Rehabilitation and the long-term outcomes of persons with trauma-related amputations

Pezzin, Liliana E.; Dillingham, Timothy R.; MacKenzie, Ellen J.

doi:10.1016/s0003-9993(00)90074-1

Cited by 244 publications

(133 citation statements)

References 12 publications

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“…Differences between group scores were approximately 5 points, which are within the established MID of 4–6 points. 32 Previous studies have found greater experiences of pain in people with LLL compared to people without LLL, 1,2,34,35 and one study found that more than 90% of 255 participants with LLL reported chronic experiences with pain. 11 Additionally, participants with dysvascular etiology had significantly greater pain interference than people with traumatic etiology.…”

Section: Discussionmentioning

confidence: 98%

“…1–8 Limited mobility often persists in the months and years following limb amputation. 2–4,9 LLL is also associated with other physical and mental health problems, such as pain (e.g., phantom limb, 10,11 residuum, 10,11 and back pain 12,13 ) and depression. 10 Health indicators in people with LLL also differ by factors such as level of amputation and etiology.…”

mentioning

confidence: 99%

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Health-Related Profiles of People With Lower Limb Loss

Amtmann

Morgan

Kim

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Objective To construct profiles of self-reported health indicators to examine differences and similarities between people with lower limb loss (LLL) and a normative sample (hereafter called the norm), and to compare health indicators between subgroups based on level and etiology of limb loss. Design Survey Setting General community Participants Adults with unilateral lower limb loss (n=1091) participated in this study. Eligibility criteria included LLL resulting from trauma or dysvascular complications and regular use of a prosthesis. Interventions Not applicable Main Outcome Measures Patient-Reported Outcomes Measurement Information System 29-item profile (PROMIS-29) version 1.0 measures physical function, pain interference, fatigue, sleep disturbance, anxiety, depression and satisfaction with participation in social roles. The norms are based on 5,239 individuals representative of the U.S. general population in gender, age, race, ethnicity and education. Results People with LLL reported statistically significantly worse physical function, pain interference and satisfaction with participation in social roles and significantly less fatigue than the norm. People with transfemoral (i.e., above-knee) amputation significantly differed from people with transtibial (i.e., below-knee) amputation on physical function. Similarly, people with amputation due to trauma and dysvascular etiology significantly differed on physical function and satisfaction with social roles after adjusting for relevant clinical characteristics. Conclusions People with LLL generally report worse physical function, pain interference and satisfaction with social roles when compared to norm. People with dysvascular amputation reported worse physical function and satisfaction with social roles than people with traumatic amputation. Health indicator profiles are an efficient way of providing clinically meaningful information about numerous aspects of self-reported health in people with LLL.

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Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

Health-Related Profiles of People With Lower Limb Loss

Amtmann

Morgan

Kim

et al. 2015

Archives of Physical Medicine and Rehabilitation

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“…Specifically, TFA has been associated with decreased balance [1][2][3][4][5]; increased metabolic energy expenditure while walking [6][7][8][9]; decreased walking speed [7,[10][11]; increased frequency of stumbles and falls [12][13]; reduced activity level [14][15][16]; and difficulties negotiating uneven terrain, hills, and stairs [17][18][19][20]. These physical impairments and functional limitations likely contribute to the reduced health-related quality of life (HRQOL) [21][22][23][24] reported by people with TFA compared with nonamputee (nondisabled) norms [25][26]. Interventions capable of addressing the challenges inherent to proximal lower-limb amputations are therefore much desired and are considered vital to the rehabilitation of individuals with TFA.…”

Section: Introductionmentioning

confidence: 99%

Physical performance and self-report outcomes associated with use of passive, adaptive, and active prosthetic knees in persons with unilateral, transfemoral amputation: Randomized crossover trial

Hafner¹,

Askew²

2015

J Rehabil Res Dev

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Abstract-Prosthetic knees are a vital component in an artificial limb. Contemporary knees include passive (mechanical), adaptive (computerized), or active (motorized) control systems and have the potential to mitigate amputation-related functional impairments and activity limitations. A 14 mo randomized crossover trial was conducted. Participants (n = 12, mean age = 58 yr) were tested under three conditions: passive control (existing knee), adaptive control (Ossur Rheo Knee II), and active control (Ossur Power Knee II). Training and acclimation time were provided to participants in the adaptive and active knees. Outcome measures included indoor tests (Timed Up and Go test [TUG], stairs, and ramp), outdoor tests (walking course and perceived exertion), step activity monitor, self-report surveys (mobility, balance confidence, physical function, fatigue, and general health), and fall incidence. Mixed-effects linear regression modeling was used to evaluate data. Compared with passive control, adaptive control significantly improved comfortable TUG time (difference = 0.91 s, p = 0.001) and reported physical function (difference = 1.26 [T-score], p = 0.03). Active control significantly increased comfortable TUG, fast TUG, and ramp times (difference = 3.02, 2.66, and 0.96 s, respectively, all p < 0.03) and increased balance confidence (difference = 3.77, p = 0.003) compared with passive control. Findings suggest that adaptive knee control may enhance function compared with passive control but that active control can restrict mobility in middle-age or older users with transfemoral amputation.

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“…LLL may also affect patients' health-related quality of life (HRQL), as suggested by lower 36-Item Short-Form Health Survey (SF-36) scores [48][49][50][51] among individuals with TFLL than nondisabled individuals [52][53]. Correspondingly, surgical, medical, therapeutic, and prosthetic interventions that address these challenges are considered important to the successful rehabilitation of individuals with TFLL.…”

Section: Introductionmentioning

confidence: 99%

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.

show abstract

Rehabilitation and the long-term outcomes of persons with trauma-related amputations

Cited by 244 publications

References 12 publications

Health-Related Profiles of People With Lower Limb Loss

Health-Related Profiles of People With Lower Limb Loss

Physical performance and self-report outcomes associated with use of passive, adaptive, and active prosthetic knees in persons with unilateral, transfemoral amputation: Randomized crossover trial

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

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