Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4

Beisheim, Emma Haldane; Horne, John Robert; Pohlig, Ryan T.; Sions, Jaclyn Megan

doi:10.1097/phm.0000000000001183

Cited by 11 publications

(23 citation statements)

References 29 publications

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“…Static balance tests could be performed in addition to dynamic balance tests, which have been shown to be suitable for K-level distinction among participants with TFA. 10 Several limitations have to be addressed. The major limitation is the small number of participants in each K-level group as well as the heterogeneity between groups, which may be the reason that no significant differences were detected.…”

Section: Discussionmentioning

confidence: 99%

Differences in Hip Muscle Strength and Static Balance in Patients With Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study

John

Orlowski

Mrkor

et al. 2022

Can. Prosthet. Orthot. J.

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BACKGROUND: Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVE(S): The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY: Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS: Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION: Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants. Layman's Abstract Patients with lower limb amputation (LLA) are classified into different mobility levels, so-called K-levels, which are ranging from K0 (lowest) to K4 (highest). K-level classification is relevant for the patients as it determines the type of prosthetic components available. However, K-level can vary greatly based on the clinician or orthopedic technician individual assessment. Objective data from physical performance tests can help to improve K-level classification. Therefore, muscle strength tests of the amputation stump as well as balance tests were performed in this study to determine whether these parameters have the potential to support K-level classification. Twenty-two participants with a thigh amputation participated in the study (four K1/2-, six K3- and twelve K4-participants). Hip muscle strength on the amputation side was assessed as well as static balance in the double leg stance with eyes open and eyes closed. Analysis of the data showed that all hip strength parameters differed between the K-level groups, with maximum strength increasing from the K1/2 group to the K4 group. Group differences were also seen in the balance parameters with greater body sway for the K1/2 group when compared to the K4 group, especially when participants had their eyes closed. These results show that muscle strength tests of the residual limb and static balance tests may serve as additional measures to improve K-level assignment for patients with LLA. This was only an initial study and further studies with a larger number of participants are required to confirm these results. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37456/28905 How To Cite: John S, Orlowski K, Mrkor K.U, Edelmann-Nusser J, Witte K. Differences in hip muscle strength and static balance in patients with transfemoral amputations classified at different K-levels: A preliminary cross-sectional study. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.5. https://doi.org/10.33137/cpoj.v5i1.37456 Corresponding Author: Stefanie John,Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany.E-Mail: Stefanie.John@ovgu.deORCID ID: https://orcid.org/0000-0001-6722-7195

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Section: Discussionmentioning

confidence: 99%

Differences in Hip Muscle Strength and Static Balance in Patients With Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study

John

Orlowski

Mrkor

et al. 2022

Can. Prosthet. Orthot. J.

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“…2 ), is a valid measure of walking skill, and provides complimentary information to gait speed [ 26 ]. F8WT can differentiate between adults with lower-limb pathology with varying functional mobility levels [ 27 ]. Among adults post-stroke and -total knee arthroplasty, test–retest reliability for time and number of steps, where a greater number of steps indicates poorer performance, has been reported [ 26 , 28 – 30 ].…”

Section: Methodsmentioning

confidence: 99%

“…Thus, the mFSST, which substitutes taped lines for canes, was used (Fig. 2 ) [ 27 , 39 ]. Aligning with prior research, [ 39 ] reliability for ‘average’ and ‘best’ performance over two trials, was determined.…”

Section: Methodsmentioning

confidence: 99%

Test–retest reliability for performance-based outcome measures among individuals with arthrogryposis multiplex congenita

Sions

Donohoe

Beisheim‐Ryan

et al. 2022

BMC Musculoskelet Disord

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Background Most individuals with arthrogryposis multiplex congenita, a rare condition characterized by joint contractures in ≥ 2 body regions, have foot and ankle involvement leading to compromised gait and balance. The purpose of this study was to establish between-days, test–retest reliability for performance-based outcome measures evaluating gait and balance, i.e., the 10-m Walk Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four Square Step Test, among adolescents and adults with arthrogryposis multiplex congenita. Methods This reliability study included ambulatory participants, aged 10 to 50 years, with a medical diagnosis of arthrogryposis multiplex congenita. Participants completed performance-based measures, in a randomized order, on two separate occasions. Intraclass correlation coefficients with 95% confidence intervals and minimal detectable changes at the 90% and 95% confidence level were calculated. Results Participants included 38 community-ambulators with a median of 13 out of 14 upper and lower joint regions affected. Intraclass correlation coefficient point estimates and 95% confidence intervals ranged from .85-.97 and .70-.98, respectively. Minimal detectable changes were 10 to 39% of sample means and were largest for the modified Four Square Step Test. Conclusions Among individuals with arthrogryposis, gait speed per the 10-m Walk Test, as well as non-linear walking and dynamic balance assessment per the Figure-of-8 Walk and 360 Degree Turn Tests, have adequate test–retest reliability enabling evaluation of individual patient changes. Changes in groups of ambulatory individuals with arthrogryposis multiplex congenita may be reliably evaluated with all of the studied outcome measures.

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“…Finally, the 5TSTS and 4SST have been used in other socket and rehabilitation intervention comparisons and has been shown to identify functional classification in LLA. [27][28][29][30] However, the AMP is a reliable and valid measure for the assessment of functional ambulation in lower-limb amputee subjects and is recommended for use in clinical practice. 23,49 The psychometric basis substantiating the selected Outcome Measures (OMS) continues to develop; however, given the limited current state of psychometric evidence, the aforementioned outcome measures were chosen as the best options to detect a difference in socket comparison and have been shown to be valid and reliable among people with LLA.…”

Section: Outcome Measuresmentioning

confidence: 99%

Effect of transfemoral prosthetic socket interface design on gait, balance, mobility, and preference: A randomized clinical trial

Kahle

Miro

et al. 2021

Prosthetics &Amp; Orthotics International

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Background: There are alternative transfemoral (TF) socket interface designs that have not been compared with the standard of care, ischial ramus containment (IRC). The interface directly affects performance. Objectives: To compare 3 TF interface designs, IRC, dynamic socket (DS), and subischial (Sub-I), regarding gait, balance, mobility, and preference. The authors hypothesized that these more active users may experience gait, mobility, and preference benefits from the less intrusive DS and Sub-I interface designs. Study Design: Single-blind, repeated-measures, 3-period randomized controlled crossover clinical trial. Methods: People with unilateral TF amputation with 1 year or longer prosthesis use experience, independent community ambulatory status, 18 to 60 years of age, of any race or ethnicity, with a body mass of 45 to 125 kg, and with a self-reported ability to walk for 20 minutes continuously were included in the study. Each participant was fit in all 3 interface designs. Results: Thirteen participants completed the clinical trial. Velocity, cadence, mobility, and balance were not statistically different between the 3 socket conditions. The DS demonstrated significantly greater symmetry in swing, stance, single support percentage, and toe angle compared with IRC and Sub-I. Sixty days after study completion, 7 participants changed interfaces, trending away from IRC. Conclusions: Large differences were not observed. Small differences in spatiotemporal gait measures combined with patient preference may make a meaningful difference to individual patients and should be considered.

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Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4

Cited by 11 publications

References 29 publications

Differences in Hip Muscle Strength and Static Balance in Patients With Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study

Differences in Hip Muscle Strength and Static Balance in Patients With Transfemoral Amputations Classified at Different K-Levels: A Preliminary Cross-Sectional Study

Test–retest reliability for performance-based outcome measures among individuals with arthrogryposis multiplex congenita

Effect of transfemoral prosthetic socket interface design on gait, balance, mobility, and preference: A randomized clinical trial

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