A Review of the Literature Pertaining to KAFOs and HKAFOs for Ambulation

Fatone, Stefania

doi:10.1097/00008526-200606001-00003

Cited by 28 publications

(15 citation statements)

References 200 publications

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“…While this is fewer than the number of publications (n = 240) included in one recent systematic review of O&P outcomes [108], it is consistent with the number of publications (n = 25-34) that have appeared in others performed using similar strategies [109][110][111][112]. The number of publications included in this review is also similar to a 2004 Cochrane Review of prosthetic feet that included 29 total publications [113][114].…”

Section: Discussionsupporting

confidence: 79%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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Abstract-Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessorcontrolled knees (NMPKs) to address challenges facing individuals with lower-limb loss. A body of scientific literature comparing MPKs and NMPKs exists but has yet to be critically appraised. Therefore, we conducted a systematic review to examine outcomes associated with the use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications, of which 27 met the inclusion and exclusion criteria and were reviewed for methodological quality and content. We developed 28 empirical evidence statements (EESs) in 9 outcome categories (metabolic energy expenditure, activity, cognitive demand, gait mechanics, environmental obstacle negotiation, safety, preference and satisfaction, economics, and health and quality of life) based on findings in the literature. The level of evidence supporting these EESs varied due to quantity, quality, and consistency of the results. EESs supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice and that additional research is needed to confirm existing evidence and better understand outcomes associated with the use of NMPKs and MPKs.Key words: amputation, artificial limb, function, gait, knee, microprocessor, outcome, preference, rehabilitation, safety. Abbreviations: AAOP = American Academy of Orthotists andProsthetists, ABC = Activities-specific Balance Confidence, CWS = controlled walking speed, DLW = doubly labeled water, EBP = evidence-based practice, EES = empirical evidence statement, EV = external validity, GRF = ground reaction force, HAI = Hill Assessment Index, HRQL = health-related quality of life, IV = internal validity, LLL = lower-limb loss, MFCL = Medicare Functional Classification Level, MP = microprocessor, MPC = microprocessor control, MPK = microprocessor-controlled prosthetic knee, MRPP = Montreal Rehabilitation Performance Profile, NMPK = non-microprocessor-controlled prosthetic knee, O 2 = oxygen, O&P = orthotic and prosthetic, PAEE = physical activity-related energy expenditure, PCBS = Prosthetic Cognitive Burden Scale, PCI = physiological cost index, PEQ = Prosthesis Evaluation Questionnaire, PEQ-A = PEQ Addendum, PRO = patient-reported outcome, QALY = quality adjusted life year, QOL = quality of life, RPE = rating of perceived exertion, SAI = Stair Assessment Index, SF-36 = 36-Item Short-Form Health Survey, SOT = sensory organization test, SSWS = selfselected walking speed, SSC = State of the Science Conference, TDEE = total daily energy expenditure, TFLL = transfemoral limb loss.

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Section: Discussionsupporting

confidence: 79%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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“…67,106 The methodical approach to the collection, evaluation, and synthesis of a body of literature inherent to a systematic review provides the means to address a focused and relevant clinical question. While this is fewer than the number of publications (i.e., n = 240) included in one recent systematic review of O&P outcomes, 107 it is consistent with the number of publications (i.e., n = 25 to 34) that have appeared in others that were performed using similar strategies. Thus, the goal of this review was to systematically identify, assess, and interpret the body of scientific literature that compared MPK and NMPK interventions and to synthesize the knowledge obtained through that process into clinically-useful empirical evidence.…”

Section: Discussionsupporting

confidence: 75%

Outcomes Associated with the Use of Microprocessor-Controlled Prosthetic Knees among Individuals with Unilateral Transfemoral Limb Loss

Sawers

Hafner

2013

JPO Journal of Prosthetics and Orthotics

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Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessor-controlled knees (NMPKs) to address challenges facing individuals with lower limb loss. A body of scientific literature comparing MPKs and NMPKs exists, but has yet to be critically appraised. Therefore, a systematic review was conducted to examine outcomes associated with use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications. Twenty-seven met the inclusion/exclusion criteria and were reviewed for methodological quality and content. Twenty-eight evidence statements, in nine outcome categories (Metabolic Energy Expenditure, Activity, Cognitive Demand, Gait Mechanics, Environmental Obstacle Negotiation, Safety, Preference & Satisfaction, Economics, and Health & Quality of Life) were developed based on findings in the literature. The level of evidence supporting these statements varied due to quantity, quality, and consistency of the results in the literature. Evidence statements supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice, and that additional research is needed to confirm existing evidence and better understand outcomes associated with use of NMPKs and MPKs. (J Prosthet Orthot. 2013;25:P4YP40.) non-digit) loss of the limb. More than 42% of all amputations are attributed to major limb loss, with the vast majority of those (i.e., approximately 94%) 1 occurring in the lower limb. Given the importance of the lower limb to balance, transfer, and ambulation activities, lower limb loss (LLL) negatively affects an individual's functional ability at home and in the community. 4Y9 For example, a 2006 systematic review of walking ability following LLL noted that, while 56 to 97% of individuals regain walking ability following LLL, only 26 to 62% regain the ability to ambulate outdoors. 4 This specific limitation seems critical, as an inability to ambulate outside of the home may impede participation in both vocational and avocational activities and increase individuals' reliance upon physical, personal, and financial assistance.The physiological and functional challenges associated with LLL are also exacerbated at more proximal levels of limb loss, 8,10Y13 as evidenced by significantly fewer individuals with transfemoral limb loss (TFLL) than individuals with transtibial limb loss who are reported to achieve household (50% vs. 66%, p = 0.007) or community (29% vs. 54%, p = 000) ambulation. 8 Limb loss at the transfemoral level, when compared to limb loss at more distal levels, has also been reported to be associated with a decreased frequency of prosthetic fitting, 7,14,15 and an increased frequency of back, knee, and hip pain, 16Y19 obesity, 20 and osteoarthritis. 17,21 These medical issues may ultimately contribute to the extended period of ...

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“…Each of these joints uses a different design strategy, but all prevent stance-phase knee flexion to provide stability, while allowing swing-phase knee flexion. Currently, limited research has been conducted on KAFOs in general [9] and in particular on the effects that stance-control KAFOs may have on a user's gait. To date, six studies have evaluated stance-control KAFOs [8,[10][11][12][13][14], with only two of these investigating commercially available joints: McMillan et al fitted three KAFO users with Horton's weightactivated Stance-Control Orthotic Knee Joint (SCOKJ ® ) (Horton Technology, Inc, Little Rock, Arkansas) [13] and Hebert and Liggins fitted a single postpolio subject with the ankle-motion activated SCOKJ [10].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical and energetic effects of a stance-control orthotic knee joint

Zissimopoulos

Fatone

Gard

2007

JRRD

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Abstract-Users of traditional knee-ankle-foot orthoses (KAFOs) walk with either locked or unlocked knee joints depending on the level of stability required. Some users may benefit from new stance-control KAFOs that prevent stancephase knee flexion but allow swing-phase flexion. We collected data from nine nondisabled adults who walked with KAFOs that incorporated the Horton Stance-Control Orthotic Knee Joint (SCOKJ) in the locked, unlocked, and auto (which provides knee stability during stance phase and knee flexion during swing phase) modes to investigate the biomechanical and energetic effects of stance-control orthoses. Studying nondisabled subjects allowed us to analyze the effects of stancecontrol orthoses in a homogenous population. In general, gait kinematics for the auto and unlocked modes were more similar than for the auto and locked modes. Despite the elimination of hip hiking in the auto mode, oxygen cost was not different between the auto and locked modes (p > 0.99). The SCOKJ allowed our nondisabled subjects to walk with a more normal gait pattern; however, future research should explore the effect of stance-control orthoses on persons with gait pathology.

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A Review of the Literature Pertaining to KAFOs and HKAFOs for Ambulation

Cited by 28 publications

References 200 publications

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Outcomes Associated with the Use of Microprocessor-Controlled Prosthetic Knees among Individuals with Unilateral Transfemoral Limb Loss

Biomechanical and energetic effects of a stance-control orthotic knee joint

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