Developing consensus on important factors associated with lower limb prosthetic prescription and use

Schaffalitzky, Elisabeth; MacLachlan, Malcolm; Wegener, Stephen T.

doi:10.3109/09638288.2012.671885

Cited by 81 publications

(68 citation statements)

References 46 publications

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“…Instead, improved quality of life and comfort while walking and sitting were reported as important outcomes. 39 This is in line with the benefits of bone-anchored prostheses.…”

Section: Figsupporting

confidence: 54%

Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

Hagberg

Hanssoń

Brånemark

2014

Archives of Physical Medicine and Rehabilitation

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“…Instead, improved quality of life and comfort while walking and sitting were reported as important outcomes. 39 This is in line with the benefits of bone-anchored prostheses.…”

Section: Figsupporting

confidence: 54%

Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

Hagberg

Hanssoń

Brånemark

2014

Archives of Physical Medicine and Rehabilitation

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“…We define motor performance in this context as the neuromotor response and capacity (i.e., inherent neural and musculoskeletal structure) that underlie prosthetic ambulation 22–24 . Additionally, objectives depend on the importance patients place on certain aspects of ambulation (e.g., comfort, mobility, appearance, safety, and fatigue) 14–16, 18, 19, 24–28 . As an example, normalizing elevated metabolic energy expenditure or reducing asymmetric bilateral joint mechanics are objectives supported by the literature for unilateral lower-limb prosthesis users.…”

Section: Introductionmentioning

confidence: 99%

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

Major

Fey

2017

Physical Therapy Reviews

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Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.

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“…Factors that were critical to achieving these outcomes were safety, balance, comfort, and having confidence in walking. 10,11 Factors that diminished quality of life included impaired mobility, followed by pain, progression of limb ischemia in the contralateral limb, and depression/frustration. 12 Participants in one study unanimously agreed that prostheses improve quality of life; however, 83% resorted to a wheelchair for mobility when walking was not feasible.…”

Section: Introductionmentioning

confidence: 99%

“…Stakeholder focus groups convened by Klute et al 14 identified a lack of flexibility and function in the ankle and foot components as being problematic. Klute’s study is notable because the researchers focused specifically on the prosthetic foot, rather than looking more generally at lower-limb prostheses as other studies have done (e.g., Schaffalitzky et al 10 ).…”

Section: Introductionmentioning

confidence: 99%

What People Want in a Prosthetic Foot: A Focus Group Study

et al. 2016

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Introduction Most people with lower-limb amputation (LLA) rely on a prosthetic foot for participation at home and in the community. The published literature describes problems with mobility after LLA, yet there have been few published accounts of peoples' participation experiences. The purpose of this study was to increase understanding of the impact of prosthetic feet on participation in the activities of daily life by examining the experience of prosthetic users and professionals. Materials and Methods Users of prosthetic feet and health care professionals who prescribe prosthetic feet were invited to complete a brief online questionnaire before participating in one of five focus groups. Descriptive statistics were used to summarize questionnaire data. Focus group sessions were audio recorded and transcribed. Each transcript was thematically coded independently by four researchers. Emergent themes were discussed, categorized, and cross-referenced. Results Eleven prosthetic foot users (68.8%) and 11 professionals (100%) completed the online questionnaires. Although the prosthetic foot users rated their difficulty with usual activities as none to slight, 36% reported falling within the last 6 months, and 45% indicated that they modified their participation because of the potential for falls. Sixteen prosthetic foot users and 11 health care professionals took part in focus groups. There was a significant overlap in themes discussed by prosthetic foot users and health care professionals. Identified barriers to full participation included the ability to stand for extended periods, navigate in confined spaces, carry heavy objects, and change body posture. Absence of sensory feedback created significant concerns about safety when driving a car, navigating uneven terrain, or climbing ladders. Characteristics of existing prosthetic feet that impact participation included limited durability, lack of waterproofing, and limited range of motion. Current designs limited choices of footwear and created difficulties donning and doffing shoes. Conclusions Participants' reported confidence in forward walking on even ground suggests that current prosthetic feet are well-suited for this limited use. However, they also identified a number of situations in which their current prosthetic feet caused significant difficulties, often with safety implications. While some stories, such as rocks on the sidewalk, are consistent with the literature, other stories describe situations such as ladders and stepstools that are not well documented. Our study highlights the utility of focus groups in identifying previously unrecognized needs and concerns, with significant implications for the design of prosthetic feet. Future studies should include more diverse participants, particularly with regard to age and overall physical health.

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Developing consensus on important factors associated with lower limb prosthetic prescription and use

Abstract: Psychosocial factors related to service provision and prosthetic use have not been widely recognized or incorporated into clinical practice. We highlight the need for creating standardized measures tha[Box: see text].

Cited by 81 publications

References 46 publications

Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

Outcome of Percutaneous Osseointegrated Prostheses for Patients With Unilateral Transfemoral Amputation at Two-Year Follow-Up

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

What People Want in a Prosthetic Foot: A Focus Group Study

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