Prosthetic Limb Users Research Articles

An alternate sleeve design in transtibial prosthetics

The term prosthesis is usually used in analogy with Biomechanics. The motion of the body is provided by the bones, joints that form the basic linkage mechanism along with the activity of the muscle. The prime motive of biomechanics is to study about these linkages, their ranges of motion and their degree of freedom. In medicine, a body part which is missing, is been replaced by an artificial device or an extension, namely prosthesis. It is a part of Biomechanics, which deals with the usage of mechanical devices to assist human muscle, skeleton and nervous system in enhancing motor control lost due to trauma, defect or a disease. This paper aims to provide an improved system for lower limb prosthetic users through a better sleeve design. Braided designs with variations are created and analysed. The results suggest that the braided pattern shall be implemented in sleeve design with slight modifications.

A Wearable Vibrotactile Biofeedback System Targeting Gait Symmetry of Lower-limb Prosthetic Users.

Lower limb prosthetic users exhibit gait deviations, which include asymmetrical stance time (ST), leading to secondary musculoskeletal problems. Biofeedback (BFB) systems have the potential to provide gait training to correct gait deviations. In this work, we describe a wearable BFB system that delivers vibrotactile feedback via two tactors (located at the anterior and posterior side of the residual limb of prosthetic users) to correct asymmetrical ST (%) using two strategies - single threshold feedback (SF) and bandwidth threshold feedback (BF). Validation of the system involved a sample of five lower limb amputees to examine the effectiveness of each strategy when compared to no feedback (NF) gait trials. Significant differences were found between no feedback and feedback trials. Although no significant differences were found between SF and BF, there are small but evident trends indicating that BF encourages ST (%) that is closest to the target with less error.

Is an artificial limb embodied as a hand? Brain decoding in prosthetic limb users.

The potential ability of the human brain to represent an artificial limb as a body part (embodiment) has been inspiring engineers, clinicians, and scientists as a means to optimise human-machine interfaces. Using functional MRI (fMRI), we studied whether neural embodiment actually occurs in prosthesis users' occipitotemporal cortex (OTC). Compared with controls, different prostheses types were visually represented more similarly to each other, relative to hands and tools, indicating the emergence of a dissociated prosthesis categorisation. Greater daily life prosthesis usage correlated positively with greater prosthesis categorisation. Moreover, when comparing prosthesis users' representation of their own prosthesis to controls' representation of a similar looking prosthesis, prosthesis users represented their own prosthesis more dissimilarly to hands, challenging current views of visual prosthesis embodiment. Our results reveal a use-dependent neural correlate for wearable technology adoption, demonstrating adaptive use-related plasticity within the OTC. Because these neural correlates were independent of the prostheses' appearance and control, our findings offer new opportunities for prosthesis design by lifting restrictions imposed by the embodiment theory for artificial limbs.

Retrospective analysis of Quality of Life for patients received Prosthetic limbs to overcome their Physical Disability

Background: Quality of life (QoL) is affected by physical and psychosocial parameters after amputation. Aims of Person with amputations are to reintegrate in community and improved mobility, optimum quality of life should be among the top priorities of prosthetic and rehabilitation center. The purpose of the study was to retrospectively assess the QoL of the patient receiving artificial limbs to overcome their physical disability. Methodology: A retrospective cross-sectional study was conducted among 120 lower limb prosthetic users; the study duration was four months. Data were collected using the World Health Organization Quality of Life Instruments (WHOQoL-BREF) questionnaire. SPSS Version 16.0 was used for statistical analysis, Mann-Whitney U test and Kruskal-Wallis test were used to compare domain QoL score. Results: Out of 120 respondents, 66(55%) were early prosthetic users and 54(45%) were late prosthetic users. 61(50.8%) lower limb amputees were availing rehabilitative services and 44(36.7%) were employed. Male participant's mean scores were significantly higher in all domains of QoL as compared to females. There was a significant mean difference among male and female patients concerning physical health (p=0.003), psychological health (p=0.027), social relationship (p=0.005) and environment (p=0.000). There were significant differences in the overall QoL domain and the above-mentioned aspects (p<0.05) among the enrolled patients with different working statuses. There was a significant difference in the environment and overall QoL scored in different age group participants. Conclusion: The findings of the study showed that gender, working status and age have significant influences on the QoL of the patients who received Prosthetic limbs to overcome their Physical Disability.

Comparative Effectiveness of Microprocessor-Controlled and Carbon-Fiber Energy-Storing-and-Returning Prosthetic Feet in Persons with Unilateral Transtibial Amputation: Patient-Reported Outcome Measures

ABSTRACT Introduction Microprocessor ankles (MPAs) have recently been developed for persons with lower-limb amputation to overcome known limitations of fixed-ankle energy-storing-and-returning (ESAR) feet. This study aimed to examine differences in patient-reported balance, mobility, socket comfort, and preference between an ESAR foot and an MPA in persons with unilateral transtibial amputation (UTA). Materials and Methods Twenty-three participants with UTA enrolled in an institutional review board–approved, randomized crossover protocol with ESAR (Pacifica LP) and microprocessor-ankle configurations (Kinnex, Freedom Innovations) and a 4-week accommodation period. The outcome measures collected included Activities Specific Balance Confidence Scale (ABC), Prosthesis Evaluation Questionnaire–Mobility Subscale (PEQ-MS), and Prosthetic Limb User Survey of Mobility (PLUS-M). Participants were asked to rate Socket Comfort Score (SCS) while ascending and descending a 15° sloped ramp. Finally, ankle-foot preference and aspects liked and disliked about each configuration were recorded. Results Significant improvements were seen with the MPA in patient-reported mobility in the community (PEQ-MS, ρ = 0.0465) and socket comfort walking and standing on slopes (SCS, ρ < 0.001). Differences in balance confidence (ABC) did not reach a level of significance, whereas improvement in perceived mobility with a prosthesis approached a level of significance (PLUS-M, ρ = 0.102). When asked, 81% of participants preferred the MPA over the ESAR foot. Participants reported positively about the reduced weight of the ESAR foot, whereas they frequently reported that the MPA was better on slopes and uneven terrain. Conclusions The 30° range of motion in the MPA can allow greater mobility when ambulating on typical environmental barriers (e.g., uneven terrain, ramps, and stairs) and allow patients to stand and walk on slopes with less socket discomfort. Most participants preferred the MPA. Frequently reported positive and negative aspects of both systems may be useful for patient consultation regarding ankle-foot technology. This study represents the largest known investigation of MPAs, and the results provide evidence of benefits from MPAs over ESAR feet in persons with UTA.

Efficacy of a topical formulation of henna (Lawsonia inermis L.) in contact dermatitis in patients using prosthesis: A double-blind randomized placebo-controlled clinical trial

BackgroundContact dermatitis is a common complication in prosthetic limb users. There are no effective, available and cheap treatments for skin problems of these patients. In traditional Iranian medicine, henna (Lawsonia inermis L.) is a plant that has anti-inflammatory, antimicrobial and skin-enhancing properties, all of which are beneficial for people with artificial limbs. The aim of this study was to assess the efficacy of a topical henna preparation in management of contact dermatitis in patients using lower limb prosthetics. MethodsThe current randomized, double-blind, placebo-controlled clinical trial was conducted on ninety-five participants with lower extremity amputation using limb prosthetics, aged 12–70 years who complained of contact dermatitis. They were randomly assigned to receive either two weeks of topical henna preparation every night as the intervention group, or topical placebo as the control group. Participants were instructed to spread henna preparation on the surfaces of the amputated limb that were in contact with the prosthesis. Severity of contact dermatitis symptoms was set as the primary outcome measure. Edema, papules and erythema were evaluated by a physician using standard color atlas. Secondary outcomes included symptoms such as burning, itching, pain, thickness and skin sweating evaluated by a self-administered questionnaire. ResultsA significant improvement was observed in the symptoms of contact dermatitis including skin edema, itching, sweating, skin thinning and pain (p-value<0.05) in the henna group compared to the placebo group. Skin burning decreased more in the henna group compared to the placebo group, but this was not statistically significant (p-value = 0.052). Moreover, skin redness significantly increased in the henna group (p-value = 0.001). ConclusionTopical formulation of henna might be a complementary choice for improving contact dermatitis in patients using lower limb prosthetics.

Methodological tools used for tripping gait analysis of elderly and prosthetic limb users: a systematic review.

Tripping during walking is known to be the predominant cause of falls in elderly and prosthetic limb users. To standardise measurements and analysis of trips, it is critical to summarise the methods used in laboratory-controlled trials. The aim of this study was to reach a clearer standardisation measurement and analysis of trips during elderly and prosthetic gait through a systematic review. Studies that assessed elderly and prosthetic tripping gait characteristics were included in this review. The search resulted in an initial yield of 2493 unique articles after duplicates were removed (PubMed, Scopus and Science Direct). Title analysis resulted in 1697 articles excluded and 659 articles were assessed for further eligibility on the basis of the abstract. 174 articles were excluded based on a full-text appraisal. The final yield was 21 unique articles that met all the inclusion criteria. The findings revealed a number of inconsistencies among the studies, namely ambiguity in relation to gait speed, differences in overground and treadmill locomotion. Subsequently, different experimental setups such as trip inducement strategies may influence the collected data, and thus have implications for study outcomes. A gold standard should be set to have better standardised results, thus creating a more robust and holistic approach towards the rehabilitation of prosthetic gait and in the elderly.

The Influence of Socio-economic Deprivation on Mobility, Participation, and Quality of Life Following Major Lower Extremity Amputation in the West of Scotland

Lower extremity amputation (LEA) is more common in people from lower socio-economic groups. This study examined this further by investigating the influence of socio-economic status on mobility, participation, and quality of life (QoL) after LEA. Prospective data were gathered for all LEAs performed in one year in one Scottish Health Board, commencing March 2014. A postcode derived Scottish Index of Multiple Deprivation (SIMD) was applied by quintile (SIMD 1=most deprived). Routine data were collected on the cohort of 171 patients; 101 participants consented and received postal questionnaires on QoL (EQ-5D-5L), participation (Reintegration to Normal Living Index [RNLI]), and mobility (Prosthetic Limb User Survey of Mobility), six (n=67) and 12 months (n=50) after LEA. The mean±SD age of the cohort was 66.2±11.4 years; 75% were male and 53% had diabetes. In total, 67% lived in SIMD 1 and 2 and 11.1% in SIMD 5. Sixty per cent had a transtibial amputation. Mortality was 6% at 30 days 17% at six, and 29% at 12 months. Those in SIMD 1 were significantly younger (62.9 years) than those in SIMD 5 (76.3 years). Significantly more participants with a transfemoral amputation (TFA) lived in SIMD 1 (44%) compared with SIMD 5 (11%) (p=.004). Participation was low (RNLI scores: 6 months=55.7; 12 months=56.6) and PLUS M scores suggested mobility was poor overall at six (39.1) and 12 months (38.9). Mean QoL was 0.37at 6 months and 0.33at 12 months. Although this study observed more LEAs in those from low socio-economic areas, it is impossible to conclude whether QoL after LEA is truly influenced by socio-economic status. There was an association between the disproportionately high rate of LEAs in SIMD groups 1 and 2 and the high prevalence of smoking, 61% vs. only 21% of those in the least deprived areas (SIMD 3, 4, and 5) being current smokers.

Mobility analysis of AmpuTees (MAAT 5): Impact of five common prosthetic ankle-foot categories for individuals with diabetic/dysvascular amputation.

IntroductionDiabetes and vascular disease represent the most common etiologies for lower limb amputations. In lower limb loss rehabilitation, the prosthetic ankle-foot mechanism is the most common major component needed to restore function. The purpose of this study was to examine the impact of five common prosthetic ankle-foot mechanisms on functional mobility in a large sample of individuals with amputation due to diabetes/dysvascular disease.MethodsA retrospective analysis of the Prosthetic Limb Users' Survey of Mobility (PLUS-M®) captured in the patient care setting. A total of 738 individuals were included and subsequently subdivided into five groups based on the ankle-foot mechanism of their current prosthesis. Groups were compared using a general linear univariate model with age, body mass index, comorbid health status, time since amputation, and amputation level entered as covariates.ResultsThe microprocessor ankle-foot group had the highest mobility (F4,728 = 3.845, p=0.004), which was followed by the vertical loading pylon type ankle-foot, the hydraulic ankle-foot, the flex-walk-type ankle-foot, and lastly the flex-foot-type ankle-foot.ConclusionThese results demonstrate that the selection of different prosthetic ankle-foot technology directly impacts functional mobility for the patient with an amputation due to diabetes and/or vascular disease.

JAPANESE TRANSLATION OF THE PROSTHETIC LIMB USERS SURVEY OF MOBILITY

INTRODUCTION&#x0D; Patient-reported outcome measures (PROMs) are used by prosthetists to assess and communicate effectiveness of prosthetic interventions. The Prosthetic Limb Users Survey of Mobility (PLUS-M) is a PROM developed to evaluate lower limb prosthetic mobility.1 Valid and reliable translations of prosthetics-specific PROMs, like PLUS-M, do not exist for Japanese-speaking patients. The purpose of this research was to translate PLUS-M to Japanese using rigorous translation guidelines in order to maintain the meaning and applicability of items across both languages.&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32017/24436&#x0D; How to cite: Balkman G, Samejima S, Aoki D, Hafner B.J. JAPANESE TRANSLATION OF THE PROSTHETIC LIMB USERS SURVEY OF MOBILITY. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, POSTER PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32017 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/

PROSTHETIC LIMB USER EXPERIENCES WITH CROSSOVER FEET: A FOCUS GROUP STUDY TO EXPLORE OUTCOMES THAT MATTER

INTRODUCTION&#x0D; A variety of prosthetic feet are available to meet the diverse needs of people with lower limb amputation. Outcome measures selected to assess comparative effectiveness of prosthetic feet are most often chosen by clinicians and researchers.1 Therefore, these measures may not reflect the outcomes that are most important to lower limb prosthesis users. Qualitative research can give voice to prosthesis users and promote the consideration of user priorities when selecting outcome measures for clinical assessment and research studies. This study explored the lived experience and outcomes of importance to individuals who have worn both traditional energy storing feet and crossover feet.&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32042/24456&#x0D; How to cite: McDonald C.L, Cheever S.M , Morgan S.J., Hafner B.J. PROSTHETIC LIMB USER EXPERIENCES WITH CROSSOVER FEET: A FOCUS GROUP STUDY TO EXPLORE OUTCOMES THAT MATTER. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32042 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa.

Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. A generic qualitative approach and an explorative design were utilised in this study. A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.

Iodine–Starch test for assessment of hyperhidrosis in amputees, evaluation of different methods of application*

Purpose: Hyperhidrosis is a common problem for amputees. The iodine–starch test is frequently used to assess hyperhidrosis, but a method for its application has not been described for amputees.Methods: We performed an unblinded comparison of the iodine–starch test using various methods to protect the prosthesis in 10 prosthetic limb users with hyperhidrosis.Results: Plastic wrap produced a diffuse pattern of sweating in 70% of subjects. Forty percent had complaints about this method, and 50% experienced leakage of iodine stain onto prosthetic liners. The prosthetic sheath produced a focal or multifocal reaction in 100% of subjects after 10 min of ambulation. Eighty percent had minor leakage onto the liner, and complaints were noted in 10%. The proportion that experienced diffuse sweating was significantly higher in the plastic wrap condition (p = 0.016; difference in proportions = 70%; 95% confidence interval = 32–100%). The prosthetic sock was tested in four subjects and all had at least mild complaints; three had minor leakage onto the liner. Repeated complaints and lack of stain prevention led to discontinuation with this method.Conclusions: Of the three methods, the sheath produces a focal or multifocal reaction after 10 min of ambulation and tends to cause less subject complaints. It should be the preferred method to apply the iodine–starch test to amputees.Implications for rehabilitationHyperhidrosis is a common problem in amputees which negatively affects quality of life.The iodine–starch test is commonly used to guide treatment decisions for hyperhidrosis, but a preferred method for applying it in amputees has not been described.This study describes different methods for applying the iodine–starch test.A prosthetic sheath covering should be the preferred method for the iodine–starch test in amputees.

Validation of the virtual elevation field test method when assessing the aerodynamics of para-cyclists with a uni-lateral trans-tibial amputation

Lower-limb amputees typically require some form of prosthetic limb to ride a bicycle for recreation or when competing. At elite-level racing speeds, aerodynamic drag can represent the majority of the resistance acting against a cyclists’ forward motion. As a result, the reduction of such resistance is beneficial to an amputee whereby the form and function of the prosthetic limb can be optimized through engineering. To measure the performance of such limbs, field testing provides a cost-effective and context-specific method of aerodynamic drag measurement. However, few methods have been formally validated and none have been applied to amputees with lower-limb amputations. In this paper, an elite level para-cyclist wore two different prosthetic limb designs and had their total aerodynamic drag of a wind tunnel reference method statistically correlated against a velodrome-based virtual elevation field test method. The calculated coefficient of variation was in the range of 0.7–0.9% for the wind tunnel method and 2–3% for the virtual elevation method. A 0.03 m2 difference was identified in the absolute values recorded between the two methods. Ultimately, both methods exhibited high levels of precision, yet relative results to each other. The virtual elevation method is proposed as a suitable technique to assess the aerodynamic drag of amputee para-cyclists.Implications for rehabilitationThis assessment method will provide practitioners a reliable means of assessing the impact of changes made to prosthetics design for cyclists with limb absence.The proposed method offers a low cost and geographically accessible solution compared to others proposed in the past.This assessment method has significant potential for impact among prosthetic limb users looking to improve their cycling performance whereas previous attention in this field has been extremely limited.

Examining the needs of affordable upper limb prosthetic users in India: A questionnaire-based survey

Examining the needs of affordable upper limb prosthetic users in India: A questionnaire-based survey

Cross-Sectional Assessment of Factors Related to Pain Intensity and Pain Interference in Lower Limb Prosthesis Users

ObjectiveTo determine relationships between pain sites and pain intensity/interference in people with lower limb amputations (LLAs). DesignCross-sectional survey. SettingCommunity. ParticipantsLower limb prosthesis users with unilateral or bilateral amputations (N=1296; mean time since amputation, 14.1y). InterventionsNot applicable. Main Outcome MeasuresPatient-Reported Outcomes Measurement Information System (PROMIS) pain intensity (1 item to assess average pain), PROMIS pain interference (4-item short form to assess the consequences of pain in desired activities), and questions that asked participants to rate the extent to which each of the following were a problem: residual limb pain (RLP), phantom limb pain (PLP), knee pain on the nonamputated side, back pain, and shoulder pain. ResultsNearly three quarters (72.1%) of participants reported problematic pain in 1 or more of the listed sites. Problematic PLP, back pain, and RLP were reported by 48.1%, 39.2%, and 35.1% of participants, respectively. Knee pain and shoulder pain were less commonly identified as problems (27.9% and 21.7%, respectively). Participants also reported significantly (P<.0001) higher pain interference (T-score ± SD, 54.7±9.0) than the normative sample based on the U.S. population (T-score ± SD, 50.0±10.0). Participants with LLAs rated their pain intensity on average ± SD at 3.3±2.4 on a 0-to-10 scale. Pain interference (ρ=.564, P<.0001) and intensity (ρ=.603, P<.0001) were positively and significantly correlated with number of pain sites reported. ConclusionsProblematic pain symptoms, especially RLP, PLP, and back pain, affect most prosthetic limb users and have the potential to greatly restrict participation in life activities.

The Timed Up and Go and Two-Minute Walk Test: Exploration of a method for establishing normative values for established lower limb prosthetic users

The Timed Up and Go (TUG) and Two-Minute Walk Test (2MWT) are clinically appropriate mobility measures in amputee rehabilitation. Despite the tests being routinely performed, reference values for amputees have yet to be established. This study aimed to establish and trial a method for estimating normative values of the TUG and 2MWT for transtibial and transfemoral amputees. Thirty-seven established prosthetic users aged 40–69 years (28 unilateral transtibial amputees and nine unilateral transfemoral) performed two recorded trials of the TUG and 2MWT. Participant characteristics were collected using the Trinity Amputation and Prosthesis Experience Scale. Preliminary normative data for the TUG and 2MWT were produced for three age cohorts and the two amputee subpopulations. Poorer mobility performance with transfemoral amputation was evident for both mobility measures. Multivariate analysis displayed relationships between age, length of time with a prosthesis and performance of both tests. In conclusion, normative values for the TUG and 2MWT for transtibial and transfemoral amputees may be calculated. Preliminary results indicate that higher levels of amputation relate to poorer performance on both the TUG and 2MWT. Studies with larger samples are required to further develop these values for use in rehabilitation.

Monitoring activity of inpatient lower limb prosthetic users in rehabilitation using accelerometry: Validation study.

PurposeDue to limited accuracy of self-reported activities of lower limb prosthetic users, there is increasing interest in providing accurate walking time for those who are mobilising using their prosthesis in the rehabilitation ward. The aim of this study was to test the accuracy of a tri axial accelerometer (ActivPAL) in measuring walking activity of amputee patients while using their prosthetic limb.MethodFor the study, 21 subjects wore accelerometer devices taped to the thigh on both the amputated and non-amputated side. Each subject was asked to perform a set of activity routines: walking with prosthesis for 5 minutes, self-propelling in a wheel chair for 3 minutes and being pushed in a wheel chair for 3 minutes. Each activity was observed and timed by a physiotherapist and the observed times were compared with the output from accelerometer monitoring.ResultsUsing the Bland–Altman method, the mean difference between observed and ActivPal monitor for total time spent walking for the non-amputated side was 0.004 seconds (limits of agreement −0.09 to 0.10 seconds) and for amputated side was 0.11 seconds (limits of agreement −0.43 to 0.66 seconds). An analysis between monitored and observed time found the sensitivity for the non-amputated side was 90.5% and 86% for the amputated side.ConclusionThe use of ActivPAL accelerometers in measuring walking time for an individual using a prosthesis is within acceptable levels of accuracy for continuous ambulation monitoring. It has potentially important clinical application for prescribing prostheses.

Characterizing mobility from the prosthetic limb user's perspective: Use of focus groups to guide development of the Prosthetic Limb Users Survey of Mobility.

Input from target respondents in the development of patient-reported outcome measures is necessary to ensure that the instrument is meaningful. To solicit perspectives of prosthetic limb users about their mobility experiences and to inform development of the Prosthetic Limb Users Survey of Mobility. Qualitative study. Four focus groups of lower limb prosthesis users were held in different regions of the United States. Focus group transcripts were coded, and themes were identified. Feedback from participants was used to develop a framework for measuring mobility with a lower limb prosthesis. Focus group participants (N = 37) described mobility as a confluence of factors that included characteristics of the individual, activity, and environment. Identified themes were defined as individual characteristics, forms of movement, and environmental situations. Prosthetic mobility was conceptualized as movement activities performed in an environmental or situational context. Respondent feedback used to guide development of Prosthetic Limb Users Survey of Mobility established a foundation for a new person-centered measure of mobility with a prosthetic limb. Perspectives of target respondents are needed to guide development of instruments intended to measure health outcomes. Focus groups of prosthetic limb users were conducted to solicit experiences related to mobility with a lower limb prosthesis. Results were used to inform development of a clinically meaningful, person-centered instrument.

Exercise programs to improve gait performance in people with lower limb amputation: A systematic review.

Few studies have explored the effects of exercise on gait performance in people with lower limb amputations. To (1) summarize the effects of exercise programs on gait performance and (2) assess the overall quality of the evidence for adults ambulating with leg prostheses. Systematic review. Six databases were searched for one- and two-group studies published through June 2013 reporting effects of exercise on gait speed, a universal measure of performance in lower limb prosthetic users. The search adhered to a predetermined protocol following Cochrane Collaboration guidelines. In all, 623 citations were reviewed and eight studies included. The quality level of the combined evidence was low with few randomized control trials and multiple sources of bias evident within the heterogeneous group of studies. The 11 exercise programs, including three control conditions, demonstrated small to large effect size improvements in self-selected gait speed. Use of exercise to improve gait speed was supported by low-quality level evidence, with low-moderate quality evidence to suggest that specific functional exercise programs were more effective than supervised walking. Using exercise to improve gait speed in people with lower limb amputation received a B grade recommendation. Future high-quality research is required. Supervised walking, muscle strengthening, balance exercises, gait training, and functional training programs demonstrated small to large effect size gait performance improvements in people with lower limb amputation. Self-selected gait speed was the most consistent outcome measure. Exercise programs emphasizing resisted gait and functional training were more effective than supervised walking.