Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey

Devan, Hemakumar; Hendrick, Paul; Hale, Leigh; Carman, Allan; Dillon, Michael P.; Ribeiro, Daniel Cury

doi:10.1016/j.pmrj.2017.02.004

Cited by 29 publications

(44 citation statements)

References 59 publications

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“…The search identified 20 relevant studies, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] reporting back pain and 14 studies, 5-8, 11, 13, 20, 24-30 on osteoarthritis. The prevalence of back pain is increased for amputees in comparison to the able-bodied population.…”

Section: Resultsmentioning

confidence: 99%

Back Pain and Osteoarthritis as Secondary Disabilities of Lower Limb Amputation

Pröbsting

Kannenberg²,

Blumentritt

2018

Can. Prosthet. Orthot. J.

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INTRODUCTION Long-term damages after lower extremity amputation have previously been analysed in three systematic reviews 5–7 showing that amputees have a higher risk for developing knee and hip osteoarthritis on the sound side. The altered gait pattern appears to increase the load on the sound side.1–3 This paper analysed the extent to which the above described assumption is supported by the scientific literature with specific focus on the risk of developing back pain and osteoarthritis in amputees. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32034/24450 How to cite: Pröbsting E, Kannenberg A, Blumentritt S. BACK PAIN AND OSTEOARTHRITIS AS SECONDARY DISABILITIES OF LOWER LIMB AMPUTATION. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32034 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/

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Section: Resultsmentioning

confidence: 99%

Back Pain and Osteoarthritis as Secondary Disabilities of Lower Limb Amputation

Pröbsting

Kannenberg²,

Blumentritt

2018

Can. Prosthet. Orthot. J.

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“…This supports previous studies in which individuals with phantom limb pain had an increased risk of also having LBP. 14,43 Together, they suggest that addressing phantom limb pain early in the postoperative period may be an important component in managing LBP.…”

Section: Discussionmentioning

confidence: 99%

“…Due in part to the aging population and an increase in prevalence of those living with diabetes, the number of Americans with an amputation is projected to double by the year 2050 . Reported risk factors for affecting the presence and intensity of LBP that are unique to individuals with amputation include musculoskeletal imbalance secondary to altered gait mechanics and postural changes, deconditioning, poor prosthetic fit, leg‐length discrepancy, amputation level, multiple comorbidities, and presence of phantom limb or residual pain . Results are mixed; however, the majority of studies report that individuals with transfemoral amputation (TFA) tend to have a higher prevalence of LBP compared with those with transtibial amputation …”

Section: Introductionmentioning

confidence: 99%

“…8,11 Reported risk factors for affecting the presence and intensity of LBP that are unique to individuals with amputation include musculoskeletal imbalance secondary to altered gait mechanics and postural changes, deconditioning, poor prosthetic fit, leglength discrepancy, amputation level, multiple comorbidities, and presence of phantom limb or residual pain. [12][13][14][15][16][17] Results are mixed; however, the majority of studies report that individuals with transfemoral amputation (TFA) tend to have a higher prevalence of LBP compared with those with transtibial amputation. 1,2,4,5 Between 1996 and 2013, diabetes and the combination of low back and neck pain accounted for the first and third, respectively, highest health care spending in the United States and together were the conditions with the largest increase in health care spending over the 18-year period.…”

Section: Introductionmentioning

confidence: 99%

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Low Back Pain in Adults With Transfemoral Amputation: A Retrospective Population‐Based Study

Luetmer

Mundell

Kremers

et al. 2019

PM&R

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Background Low back pain (LBP) is common among individuals with transfemoral amputation (TFA) and has a negative impact on quality of life. Little is known about health care utilization for LBP in this population and whether utilization varies by amputation etiology. Objective To determine if individuals with TFA have an increased likelihood of seeking care or reporting symptoms of acute or chronic LBP during physician visits after amputation compared with matched individuals without amputation. Design Retrospective cohort. Setting Olmsted County, Minnesota (2010 population: 144 248). Participants All individuals with incident TFA (N = 96), knee disarticulation, and transfemoral amputation residing in Olmsted County between 1987 and 2014. Each was matched (1:10 ratio) with non‐TFA adults on age, sex, and duration of residency. Individuals were divided by etiology of amputation: dysvascular and trauma/cancer. Interventions Not applicable. Main Outcome Measurements Death and presentation for evaluation of LBP (LBP event) while residing in Olmsted County. LBP events were identified using validated International Classification of Diseases, Ninth Revision (ICD‐9) codes and corresponding Berkson, Hospital International Classification of Diseases Adapted (HICDA), and ICD‐10 diagnostic codes. Hurdle and competing‐risk Cox proportional hazard models were used. Results Having a TFA of either etiology did appear to correlate with increased frequency of LBP events, although this association was only statistically significant within the dysvascular TFA cohort (dysvascular TFA cohort: relative risk [RR] 1.80, 95% confidence interval [CI] 1.07‐3.03, median follow‐up 0.78 years; trauma/cancer TFA cohort: RR 1.14, 95% CI 0.58‐2.22, median follow‐up 7.95 years). In time to event analysis, dysvascular TFA had an increased risk of death and event. Obesity did not significantly correlate with increased frequency of LBP events or time to event for either cohort. At any given point in time, individuals with TFA of either etiology who had phantom limb pain were 90% more likely to have an LBP event (hazard ratio [HR] 1.91, 95% CI 1.11‐3.31). Conditional on not dying and no LBP event within the first 2.5 years, individuals with prosthesis had a decreased risk of LBP events in subsequent years. Conclusions Risk of LBP events appears to vary by TFA etiology. Obesity did not correlate significantly with increased frequency of LBP event or time to event. Phantom limb pain correlated with decreased time to LBP event after amputation. The association between prosthesis receipt and LBP events is ambiguous. Level of Evidence III.

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“…Such biomechanical benefits, if any, could pave the way for them to reproduce a normalized gait similar to the healthy limb in comparison to their predicate MPK device. Additionally improving body biomechanics in transfemoral amputees could potentially minimize the risk of exposure of the low back region and contralateral side, to abnormal loading-based secondary musculoskeletal injuries in transfemoral amputees (a serious health-concern in transfemoral amputees; Devan et al, 2017 ). Consequently, this case series investigated the potential benefits the PKA could offer to transfemoral amputees who are currently using a MPK as their predicate device.…”

Section: Introductionmentioning

confidence: 99%

Impact of Powered Knee-Ankle Prosthesis on Low Back Muscle Mechanics in Transfemoral Amputees: A Case Series

et al. 2018

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Regular use of prostheses is critical for individuals with lower limb amputations to achieve everyday mobility, maintain physical and physiological health, and achieve a better quality of life. Use of prostheses is influenced by numerous factors, with prosthetic design playing a critical role in facilitating mobility for an amputee. Thus, prostheses design can either promote biomechanically efficient or inefficient gait behavior. In addition to increased energy expenditure, inefficient gait behavior can expose prosthetic user to an increased risk of secondary musculoskeletal injuries and may eventually lead to rejection of the prosthesis. Consequently, researchers have utilized the technological advancements in various fields to improve prosthetic devices and customize them for user specific needs. One evolving technology is powered prosthetic components. Presently, an active area in lower limb prosthetic research is the design of novel controllers and components in order to enable the users of such powered devices to be able to reproduce gait biomechanics that are similar in behavior to a healthy limb. In this case series, we studied the impact of using a powered knee-ankle prostheses (PKA) on two transfemoral amputees who currently use advanced microprocessor controlled knee prostheses (MPK). We utilized outcomes pertaining to kinematics, kinetics, metabolics, and functional activities of daily living to compare the efficacy between the MPK and PKA devices. Our results suggests that the PKA allows the participants to walk with gait kinematics similar to normal gait patterns observed in a healthy limb. Additionally, it was observed that use of the PKA reduced the level of asymmetry in terms of mechanical loading and muscle activation, specifically in the low back spinae regions and lower extremity muscles. Further, the PKA allowed the participants to achieve a greater range of cadence than their predicate MPK, thus allowing them to safely ambulate in variable environments and dynamically control speed changes. Based on the results of this case series, it appears that there is considerable potential for powered prosthetic components to provide safe and efficient gait for individuals with above the knee amputation.

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Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey

Abstract: Ethical approval: The University of Otago Ethics Committee approved this study. All participants gave written informed consent along with returned surveys.

Cited by 29 publications

References 59 publications

Back Pain and Osteoarthritis as Secondary Disabilities of Lower Limb Amputation

Back Pain and Osteoarthritis as Secondary Disabilities of Lower Limb Amputation

Low Back Pain in Adults With Transfemoral Amputation: A Retrospective Population‐Based Study

Impact of Powered Knee-Ankle Prosthesis on Low Back Muscle Mechanics in Transfemoral Amputees: A Case Series

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