back and sound limb pain. Using numbered iPads that corresponded to the self-reports, subjects played the Recognise Foot game to assess limb laterality recognition ability. Subjects identified the laterality of 20 foot images, within two seconds each. The software collected accuracy and speed scores in basic, vanilla, and context conditions for two rounds in random order. Basic showed feet against black backgrounds, vanilla showed feet with various monochromatic backgrounds, and context showed feet in clothed or environmental contexts. So that greater accuracy in less time meant a better score, accuracy scores were divided by completion speed. Intraclass correlation coefficient (ICC)3,1 assessed test-retest reliability. Correlations between accuracy/speed and phantom limb pain measures were assessed with Spearman's rho (categorical) and Pearson coefficients (continuous). Accuracy/speed test-retest reliability was strong (ICC = 0.72) and inversely associated with phantom limb pain frequency (context rho = 0.72). Limb laterality recognition accuracy/speed in the context condition had good test-retest reliability and correlated strongly with phantom limb pain frequency. Accuracy/speed limb laterality recognition ability relates to phantom limb pain and may be a valid clinical or research measure.

Effects of Vacuum-Assisted Socket Suspension on Energetic Costs of Walking, Functional Mobility, and Prosthesis-Related Quality of Life

ABSTRACT Introduction Proper suspension is critical to maintaining socket comfort and fit. Vacuum-assisted socket suspension (VASS) improves fit and comfort by reducing peak socket pressure and pistoning of the residual limb. The purpose of this study was to quantify the effects of VASS on metabolic costs of gait and performance-based outcomes by evaluating changes in these measures immediately after altering suspension and to compare self-reported outcome measures between groups of VASS and non-VASS users. Materials and Methods Eighteen current VASS users and 18 non-VASS users, all of whom were active community ambulators, participated in two related studies. For study 1, VASS users completed three tasks in the following order: 1) a quantitative gait analysis, 2) function and mobility tests (10-m walk test [10MWT] and timed up and go [TUG]); and 3) 6 minutes of walking at self-selected speed (SSS) to determine energetic costs of walking and socket comfort. Participants performed each task under three suspension conditions, in random order, before proceeding to the next task. The conditions were altering VASS by inactivating the vacuum and blocking the one-way valve. Participants completed tasks immediately after alterations in suspension; that is, we provided no specific accommodation period. All tasks in study 1 were completed during a single testing session. For study 2, both VASS and non-VASS subjects completed electronic versions of surveys to assess prosthetic use and locomotor function including sections of the Prosthetic Evaluation Questionnaire. Results Study 1: There was no effect of suspension on cost of transport (p = 0.47 for main effect of suspension). However, participants performed TUG in shorter time using VASS and suction (p = 0.02 VASS vs. sleeve; p = 0.049 suction vs. sleeve; p = 0.54 VASS vs. suction) and performed the 10MWT with greater speed while using VASS compared with both suction (p = 0.027) and sleeve (p = 0.011). The use of VASS resulted in a significant within-subject increase of 1.5 and 3 points in socket comfort compared to suction (p = 0.001) and sleeve (p = 0.001), respectively. Study 2: There were no significant differences in any self-reported outcomes measures between VASS and non-VASS users. Conclusions In absence of active vacuum, current users of VASS experience an immediate reduction in comfort, presumably reflecting worse fit, which may limit their ability to attain faster walking speeds but which does not have an immediate negative affect on the cost of transport. The self-reported measures used to quantify the effects of suspension on prosthetic use, locomotor capabilities, and domains reflecting prosthesis-related quality of life may have been ill-suited for identifying difference in the high-functioning heterogeneous population considered.

Long-term clinical evaluation of the automatic stance-phase lock-controlled prosthetic knee joint in young adults with unilateral above-knee amputation

Purpose: The purpose of this study was to clinically evaluate the automatic stance-phase lock (ASPL) knee mechanism against participants’ existing weight-activated braking (WAB) prosthetic knee joint.Method: This prospective crossover study involved 10 young adults with an above-knee amputation. Primary measurements consisted of tests of walking speeds and capacity. Heart rate was measured during the six-minute walk test and the Physiological Cost Index (PCI) which was calculated from heart rate estimated energy expenditure. Activity was measured with a pedometer. User function and quality of life were assessed using the Lower Limb Function Questionnaire (LLFQ) and Prosthetic Evaluation Questionnaire (PEQ). Long-term follow-up over 12 months were completed.Results: Walking speeds were the same for WAB and APSL knees. Energy expenditure (PCI) was lower for the ASPL knees (p = 0.007). Step counts were the same for both knees, and questionnaires indicated ASPL knee preference attributed primarily to knee stability and improved walking, while limitations included terminal impact noise. Nine of 10 participants chose to keep using the ASPL knee as part of the long-term follow-up.Conclusions: Potential benefits of the ASPL knee were identified in this study by functional measures, questionnaires and user feedback, but not changes in activity or the PEQ.Keywords: Amputee; artificial knee joint; energy expenditure; prosthesis; stance-phase control; transfemoral amputation, stance-phase control

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.

Transfemoral interfaces with vacuum assisted suspension comparison of gait, balance, and subjective analysis: Ischial containment versus brimless

ObjectiveInvestigate the effect of a brimless interface design compared with ischial ramus containment (IRC) of interfaces when using vacuum-assisted suspension (VAS) on transfemoral amputees (TFAs). DesignRandomized experimental crossover. SettingHousehold, community, and clinic. ParticipantsUnilateral TFAs (N=12 enrolled, N=10 analyzed). Mean age: 42.9 years. Mean residual limb length: 60.3% of the sound side femur length. Participants’ mean time as an amputee: 8.3 years and median AMP score: 43. Interventions(1) IRC VAS interface, and (2) brimless VAS interface. Average medial wall height for IRC interfaces was 0.7cm proximal to the distal-most aspect of the ischial tuberosity (IT). The medial wall on the brimless design was an average of 3.3cm distal to the distal-most aspect of the IT. Main outcome measuresSpatiotemporal gait parameters, limits of stability, four square step test, and subjective perception using the prosthetic evaluation questionnaire (PEQ). ResultsStep length was significantly improved towards the IRC (p=0.04), when calculating degree of asymmetry. Base of support was significantly narrowed toward the brimless (p=0.03). All subjective measures reached statistical significance in favor of improvement with the brimless design, compared to the IRC. ConclusionsThe brimless design was equivalent to IRC in most gait and balance outcome measures. However, step length was more symmetrical toward the IRC while base of support was narrowed toward the brimless demonstrating mixed inconsistent performance changes. Further, the PEQ demonstrated significant subjective improvements in prosthetic related function and quality of life when participants used the brimless design. Brimless interface design may be a clinically viable choice.

Investigation of the Quality of Life of Persons with a Transfemoral Amputation Who Use a C-Leg® Prosthetic Device

Recently, microprocessor-controlled knees, such as the C-Leg® (Ottobock, Duderstadt, Germany, and Minneapolis, MN, USA), have improved ambulatory function in persons with transfemoral amputation. The purposes of this study were to assess the quality of life (QoL) of users of the C-Leg and to determine the factors that contributed to it. Packets including the SF-36 QoL assessment, the Prosthetic Evaluation Questionnaire (PEQ), and a demographic questionnaire were mailed to 100 individuals who were using the C-Leg; 33 surveys with complete and useable data were returned. On the SF-36v2, 61% of the respondents were below the general population norm in the physical component summary (PCS), whereas 88% were at or above the general population norm for the mental component summary (MCS). The average rating on the PEQ Well-Being (WB) scale was 76.1%. No significant differences were identified when looking at either the PEQ WB score or the PCS on the SF-36v2 when age and sex were the grouping variables. Men scored higher on the MCS of the SF-36v2. Those living in rural areas had significantly higher scores (p = 0.38) than did those living in urban areas on the PEQ WB scale, but there was no significant difference on either of the SF-36v2 component summaries. Low frustration with the prosthesis and high ambulation scores on the PEQ predicted 62.5% of the WB scores. This study suggests that clinical interventions should be aimed at obtaining a high level of ambulatory mobility for optimal QoL outcomes for the person with lower limb amputations using the C-Leg.