The impact a surgeon has on primary amputee prosthetic rehabilitation: A survey of residual lower limb quality

2018 ◽  
Vol 42 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Sellaiah Sooriakumaran ◽  
Maggie Uden ◽  
Sarah Mulroy ◽  
David Ewins ◽  
Thomas Collins
Keyword(s):  
Lower Limb ◽  
Limb Amputation ◽  
Residual Limb ◽  
Surgical Results ◽  
Prosthetic Rehabilitation ◽  
Rehabilitation Centre ◽  
Rehabilitation Professionals ◽  
High Standards ◽  
Key Aspects ◽  
The Impact

Background: Substantial improvements have been perceived in surgical results following major lower limb amputation, but there remains observed variation in amputation quality for patients referred for prosthetic rehabilitation from different hospitals. Objectives: To assess various elements that influence residual limb quality and evaluate their impact on progress through initial prosthetic rehabilitation and mobility outcome after rehabilitation. Study design: Clinical survey. Methods: A revised 10-item residual limb scoring system was used to survey a succession of 95 primary amputees with transtibial and transfemoral amputations (100 residual limbs) presenting for rehabilitation. Results: The majority of residual limbs scored highly, supporting the perception of generally good amputation quality. There were significant differences in average residual limb scores between some hospitals. The overall scores showed weak or minimal correlation to progress through rehabilitation and mobility outcome but residual limbs scoring higher in seven of the items of the score showed significant advantages in key aspects of progress or mobility at discharge. Conclusion: There is need for continued collaboration between surgeons and rehabilitation centres to ensure consistent high standards. The revised residual limb score used in this survey needs further refinement for future use. Clinical relevance Residual limb quality is an important component influencing prosthetic rehabilitation. This survey of residual limbs at one Rehabilitation Centre suggests encouragingly good surgical results but highlights differences between hospitals. A particular issue is the need for effective collaboration between surgeons and prosthetic rehabilitation professionals to optimise residual limb preparation.

scholarly journals Obesity and Skin Problems in Persons With a Lower Limb Amputation: An Observational Study

2021 ◽  
Author(s):  
Terezka S. Mollee ◽  
Pieter U. Dijkstra ◽  
Rienk Dekker ◽  
Jan H.B. Geertzen
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Confidence Interval ◽  
Body Mass ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Residual Limb ◽  
Prevalence Of Obesity ◽  
The Impact

Abstract Background: A lower limb amputation can lead to weight gain and obesity. However, data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results: In total, 413 persons were enrolled. Of them, 39% (95% confidence interval 35%−44%) was overweight and 28% (95% confidence interval 24%−33%) was obese. A total of 77% (95% confidence interval 73%−81%) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0−8.9)). Conclusion: Our findings show that obesity is common in the ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

scholarly journals The association between body mass index and skin problems in persons with a lower limb amputation: an observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Terezka S. Mollee ◽  
Pieter U. Dijkstra ◽  
Rienk Dekker ◽  
Jan H.B. Geertzen
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Confidence Interval ◽  
Body Mass ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Residual Limb ◽  
Prevalence Of Obesity ◽  
The Impact

Abstract Background Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. Methods A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects’ body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. Results In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). Conclusions Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

scholarly journals USING PERFORATED LINERS TO COMBAT THE DETRIMENTAL EFFECTS OF EXCESSIVE SWEATING IN LOWER LIMB PROSTHESIS USERS

2020 ◽  
Vol 3 (2) ◽  
Author(s):  
Katherine C. Davies ◽  
Mike McGrath ◽  
Alison Stenson ◽  
Zoe Savage ◽  
David Moser ◽  
...  
Keyword(s):  
Lower Limb ◽  
The Body ◽  
Limb Amputation ◽  
Control Group ◽  
Residual Limb ◽  
Excessive Sweating ◽  
Lower Limb Prosthesis ◽  
Skin Conditions ◽  
The Impact ◽  
Limb Prosthesis

BACKGROUND: Excessive sweating of the residual limb has a substantial effect on the daily activities of people with lower limb amputation. Prosthetic liners offer protection and comfort to sensitive areas but often exacerbate perspiration. They act as insulators, trapping sweat on the skin’s surface to the detriment of skin health. Recently, liners with perforations have been developed, allowing the moisture to escape. The goal of this study was to assess the impact of such liners. METHODS: A sample group of 13 patients with unilateral transtibial amputation, who wore a perforated liner (PL) as part of their current prescription, was compared to 20 control patients who wore non-perforated liners (NPL). During their routine appointments, they completed a survey of scientifically validated outcome measures relating to their limb health, pain and the impact on daily life over a 12-month period. RESULTS: Patients using the PL had healthier residual limbs, reporting higher scores on questions relating to limb health, experiencing fewer skin issues (p<0.001) and estimating a 61.8% lower rating in perceived sweat (p=0.004). Perhaps consequentially, there was a lower incidence of residual (p=0.012) and phantom (p=0.001) limb pain when compared to the control group. The prevalence of individual issues affecting the residual limbs of PL users was also lower. Of the issues that remained, only 23% were attributed to sweating in PL users, compared to 49% for the NPL group (p=0.066). PL users missed fewer days of work in the year (2.4 vs 11.6, p=0.267) and were also limited on fewer days (1.4 vs 75.4, p=0.009). CONCLUSION: The use of perforated liners shows much promise within prosthetic care, significantly improving the health of the residual limb. The observed effects on perceived sweat reduction, residual skin health, pain levels and patient limitation suggest that perforated liners are highly beneficial to patients. Layman's Abstract Individuals with amputation often find that they sweat more as they exert more energy when walking and because the total surface area of their body is reduced. Silicone liners are used to cushion the residual limb and as a way of attaching a prosthetic leg, but they act as insulators causing the residual limb to get hot and sweaty. The material isn’t breathable, so the sweat is not able to escape, instead staying on the skin’s surface and causing discomfort or leading to the development of skin conditions. Liners that have small holes in them allow sweat to travel away from the body and preserve skin health. Patients who wore a perforated liner, as well as patients who wore a liner without holes, filled in questionnaires about their experience, the results of which were compared. Generally, patients who wore the perforated liner had healthier skin on their residual limbs and experienced fewer skin conditions than the other patient group. Out of the issues they did experience, fewer were attributed to sweating. The study group experienced less frequent pain both in their physical and phantom limbs. They also considered themselves less limited by their prosthetic device and missed fewer days of work. These observations suggest that perforated liners are highly beneficial to patients within the prosthetic field. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/34610/26579 How To Cite: Davies K.C, McGrath M, Savage Z, Stenson A, Moser D, Zahedi S. Using perforated liners to combat the detrimental effects of excessive sweating in lower limb prosthesis users. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.1. https://doi.org/10.33137/cpoj.v3i2.34610 Corresponding Author: K.C Davies, Blatchford Group, Unit D Antura, Bond Close, Basingstoke, RG24 8PZ, UK.E-mail: [email protected]: https://orcid.org/0000-0003-2933-4365

Aggressive Soft Tissue Infections and Amputation in Military Trauma Patients

2012 ◽  
Vol 98 (2) ◽  
pp. 14-20
Author(s):  
JG Penn-Barwell ◽  
CA Fries ◽  
ID Sargeant ◽  
PM Bennett ◽  
K Porter
Keyword(s):  
Lower Limb ◽  
Surgical Techniques ◽  
Current Treatment ◽  
Limb Amputation ◽  
Trauma Patients ◽  
Residual Limb ◽  
Amputation Level ◽  
Military Trauma ◽  
Limb Injuries ◽  
The Impact

AbstractDue to the nature of IED injuries, during the conflicts in Iraq and Afghanistan The traditional, two-stage amputation for unsalvageable combat lower limb injuries has evolved into a strategy of serial debridement and greater use of plastic surgical techniques in order to preserve residual limb length. This study aimed to characterise the current treatment of lower limb loss with particular focus on the impact of specific wound infections. The UK military trauma registry and clinical notes were reviewed for details of all lower limb amputation identifying: 51 patients with 70 lower limb amputations. The mean number of debridements per stump prior to closure was 4.1 (95% CI 3.5-4.7). A final more proximal amputation level was required in 21 stumps (30%). Recovery of A. hydrophillia from wounds was significantly associated with a requirement for a more proximal amputation level (p=0.0038) and greater number of debridements (p=0.0474) when compared to residual limb wounds without A. hydrophillia.

scholarly journals A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa

2017 ◽  
Vol 42 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Liezel Ennion ◽  
Anton Johannesson
Keyword(s):  
South Africa ◽  
Lower Limb ◽  
Rural Setting ◽  
Limb Amputation ◽  
Prosthetic Rehabilitation ◽  
Rural South ◽  
Physical Strength ◽  
District Hospitals ◽  
Fitting In ◽  
Rural South Africa

Background: There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis. Objective: To explore therapists’ experiences with providing pre-prosthetic rehabilitation in a rural setting. Study design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa. Results: The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists’ ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services. Conclusion: Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.

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.

The Impact of Comorbidities on Rehabilitation and Functional Outcomes Following Lower Limb Amputation

2017 ◽  
Vol 98 (10) ◽  
pp. e118
Author(s):  
Michael Juszczak ◽  
Leif Nelson ◽  
Jason Maikos ◽  
Jeffrey Cohen ◽  
Jeffrey Heckman ◽  
...  
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
The Impact

scholarly journals From outcome measurement to improving health outcomes following lower limb amputation - making outcome measurement work from a clinical practice perspective

2020 ◽  
Author(s):  
Chantel Ostler ◽  
Helen Scott ◽  
Imad Sedki ◽  
Sisary Kheng ◽  
Maggie Donovan-Hall ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Outcomes ◽  
Lower Limb ◽  
Care Delivery ◽  
Outcome Measurement ◽  
Narrative Review ◽  
Successful Outcome ◽  
Prosthetic Rehabilitation ◽  
Clinical Narrative ◽  
The Impact

Background: Outcome measurement is essential to understand the impact of clinical interventions and the performance of services. Despite national and professional encouragement outcome measurement has failed to become embedded in clinical practice and its value continues to be questioned. Objectives: To address the outcome measurement debate within lower limb prosthetic rehabilitation and provide a critical synthesis of the evidence surrounding the discussion applied within the clinical context of the UK National Health Service (NHS).Study Design: Narrative review Methods: The authors drew on over 20 years clinical experience in prosthetic rehabilitation to synthesise and critique the outcome literature across a breadth of healthcare services. A narrative review methodology was selected to give voice to the clinical narrative thread.Results: This review addresses why we should measure health outcomes, the health care delivery and organisational scenarios in which outcome measurement can be beneficial and explores where lessons can be learnt for prosthetic rehabilitation from approaches in different specialities. The current outcome measurement literature within prosthetic rehabilitation is critiqued and we discuss the issues facing this field in the future.Conclusions: The dilemma of successful outcome measurement in clinical practice is multifaceted. Understanding and embedding value at every step is key to success. Addressing the questions of `why’, `what’ and `how’ we measure outcome will move us closer to a national consensus. Routine outcome measurement implementation at the clinical level must ensure data collection is valuable to clinical practice, makes use of IT solutions and has all important organisational buy in.

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