Does diabetes affect stability in people with unilateral transtibial amputation?

Abstract

Introduction/Objective Currently, analysis of the stability of amputees with diabetes is lacking. The aim of this case study was to examine the effects of unilateral transtibial amputation on the stability and balance confidence of patients with below-knee amputation caused by trauma and diabetes. Methods Seventeen subjects, 12 males and five females, with the average age of 51.47 ± 12.12 years, who use a unilateral transtibial prosthesis, were examined. The balance of 10 traumatic amputees (TTA) and seven diabetic amputees (TDA) was assessed by Activities-Specific Balance Confidence (ABC) scale, Timed Up and Go (TUG) test, and One-Legged Stance Test (OLST). Plantar pressure distribution was recorded using Gaitview AFA-50. Results For 10 TTA and one TDA, ABC scores were > 80%, the mean value of the TUG test was 11 (range: 8.08-23 seconds). All the subjects could stand on the healthy leg, two women with diabetes were unable to stand on the prosthetic leg. The distribution of load between the healthy and the prosthetic leg showed higher overload on the healthy leg (average: 56.62%). Conclusion The data from this case series describe stability problems of people with transtibial amputation. Plantar pressure distribution has the potential to provide information about the properties of stability in the amputees who use prosthesis.

Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review

“…The results from the current study showed a large bias toward recruiting males in research in this area. The reported 26.4% of female lower limb prosthesis users participating in studies was lower than what has been reported in a highly regarded national amputation registry (SwedeAmp; 39%), 234 as well as in previous research (34.5%–38.4%) such as Claessen et al 235 and Ziegler-Graham et al 236 The present authors think it is noteworthy that, of the (n = 161) articles reporting characteristics on sex in the balance articles in Supplemental Table (Supplemental Digital Content 2, http://links.lww.com/POI/A170) 12-14,19-23,25,26,28,29,31-42,44,45,47,48,50-56,58,59,62-69,71-75,77-85,88-90,92,94-102,105-120,122-136,138,140-153,155,157-165,167-179,181-184,186-198,230,231 and the (n = 62) articles of balance confidence, 4,6,8,14,44,71,78,81,83,94,134,138,143,145,147,148,150,151,153,155,157,159,163,165,172,175-178,183,193,196,199-203,205-209,211-229 29.2% and 19.4% respectively, included male sex exclusively. There were only (n = 2) studies with female participants, one balance article 231 and one balance confidence article.…”

“…Looking at the protocols and tests, the most commonly found was the Berg Balance Scale, or selected items of the Berg Balance Scale (Figure 2). 14,31,73,80-82,93,94,103,107,118-120,138-140,144,147-168 Timed Up and Go 76,107,117,144,145,148,149,151,162,163,165,169-180 and Limits of Stability tests 12,13,20,25,30,37,42,46,47,59,71,72,74,83,84,89 were common (Figure 2). One leg stance test appeared with various names in about some studies.…”

“…Studies that explicitly stated limitations or confounders were just over two-thirds of the total (Table 2),. 13,14,19–22,24,28–56,71,74,76,77,80–95,108,109,115–132,140–145,147–165,169–180,182–184,188–191,193–198 The most commonly mentioned limitation was small sample size, 20,22,24,28,29,32,33,35,37,39,40,42,45,47,52,54-57,74,80,82,86,87,89,93,95,109,118,119,121,123,126,129,141,143,145,148,149,154-159,161,164,169,172,183,198 followed by generalizability issues, 14,19-21,34,38,41,42,44,52-56,80,81,87,89,109,127-130,142,148,151,155,156,162,171,175-177,184,188,189,191,193,196 recall bias, 14,148,150,157,171,173,182,184 heterogeneous groups, 29,42,54,89,142,174,176,177 homogenous groups, 21,38,39,44,45,91,164 and convenience samples. 14,161,176,177,196…”

“…13,71-108,110 Some few studies used plantar force sensor insoles, 50,112-114,139 inertial or accelerometer sensors, 95,140-142 instrumented mat or walkway, 117,124,143 or a plantar pressure platform (Figure 2). 49,61,111,144-146…”

“…In a large majority of the balance confidence studies, the Activities-Specific Balance Confidence Scale, or the modified version Activities-Specific Balance Confidence Scale-6, was used to measure balance confidence or fear of falling (Figure 2). 4,6,14,44,46,78,81,83,138,143,145,147,148,150,151,153-157,159,165,172,175-178,183,193,196,199-225 Two other tests were used a handful of times: FES/mFES/FES-I 71,163,206,226,227 and the Houghton scale (Figure 2). 155,178,204,228 Some studies posed a simple yes-or-no question to assess fear of falling, 8,94,216,224,225 while others used a numeric rating scale (Figure 2).…”