The influence of balance confidence on social activity after discharge from prosthetic rehabilitation for first lower limb amputation

2011 ◽  
Vol 35 (4) ◽  
pp. 379-385 ◽  
Author(s):  
William C Miller ◽  
A Barry Deathe
Keyword(s):  
Lower Limb ◽  
Social Activity ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability ◽  
Prosthetic Rehabilitation ◽  
Post Discharge ◽  
Balance Confidence ◽  
Confidence Levels

Background: Community living individuals with lower limb amputation have low balance confidence but the level of balance confidence in the first six months after discharge from prosthetic rehabilitation is not known.Objectives: To determine if balance confidence levels differ after discharge from prosthetic rehabilitation and to determine if balance confidence at discharge predicts social activity at three months post-discharge while controlling for important covariates such as walking ability.Study Design: Prospective study.Methods: Subjects ( n = 65) experiencing their first unilateral transfemoral or transtibial amputation were recruited and followed-up one and three months post-discharge. Measures of balance confidence (Activities-specific Balance Confidence Scale) and walking ability (L Test) collected at discharge were used to predict social activity (Frenchay Activities Index) at follow-up.Results: Despite a 14-second mean improvement in walking ability the mean balance confidence scores did not change significantly between discharge (71.2/100) and at three-month follow-up (69.4/100). Confidence scores and basic walking ability at discharge were the two strongest predictors of three-month social activity. Multiple regression modelling indicated that balance confidence and walking ability explained 64% of the variance (standardized beta = 0.34 and -0.37 respectively) in social activity (adjusted R2 = 39%).Conclusions: Balance confidence after discharge from prosthetic rehabilitation for lower limb amputation is low and scores do not improve over the first three months post-discharge despite improvements in walking ability. Discharge balance scores confidence independently predicts three-month social activity scores.

The effect of a supervised community–based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation

2017 ◽  
Vol 41 (5) ◽  
pp. 446-454 ◽  
Author(s):  
Carol A Miller ◽  
Jennifer E Williams ◽  
Katey L Durham ◽  
Selena C Hom ◽  
Julie L Smith
Keyword(s):  
Lower Limb ◽  
Repeated Measures ◽  
Exercise Program ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability ◽  
Walk Test ◽  
Community Based ◽  
Balance Confidence ◽  
Confidence Scale

Background:Many individuals with lower limb loss report concern with walking ability after completing structured traditional rehabilitation.Objectives:The purpose of this study was to explore the impact of a supervised community–based exercise program on balance, balance confidence, and gait in individuals with lower limb amputation.Study design:Repeated measures.Methods:The supervised exercise program was offered biweekly for 6 weeks. The GAITRite System by CIR Systems, Inc., the Figure-of-8 Walk Test, and Activity-specific Balance Confidence Scale were used to measure clinical outcomes pre- and post-intervention.Results:In total, 16 participants with lower limb amputation (mean age: 50.8 years) completed the study. A multivariate, repeated measures analysis of variance indicated a statistically significant effect of training across six clinical outcome measures ( F(6, 10) = 4.514, p = .018). Moderate effect sizes were found for the Figure-of-8 Walk Test ( η2= .586), Activity-specific Balance Confidence Scale ( η2= .504), and gait velocity at comfortable walking speed ( η2= .574). The average increase in gait speed was clinically meaningful at .14 m/s.Conclusion:The supervised community–based exercise program implemented in this study was designed to address specific functional needs for individuals with lower limb loss. Each participant experienced clinically meaningful improvements in balance, balance confidence, and walking ability.Clinical relevanceThe provision of a supervised community–based exercise program, after traditional rehabilitation, provides opportunity to offer a continuum of care that may enhance prosthetic functional ability and active participation in the community for individuals with lower limb amputation.

scholarly journals Rates and risk factors for amputation in people with diabetes in Japan: a historical cohort study using a nationwide claims database

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Masanori Kaneko ◽  
Kazuya Fujihara ◽  
Mayuko Yamada Harada ◽  
Taeko Osawa ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cox Regression ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Historical Cohort ◽  
Cox Regression Analysis ◽  
Claims Database ◽  
Younger Age

Abstract Background The prevalence of diabetes is rising, and diabetes develops at a younger age in East Asia. Although lower limb amputation negatively affects quality of life and increases the risk of cardiovascular events, little is known about the rates and predictors of amputation among persons with diabetes from young adults to those in the “young-old” category (50–72 y). Methods We analyzed data from a nationwide claims database in Japan accumulated from 2008 to 2016 involving 17,288 people with diabetes aged 18–72 y (mean age 50.2 y, HbA1c 7.2%). Amputation occurrence was determined according to information from the claims database. Cox regression model identified variables related to lower limb amputation. Results The mean follow-up time was 5.3 years, during which time 16 amputations occurred (0.17/1000 person-years). Multivariate Cox regression analysis showed that age (hazard ratio [HR] 1.09 [95% confidence intervals] 1.02–1.16, p = 0.01) and HbA1c (HR 1.46 [1.17–1.81], p < 0.01) were independently associated with amputations. Compared with those aged < 60 years with HbA1c < 8.0%, the HR for amputation was 27.81 (6.54–118.23) in those aged ≥60 years and HbA1c ≥8.0%. Conclusions Age and HbA1c were associated with amputations among diabetic individuals, and the rates of amputation were significantly greater in those ≥60 years old and with HbA1c ≥8.0%.

scholarly journals Perineural local anaesthetic catheter after major lower limb amputation trial (PLACEMENT): results from a randomised controlled feasibility trial

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029233 ◽  
Author(s):  
David Bosanquet ◽  
Graeme Ambler ◽  
Cherry-Ann Waldron ◽  
Emma Thomas-Jones ◽  
Lucy Brookes-Howell ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Rating Scale ◽  
Lower Limb Amputation ◽  
Feasibility Trial ◽  
Limb Amputation ◽  
Effectiveness Trial ◽  
Randomised Controlled

ObjectivesTo determine the feasibility of undertaking a randomised controlled effectiveness trial evaluating the use of a perineural catheter (PNC) after major lower limb amputation with postoperative pain as the primary outcome.DesignRandomised controlled feasibility trial.SettingTwo vascular Centres in South Wales, UK.Participants50 patients scheduled for major lower limb amputation (below or above knee) for complications of peripheral vascular disease.InterventionsThe treatment arm received a PNC placed adjacent to the sciatic or tibial nerve at the time of surgery, with continuous infusion of levobupivacaine hydrochloride 0.125% for up to 5 days. The control arm received neither local anaesthetic nor PNC. Both arms received usual perioperative anaesthesia and postoperative analgesia.Primary and secondary outcome measuresThe primary outcomes were the proportion of eligible patients who were randomised and the proportion of recruited patients who provided primary effectiveness outcome data. Secondary outcomes were: the proportion of recruited patients reaching 2 and 6 month follow-up and supplying pain data; identification of key cost drivers; development of an economic analysis framework for a future effectiveness trial; identification of barriers to recruitment and site set-up; and identification of the best way to measure postoperative pain.ResultsSeventy-six of 103 screened patients were deemed eligible over a 10 month period. Fifty (64.5%) of these patients were randomised, with one excluded in the perioperative period. Forty-five (91.3%) of 49 recruited patients provided enough pain scores on a 4-point verbal rating scale to allow primary effectiveness outcome evaluation. Attrition rates were high; 18 patients supplied data at 6 month follow-up. Costs were dominated by length of hospital stay. Patients and healthcare professionals reported that trial processes were acceptable.ConclusionsRecruitment of patients into a trial comparing PNC use to usual care after major lower limb amputation with postoperative pain measured on a 4-point verbal rating scale is feasible. Evaluation of longer-term symptoms is difficult.Trial registration numberISRCTN: 85 710 690. EudraCT: 2016-003544-37.

Factors associated with mobility apprehension in persons with lower limb amputation

2020 ◽  
Vol 44 (4) ◽  
pp. 208-214
Author(s):  
Shannon L Mathis
Keyword(s):  
Standard Deviation ◽  
Lower Limb ◽  
Avoidance Behavior ◽  
Pain Catastrophizing ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability ◽  
Factors Associated ◽  
The Mean ◽  
The Impact

Background: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. Objectives: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. Study design: Cross-sectional study. Methods: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. Results: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension ( β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. Conclusion: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. Clinical relevance Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

scholarly journals Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

2016 ◽  
Vol 18 (2) ◽  
pp. 125-137 ◽  
Author(s):  
Jason T. Kahle ◽  
M. Jason Highsmith ◽  
Hans Schaepper ◽  
Anton Johannesson ◽  
Michael S. Orendurff ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability

Lower limb amputation Part 3: Prosthetics - a 10 year literature review

2001 ◽  
Vol 25 (1) ◽  
pp. 21-28 ◽  
Author(s):  
H. Cochrane ◽  
K. Orsi ◽  
P. Reilly
Keyword(s):  
Literature Review ◽  
Lower Limb ◽  
Consensus Conference ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Amputation Surgery

This paper is intended as a follow-up to the ISPO Consensus Conference on Amputation Surgery. It reviews all the literature on lower limb prosthetics published after 1990. The review was considered under six categories: feet, knees, hips, thermoplastics, liners/suspension and computers.

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