Prosthetic Mobility Research Articles

Self-reported prosthetic mobility of lower limb prosthetic users in Norway

Self-reported prosthetic mobility of lower limb prosthetic users in Norway

Patient Outcomes in a Novel Osseointegrated Device for Transfemoral Amputation: a case series

Background Socket suspension (SS) prosthetics are the current standard for transfemoral amputee prosthetic management. The SS systems have been shown to be inefficient in energy transfer, leading to gait alteration, wear discomfort, and skin complications. Many studies have shown osseointegrated (OI) devices are not associated with these problems and offer many benefits. Purpose Through this report the authors will describe surgical outcomes following transfemoral amputation (TFA) surgery using a novel OI device. Methods Patients with problematic TFA were identified from 2013 to 2018 were treated with a novel OI system. Candidate TFA patients identified through record review as part of an IRB authorized retrospective study. The study group all had the following characteristics: (1)No diabetes, (2)no peripheral vascular disease, and (3)mature healed TFA. All study subjects had attempted use of SS and had failed for many reasons related to the skin to socket interface. The outcomes measured recorded included: (1)Q-TFA Scores, (2)SF-36 Score, (3)time coupled per day, (4)resolution of back pain, (5)residual limb pain, and (6)overall satisfaction. Radiographs of implanted stems were reviewed for evidence of loosening or bone on growth. Results A group of TFA patients (11) had been treated with the OI system and agreed for follow up evaluation. Mean age 52 (37-73) years at the time of OI stage I surgery, with a mean time of 9 (3-20) years post amputation to implantation of the OI system. Original indications for the amputation included: 1 chronic osteomyelitis, 1 neoplasm, and 9 traumatic. Mean time to from TFA to OI was 73 months (2- 216). All patients reported a reduction or complete resolution of back pain after OI. Ambulatory/device coupling status reported was mean 12 hours/day. Average Q-TFA Prosthetic use score 66.1, Prosthetic mobility score, 60.2, Problem score 18.2, and Global score 72. Average SF-36 PCS 56.2 and average MCS 70.0. Radiographs reviewed all showed 4 to 6mm of distal circumferential bone reabsorption with robust bone on growth in the diaphysis of the implanted femurs. Conclusion Early data on the effectiveness and safety of the custom Patriot™ OI device is favorable. Future study evaluating long-term device survivorship and patient reported outcomes is warranted. Bone remodeling post implantation and coupling showed positive effects of the system. This study found the custom OI device to be safe and effective in the management of TFA in patients with controlled indications.

Mobility Rates After Lower-Limb Amputation for Patients Treated with Physician-Led Collaborative Care Model

Clinical outcomes after major lower-limb amputation have been historically poor. The current care provided to most amputees is often disorganized and without physician supervision. The primary purpose of this study is to examine rates of postamputation mobility achieved with a prosthesis by patients with chronic limb-threatening ischemia and/or diabetes who required major lower-limb amputation and were treated under an established physician-led collaborative care pathway. The secondary purpose is to describe the structure and utilization of the care pathway by multiple independent vascular surgery practices in the United States to enable future exploration of its impact on key clinical outcomes within this patient population. Clinical records of 2,475 patients from 6 vascular practices that adopted this collaborative care pathway between 2017 and 2020 were retrospectively reviewed. Only records with sufficient documented histories of amputation surgeries, prosthetic services, and mobility status were included. Of 2,475 patient records reviewed, 1,787 patients (2,157 major amputations) were eligible for analysis. Sixty-two-point 2 percent (n=1,111) of patients achieved mobility with the collaborative care pathway. Mobility rate varied by amputation level in the study. Prosthetic mobility was achieved in 73.5% of transtibial amputations, 40.4% of transfemoral amputations, and 35.7% of through-knee amputations, regardless of patient laterality, which is superior or equivalent to the best published rates of mobility. The study describes the structure and utilization of a physician-led collaborative care pathway for treating patients who require lower-limb amputation that meets 5 of the 7 recommendations from the 2019 Global Vascular Guidelines on the Management of Chronic Limb Threatening Ischemia. Internal data analysis results suggest that patients treated via this care pathway can potentially achieve improved mobility rates with a prosthesis following amputation. This collaborative care pathway should be further evaluated for its ability to directly improve mobility and other clinically relevant amputation outcomes.

Four weeks of inpatient comprehensive prosthetic rehabilitation achieves contrasting results in different groups of prosthetic users.

This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss. In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest). A step-monitoring device recorded ambulatory activity. For the primary outcome measure, Prosthetic Limb Users Survey of Mobility, the between-group analysis revealed significant differences (χ2 = 10.91, df = 2, p < 0.01). Within-group Prosthetic Limb Users Survey of Mobility T-scores improved by 8.1% for the EXP-INT (p < 0.01) and 15.1% for NEW-INT (p < 0.01). Significant between-group differences were observed for the Amputee Mobility Predictor, L-test, 2-minute walk test, and 10-meter walk test. Within-group analysis demonstrated nonsignificant changes for the EXP-INT except for Prosthetic Limb Users Survey of Mobility, while the NEW-INT improved by 24.1% (p < 0.001), 34.0% (p < 0.01), 46.5% (p < 0.05), and 31.0% (p < 0.01), respectively. The number of steps during the last 7 d of rehabilitation showed significant differences between the groups (χ2 = 13.99, df = 2, p < 0.001). The NEW-INT improved by 138% (p < 0.05) compared with the first 7 d of rehabilitation, while the EXP-INT had nonsignificant changes. A 4-week rehabilitation intervention substantially increased prosthetic mobility, function, and ambulation activity for new prosthetic users but less so for experienced users. The results of the NEW-INT at discharge signify a considerable functional improvement.

Returning to work after dysvascular lower limb amputation-A novel multivariate approach to examine relative contributions of biopsychosocial predictors.

Returning to work is a key outcome of rehabilitation and social re-integration after lower limb amputation. It is important to understand what biopsychosocial factors contribute to returning to work after dysvascular amputation. Examining relative contributions of functional and contextual predictors of returning to work in participants with lower limb amputation due to diabetes and other dysvascular diseases. Cross-sectional. Return-to-work outcome, biopsychosocial characteristics including physical functioning, self-efficacy & perceived ability, and socioeconomical support data were collected from a purposive sample (n = 57) in a multi-state collaborative research network. Grouped Weighted Quantile Sum model analysis was conducted to evaluate relative contributions of biopsychosocial predictors. Less than 30% of the participants returned to work after their amputation. Physical functioning (odds ratio = 10.19; 95% CI 2.46-72.74) was the most important predictor group. Working before amputation, prosthetic mobility, and access to rehabilitation care were also identified as key factors associated with returning to work. Fewer than 1 in 3 participants with dysvascular amputation returned to work, despite an average age of only 54 years at the time of amputation. Physical functioning was shown to be the most important predictor, while socioeconomic factors such as a lack of access to care also contribute to not returning to work after dysvascular amputation.

Predicting Prosthetic Mobility at Discharge From Rehabilitation Following Major Amputation in Vascular Surgery

This study aimed to construct a decision aid to estimate the likelihood of independence with a prosthesis following rehabilitation for limb loss secondary to advanced ischaemia (acute or chronic limb threatening ischaemia) or diabetic foot disease (DFD). A secondary aim was to determine whether prosthetic independence is a surrogate marker of long term survival. A retrospective cohort study of a prospectively maintained database of unilateral amputations due to ischaemia or DFD entering rehabilitation between 2007 and 2020 was performed. Predictors of independent prosthetic mobility (IPM) were used in construction of the IPM prediction model, which underwent bootstrap internal and criterion validation through correlation with predictors of other measures of function: Timed Up and Go (TUG) and two minute walk test. Kaplan-Meier and Cox regression analyses were performed to address the secondary aim. Of the 771 patients included, only 49.9% of amputees achieved IPM. Independent negative predictors of IPM were age > 75 years, female sex, higher amputation level, active malignancy, cerebrovascular disease, end stage renal disease, and cognitive impairment. The model yielded high discrimination (C statistic 0.778), and internal validation was demonstrated with bootstrapping (C statistic 0.778), confirming no over optimism. There was a strong correlation between IPM, TUG, and two minute distance and their predictors, confirming strong criterion validity. The IPM group had a median survival of 93.7 (80.7, 105) months, whereas the non-IPM group fared worse with a median survival of 56.6 (48.5, 66.7) months (p < .001). An internally validated decision aid for estimating the likelihood of independence with a prosthesis after major amputation was constructed. A strong association between female sex and poorer prosthetic mobility was observed. Prosthetic function was shown to be a surrogate marker of long term survival. Future research will involve external validation studies to confirm the generalisability of the decision aid in clinical practice.

Daily Activity of Individuals With an Amputation Above the Knee as Recorded From the Nonamputated Limb and the Prosthetic Limb

Introduction: Mobility restriction following limb loss might lead to a sedentary lifestyle, impacting health. Daily activity monitoring of amputees has focused on prosthetic steps, neglecting overall activity. Purpose: To assess daily activity in individuals with an established amputation and to explore the amount of activity recorded from the prosthesis as compared to the overall activity. Methods: Individuals with a unilateral transfemoral amputation or knee disarticulation who had used a prosthesis in daily life for &gt;1 year and could walk 100 m (unsupported or single aided) were recruited. Descriptive information and prosthetic mobility were collected. Two activPAL™ accelerometers were attached to the nonamputated thigh and the prosthesis, respectively. The mean daily activity over 7 days was compared between the nonamputated limb and the prosthesis. Results: Thirty-nine participants (22 men/17 women; mean age 54 [14.5] years) with amputation mainly due to trauma (59%) or tumor (28%) were included. Overall, participants took 6,125 steps and spent 10.2 hr sedentary, 5.0 hr upright, and 8.7 hr laying per day. Compared to recordings from the nonamputated limb, 85% of sit-to-stand transitions (32/38), 73% of steps (4,449/6,125), and 68% of walking time (1.0/1.5 hr) were recorded from the prosthesis. Recordings seemed to be less adequate for incidental prosthetic steps than for walks. Conclusions: Sedentary behavior accounted for most of the day demonstrating the importance to encourage physical activity among established prosthetic users. The prosthesis is used for daily activity to a great extent. However, noted pitfalls in the recordings call for further refinement of the measurements.

Association between statin-use and mobility and long-term survival after major lower limb amputation.

The aim of this study was to determine if there is an association between statin-use and prosthetic mobility and long-term survival in patients receiving rehabilitation after major amputation for lower limb arterial disease. A retrospective analysis of prospectively maintained data (2008-2020) from a centre for rehabilitation was performed. Patients were grouped by statin-use status and sub-grouped by the combination of statin and antithrombotic drugs (antiplatelets or anticoagulants). Outcomes were prosthetic mobility (SIGAM score, timed-up-go and 2-min walking distance) and long-term survival. Regression, Kaplan-Meier and Cox-proportional hazard analyses were performed to test associations adjusted to confounders. Of 771 patients, 499 (64.7%) were on a statin before amputation or prescribed a statin peri-operatively. Rate of statin-use was significantly lower among female (53.3%) compared to male (68.2%) patients, P < 0.001. Statin-use was associated with significantly better prosthetic independence (53.1% vs 44.1%, P = 0.017), timed-up-go (mean difference of 4 s, P = 0.04) and long-term survival HR 0.59 (0.48-0.72, P < 0.001). Significance persisted after adjusting for confounding factors and in subgroup analyses. The combination of statin with antiplatelet was associated with the most superior survival, HR 0.51 (0.40-0.65, P < 0.001). Sensitivity analysis (exclusion of non-users of prosthesis) showed that statin-use remained a significant indicator of longer survival, maximally when combined with antiplatelet use HR 0.52 (0.39-0.68, P < 0.001). Statin-use is associated with better mobility and long-term survival in rehabilitees after limb loss, particularly when used in combination with antiplatelets. Significantly lower rates of statin-use were observed in female patients. Further research is warranted on gender disparities in statin-use and causality in their association with improved mobility and survival.

Creating Adjusted Scores Targeting mobiLity Empowerment (CASTLE 1): determination of normative mobility scores after lower limb amputation for each year of adulthood

Purpose As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. Materials and Methods A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. Results As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. Conclusions Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care. IMPLICATIONS FOR REHABILITATION Normative values of mobility are needed to qualify good outcomes in prosthetic care as healthcare shifts towards value-based care. Understanding where an individual is relative to others with similar characteristics (e.g., age, etiology, gender, amputation level, and device type) can provide clinicians with better benchmarks for individual goal-setting. The ability to generate predicted mobility scores specific to each individual can create a mobility adjustment factor to better qualify good outcomes.

Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS-M).

Achieving mobility with a prosthesis is a common post-amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient-reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research. To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility. A cross-sectional study was conducted to administer previously developed candidate items to a national sample of lower limb prosthesis users. Items were calibrated to an item response theory model and two fixed-length short forms were created. Instruments were assessed for readability, effective range of measurement, agreement with the full item bank, ceiling and floor effects, convergent validity, and known groups validity. Participants were recruited using flyers posted in hospitals and prosthetics clinics across the United States, magazine advertisements, notices posted to consumer websites, and direct mailings. Adult prosthesis users (N=1091) with unilateral lower limb amputation due to traumatic or dysvascular causes. Not applicable. Candidate items (N=105) were administered along with the Patient Reported Outcome Measurement Information System Brief Profile, Prosthesis Evaluation Questionnaire - Mobility Subscale, and Activities-Specific Balance Confidence Scale, and questions created to characterize respondents. A bank of 44 calibrated self-report items, termed the Prosthetic Limb Users Survey of Mobility (PLUS-M), was produced. Clinical and statistical criteria were used to select items for 7- and 12-item short forms. PLUS-M instruments had an 8th grade reading level, measured with precision across a wide range of respondents, exhibited little-to-no ceiling or floor effects, correlated expectedly with scores from existing PROMs, and differentiated between groups of respondents expected to have different levels of mobility. ThePLUS-M appearstobe well suited to measuring prosthetic mobility in people with lower limb amputation. PLUS-M instruments are recommended for use in clinical and research settings.

Comparison of prosthetic mobility and balance in transfemoral amputees with bone-anchored prosthesis vs. socket prosthesis.

The literature comparing bone-anchored prosthesis (BAP) with socket prosthesis (SP) consistently reports improvement in physical health and quality of life using primarily patient-reported outcome measures (PROMs). To determine the differences in mobility and balance using performance-based outcome measures and PROMs in people with transfemoral amputations (TFAs) fitted with BAP vs. SP. Causal comparative. Two groups of people with TFAs were recruited: one using a BAP (N = 11; mean age ± standard deviation, 44 ± 14.9 years; mean residual limb length as a percentage of the intact femur, 68% ± 15.9) and another group using a SP (N = 11; mean age ± standard deviation, 49.6 ± 16.0 years; mean residual limb length as a percentage of the intact femur, 81% ± 13.9), and completed the 10-meter walk test, component timed-up-and-go, Prosthetic Limb Users Survey of Mobility™ 12-item, and Activities-specific Balance Confidence Scale. There were no statistically significant differences between the BAP and SP groups in temporal spatial gait parameters and prosthetic mobility as measured by the 10-meter walk test and component timed-up-and-go, yet large effect sizes were found for several variables. In addition, Activities-specific Balance Confidence Scale and Prosthetic Limb Users Survey of Mobility™ scores were not statistically different between the BAP and SP groups, yet a large effect sizes were found for both variables. This study found that people with TFA who use a BAP can demonstrate similar temporal spatial gait parameters and prosthetic mobility, as well as self-perceived balance confidence and prosthetic mobility as SP users. Therefore, suggesting that the osseointegration reconstruction surgical procedure provides an alternative option for a specific population with TFA who cannot wear nor have limitations with a SP. Future research with a larger sample and other performance-based outcome measures and PROMs of prosthetic mobility and balance would further determine the differences between the prosthetic options.

Rasch validation of the German translation of the Prosthetic Limb Users Survey of Mobility short forms in people with lower limb amputation.

Prostheses are a primary rehabilitative intervention for people after lower limb amputation. To appropriately measure the effectiveness of prosthetic interventions, valid and reliable measures of prosthetic mobility are required. The Prosthetic Limb Users Survey of Mobility (PLUS-M) is a promising instrument for measuring prosthesis users' mobility. However, German translations of the PLUS-M short forms have not yet been validated. Rasch validation of the German translation of the PLUS-M short forms in people with lower limb amputation. This study is based on a cross-sectional survey of prosthesis-using lower limb amputees from a nation-wide cohort. PLUS-M data (the 7-item and the 12-item shortforms; PLUS-M-7 and PLUS-M-12, respectively) from 194 lower limb prosthesis users were subjected to Rasch analysis, an advanced statistical method for assessing if the measurement properties of a questionnaire comply with a wide spectrum of psychometric requirements. Analysis showed appropriate rating scale functioning, good internal construct validity (item fit), unidimensionality, and good targeting of the PLUS-M-7 and PLUS-M-12 short forms. Moreover, the greater conditional measurement precision of PLUS-M-12 (regarding higher test information and lower standard error of mobility estimates) was quantified. Rasch analysis of the German translation of both PLUS-M short forms showed good psychometric qualities. In addition, our study showed that test scores from the PLUS-M-12 are more accurate. Therefore, the PLUS-M-12 is recommended for individual-level clinical applications (e.g., classification or change assessment).

Factors influencing the self-perceived mobility of active unilateral lower limb amputees assessed with the Prosthetic Mobility Questionnaire: a brief report.

The Prosthetic Mobility Questionnaire (PMQ 2.0) represents a reliable solution for evaluating amputees' self-perceived mobility. The study aimed to evaluate the perceived mobility of middle-aged users with a traumatic amputation using the PMQ 2.0 and to assess the influence of age, stump and phantom limb pain, amputation level, time since amputation, and prosthesis use on it. Fifty subjects were recruited. The median value of the score was higher than previously published reference values, reflecting the 'active' mobility status of the sample. The hours of prosthesis use per day explained about 21% of the variance of the questionnaire score and was a significant predictor of perceived mobility. Reference values for the recently developed PMQ 2.0 survey and relative to active, traumatic amputees were reported. As prosthesis use was a significant predictor of the amputees' perceived mobility, prolonged use of the artificial limb should be always encouraged in clinical practice.

AMPREDICT PROsthetics- Predicting Prosthetic Mobility to Aid in Prosthetic Prescription and Rehabilitation Planning

Research Objectives To develop and validate a patient-specific multivariable prediction model that utilizes readily available predictors to predict 12-month mobility at the time of initial post amputation prosthetic prescription. The prediction model is designed to be used on patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation for chronic limb threatening ischemia (CLTI). The overall goal is to enhance prediction of future mobility to assist the rehabilitation team in setting appropriate, evidence-based goals, to better inform patient expectations, and to facilitate appropriate prosthetic prescription. Design Mixed-methods study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected patient reported mobility. Setting The Veterans Administration Corporate Data Warehouse (CDW), the National Prosthetics Patient Database (NPPD), participant mailings and phone calls. Participants 357 Veterans who underwent an incident TT or TF amputation for CLTI and received a qualifying lower limb prosthesis (LLP) between March 1, 2018, and November 30, 2020. Interventions Not applicable. Main Outcome Measures The Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). Results Variable selection, using a machine learning methodology, led to a final model of 23 predictors that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation – levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. Conclusions The AMPREDICT PROsthetics model can assist providers in estimating individual patient's future mobility at the time of prosthetic prescription thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for their anticipated functional goals. Author(s) Disclosures No conflicts of interest. This project was completed from funding provided by a Veterans Administration Research Rehabilitation and Development Grant. To develop and validate a patient-specific multivariable prediction model that utilizes readily available predictors to predict 12-month mobility at the time of initial post amputation prosthetic prescription. The prediction model is designed to be used on patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation for chronic limb threatening ischemia (CLTI). The overall goal is to enhance prediction of future mobility to assist the rehabilitation team in setting appropriate, evidence-based goals, to better inform patient expectations, and to facilitate appropriate prosthetic prescription. Mixed-methods study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected patient reported mobility. The Veterans Administration Corporate Data Warehouse (CDW), the National Prosthetics Patient Database (NPPD), participant mailings and phone calls. 357 Veterans who underwent an incident TT or TF amputation for CLTI and received a qualifying lower limb prosthesis (LLP) between March 1, 2018, and November 30, 2020. Not applicable. The Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). Variable selection, using a machine learning methodology, led to a final model of 23 predictors that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation – levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. The AMPREDICT PROsthetics model can assist providers in estimating individual patient's future mobility at the time of prosthetic prescription thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for their anticipated functional goals.

Social and community participation following traumatic lower limb amputation: an exploratory qualitative study

Purpose To explore barriers and facilitators to social and community participation experienced by people following traumatic lower limb amputation (LLA). Methods An exploratory qualitative study was conducted with nine adults with traumatic LLA in Victoria, Australia. Participants were a minimum of 18 months post amputation. Interview data was analysed using thematic analysis. Results Participants referenced the inaccessibility of the built environment and physical challenges associated with prosthetic mobility as barriers to participation. Chronic and complex health concerns due to their injuries resulted in physical and emotional distress for some, further limiting their social and community engagement. Participants highlighted the benefit of peer-support networks and the value of supportive community groups in assisting the transition to their pre-amputation family, work and social roles. Participants also felt that a strong, positive attitude and being self-motivated were important to aid in their return to social and community participation. Conclusion People following traumatic LLA experience a number of physical, psychological and environmental challenges to participation. The role of peer-support networks, community groups and personal attitudes are important facilitators to assist a return to family, work and life roles. The findings of this study have informed the development of recommendations to guide clinical practice. IMPLICATIONS FOR REHABILITATION Peer-support groups for people following traumatic lower limb amputation (LLA) may assist to improve their long-term adjustment to disability and community participation Retraining skills in an individual’s own community should be considered when planning community-based therapy services for people following traumatic LLA. Ongoing psychosocial support including strategies to develop self-efficacy and positive mindset may improve social and community participation Regular medical and allied health reviews can be beneficial to promote early intervention for any complications that arise to minimise time off prosthesis.

Osseointegrated prostheses for the rehabilitation of patients with transfemoral amputations: A prospective ten-year cohort study of patient-reported outcomes and complications.

BackgroundOsseointegrated implants for patients with transfemoral amputations (TFAs) are a novel treatment under development, and prospective long-term evidence is lacking. The objectives were to determine patient-reported outcomes (PROs) and complications after ten years compared to before treatment and to compare the first five-year period with the later five-year period with regard to the outcomes.MethodsIn a nonrandomized, prospective cohort study, patients with TFAs treated between 1999 and 2007 with the Osseointegrated Prosthesis for the Rehabilitation of Amputees (OPRA) system (n ​= ​51) (28 men/23 women; mean age at amputation: 32 years old; mean age at treatment: 44 years old in a single university hospital were followed for ten years. PROs included the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA, four scores 0–100) and the Short Form 36 Health Survey (SF-36, ten scores 0–100) and were answered before treatment and until the ten-year follow-up after treatment. Analyses of differences in PRO scores were conducted using Wilcoxon's signed rank test. The implant survival and revision-free rates with respect to adverse events (implant revision, mechanical complications, and deep infections) were presented as Kaplan–Meier graphs with 95% confidence intervals (CIs). The incidences of events per ten and five person-years were calculated. Spearman's correlation analysis was used for analyses of associations between adverse events.ResultsPROs showed statistically significant mean improvements between baseline and the ten-year follow-up with regard to all Q-TFA scores: the prosthetic use score (+36), prosthetic mobility score (+18), problem score (−28) and global score (+38) (all p ​< ​0.001), and the SF-36 physical functioning score (+26, p ​< ​0.001) and physical component score (+6, p ​< ​0.01). No PROs showed a statistically significant deterioration. Over the ten years, 12 patients were lost (one lost to follow-up, one dropped out of the study, two died, and eight had implants removed (four before five years and four between five and ten years). At ten years, the revision-free survival rates were 83% (CI: 69%–91%), 65% (CI: 49%–77%) and 17% (CI: 7%–29%) for implant revision, deep infection and mechanical complications, respectively. Mechanical complications, 3.9 per 10 person-years (CI: 2.2–5.1) constituted the most common serious adverse event and were more common during the last five years than during the first five years (p ​< ​0.001). No significant difference in the incidence of deep infections was observed between the earlier and the later five-year periods: 0.3 per 5 person-years (CI: 0.1–0.5) vs. 0.3 per person-years (CI: 0.1–0.5) (p ​= ​0.740). Correlation analyses between the earlier and later five years revealed a positive association between deep infections and implant removal (0.57, p ​< ​0.001) and between mechanical complications and adverse events (0.65, p ​< ​0.001).ConclusionImproved PROs were demonstrated ten years after the introduction of a novel principle for bone anchorage of amputation prostheses. Nevertheless, an increasing rate of mechanical complications is of concern.

Disparities in functional recovery after dysvascular lower limb amputation are associated with employment status and self-efficacy

Purpose Employment status is considered a determinant of health, yet returning to work is frequently a challenge after lower limb amputation. No studies have documented if working after lower limb amputation is associated with functional recovery. The study's purpose was to examine the influence of full-time employment on functioning after lower limb amputation. Methods Multisite, cross-sectional study of 49 people with dysvascular lower limb amputation. Outcomes of interest included performance-based measures, the Component Timed-Up-and-Go test, the 2-min walk test, and self-reported measures of prosthetic mobility and activity participation. Results Average participant age was 62.1 ± 9.7 years, 39% were female and 45% were persons of color. Results indicated that 80% of participants were not employed full-time. Accounting for age, people lacking full-time employment exhibited significantly poorer outcomes of mobility and activity participation. Per regression analyses, primary contributors to better prosthetic mobility were working full-time (R 2 ranging from 0.06 to 0.24) and greater self-efficacy (R 2 ranging from 0.32 to 0.75). Conclusions This study offers novel evidence of associations between employment and performance-based mobility outcomes after dysvascular lower limb amputation. Further research is required to determine cause-effect directionalities. These results provide the foundation for future patient-centered research into how work affects outcomes after lower limb amputation. IMPLICATIONS FOR REHABILITATION Lower limb amputation can pose barriers to employment and activity participation, potentially affecting the quality of life. This study found that the majority of people living with lower limb amputation due to dysvascular causes were not employed full-time and were exhibiting poorer prosthetic outcomes. Healthcare practitioners should consider the modifiable variable of employment when evaluating factors that may affect prosthetic mobility. The modifiable variable of self-efficacy should be assessed by healthcare professionals when evaluating factors that may affect prosthetic mobility.

Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation.

Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA. Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes. Self-report and performance-based standardized outcome measures assessed prosthetic mobility and balance confidence. All variables were considered and appropriately placed within a proposed International Classification of Functioning, Disability, and Health framework while using a fall-type classification framework to classify fall circumstances. Information from 69 participants was analyzed. The reported fall rate was at 46%, with those with transfemoral amputation reporting significantly more falls than those with transtibial amputation ( P = 0.001). Tripping over an object was the most common cause (62.5%), and fallers reported significantly lower perceived prosthetic mobility than nonfallers ( P = 0.001). Despite reporting high levels of balance confidence, results indicate that all groups of fallers and nonfallers are at increased fall risk according to performance-based prosthetic mobility score cutoffs. Community-dwelling people with nondysvascular LLA are at increased fall risk. Classifying fall-related variables using theoretical frameworks provides a means to structure more informative fall risk surveys for people with LLA in an attempt to identify those at greater risk for falling and its potential detrimental effects.

Free-Living User Perspectives on Musculoskeletal Pain and Patient-Reported Mobility With Passive and Powered Prosthetic Ankle-Foot Components: A Pragmatic, Exploratory Cross-Sectional Study.

IntroductionStudies with a powered prosthetic ankle-foot (PwrAF) found a reduction in sound knee loading compared to passive feet. Therefore, the aim of the present study was to determine whether anecdotal reports on reduced musculoskeletal pain and improved patient-reported mobility were isolated occurrences or reflect a common experience in PwrAF users.MethodsTwo hundred and fifty individuals with transtibial amputation (TTA) who had been fitted a PwrAF in the past were invited to an online survey on average sound knee, amputated side knee, and low-back pain assessed with numerical pain rating scales (NPRS), the PROMIS Pain Interference scale, and the PLUS-M for patient-reported mobility in the free-living environment. Subjects rated their current foot and recalled the ratings for their previous foot. Recalled scores were adjusted for recall bias by clinically meaningful amounts following published recommendations. Statistical comparisons were performed using Wilcoxon's signed rank test.ResultsForty-six subjects, all male, with unilateral TTA provided data suitable for analysis. Eighteen individuals (39%) were current PwrAF users, whereas 28 subjects (61%) had reverted to a passive foot. After adjustment for recall bias, current PwrAF users reported significantly less sound knee pain than they recalled for use of a passive foot (−0.5 NPRS, p = 0.036). Current PwrAF users who recalled sound knee pain ≥4 NPRS with a passive foot reported significant and clinically meaningful improvements in sound knee pain (−2.5 NPRS, p = 0.038) and amputated side knee pain (−3 NPRS, p = 0.042). Current PwrAF users also reported significant and clinically meaningful improvements in patient-reported mobility (+4.6 points PLUS-M, p = 0.016). Individuals who had abandoned the PwrAF did not recall any differences between the feet.DiscussionCurrent PwrAF users reported significant and clinically meaningful improvements in patient-reported prosthetic mobility as well as sound knee and amputated side knee pain compared to recalled mobility and pain with passive feet used previously. However, a substantial proportion of individuals who had been fitted such a foot in the past did not recall improvements and had reverted to passive feet. The identification of individuals with unilateral TTA who are likely to benefit from a PwrAF remains a clinical challenge and requires further research.

Microprocessor feet improve prosthetic mobility and physical function relative to non-microprocessor feet.

Introduction: The clinical benefits associated with the microprocessor regulation of prosthetic ankle position and resistance have largely been reported through manufacturer conducted research in controlled laboratory environments. Measures with greater ecological validity are needed. This study aimed to understand if there are differences in physical function and mobility outcomes as patients transitioned from a non-Microprocessor to Microprocessor Feet. Method: A retrospective analysis of patient outcomes was performed. Patient-reported benefits associated with the adoption of such prosthetic foot-ankle mechanisms were collected from 23 individuals through the longitudinal use of a custom short form of the Patient-Reported Outcomes Measurement Information System-Physical Function and individual items from the Prosthesis Evaluation Questionnaire. Results: The impact of Microprocessor Feet upon physical function and mobility were observed in a significant increase in physical function (mean increase in t-score of 5.4 ± 1.25; p = .0004) and significant improvements in several mobility items. Conclusions: Collectively, these measures support the beneficial impact of Microprocessor Feet on improving socket comfort, reducing back pain, improving sit to stand transfers and enhancing hill ascent and descent as well as stair negotiation.