Prevalence of comorbidity and its association with demographic and clinical characteristics in persons wearing a prosthesis after a lower-limb amputation

Objective: To describe the prevalence of comorbidity and its relationship with demographic and clinical characteristics in persons wearing a prosthesis after lower-limb amputation. Design: Cross-sectional study. Subjects/patients: Persons wearing a prosthesis after lower-limb amputation (n = 171; mean age 65 years (standard deviation 12); 72% men) at the end of outpatient rehabilitation treatment. Methods: Comorbidity was assessed with the Functional Comorbidity Index: a list of 18 items addressing the presence of specific comorbid conditions impacting on functional status. Comorbidities in medical records were assessed independently by 2 assessors. Associations with demographic and clinical characteristics were analysed using linear or logistic regression. Results: The median (interquartile range) number of comorbidities was 3 (2; 4). Three or more comorbidities were present in 103 of 171 (60%) participants. Diabetes was present in 71 (41%), cardiac disease in 60 (35%), and lumbago/degenerative disc disease in 39 (23%) participants. The prevalence of comorbidities was higher in women and those with vascular cause of amputation. Conclusion: There is a high prevalence of comorbidity at the end of outpatient rehabilitation treatment in persons wearing a prosthesis after a lower-limb amputation, especially in women and those with vascular cause of amputation

Perceived independence and limitations in rising and sitting down after rehabilitation for a lower-limb amputation

Objective: To study perceived independence in rising and perceived limitations in rising and sitting down in persons after a lower-limb amputation and the relationship of these perceptions with personal and clinical characteristics. Design: Cross-sectional study. Subjects/patients: Persons with a lower-limb amputation wearing a prosthesis (n=172). Methods: Perceived independence in rising was assessed with the Locomotor Capabilities Index. Limitations in rising and sitting down were assessed with the Questionnaire Rising and Sitting down. Multivariate logistic and linear regression analyses, respectively, were used to investigate the associations between independence and limitations in rising and sitting down, and personal and clinical characteristics. Results: Of the participants, 91% and 47% perceived independence in rising from a chair and rising from the floor, respectively. Older participants and women perceived less independence in rising. Participants perceived marked limitations in rising and sitting down, with those rehabilitated in a nursing home perceiving more limitations. Conclusion: After a lower-limb amputation, most persons wearing a prosthesis are able to rise independently from a chair, but many perceive decreased independence in other forms of rising, especially older participants and women. Participants, especially those rehabilitated in a nursing home, perceive considerable limitations in rising and sitting down. However, in those patients rehabilitated in a nursing home these limitations may be due to indication bias

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Development of a cosmetic knee disarticulation prosthesis:A single-patient case study

Background and aim: If a person does not become ambulant after an amputation, a knee disarticulation (KD) shouldbe considered and the person may then benefit from a cosmetic KD prosthesis. The features of a cosmetic KD prosthesis are, however, seldom described. The aim of this clinical note is to describe the development of a cosmeticKD prosthesis. Technique: A non-ambulant person with bilateral KD formulated, together with her physiatrist, the criteria for a cosmetic KD prosthesis. On the basis of these, a lightweight, natural-looking, well-fitting, easy-to-put-on and take-off KD prosthesis, with no thigh lengthening during sitting, was made. This prosthesis was fixed on a wheelchair and does not impede transfer. Discussion: A newly constructed cosmetic prosthesis for non-ambulant persons with a KD is described in detail. We hope that this will encourage physiatrists and prosthetists to offer non-ambulant persons with a KD a cosmetic prosthesis. Clinical relevance A cosmetic leg prosthesis with good cosmetic properties, good sitting comfort, and no restrictions in making transfers is described in detail for non-ambulant persons with a knee disarticulation

Climbing Stairs After Outpatient Rehabilitation for a Lower-Limb Amputation

<p>Objective: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables.</p><p>Design: Cross-sectional study.</p><p>Setting: Outpatient department of a rehabilitation center.</p><p>Participants: Persons with an LLA (N=155; mean age +/- SD, 64.1 +/- 11.2y; 73% men).</p><p>Interventions: Not applicable.</p><p>Main Outcome Measures: The necessity to climb stairs was assessed with the Prosthetic Profile of the Amputee. Several indicators of the ability to climb stairs were assessed including: (1) independence in climbing stairs with a handrail and (2) without a handrail, according to the Locomotor Capabilities Index; (3) numbers of floors actually climbed, according to a rating scale; and (4) limitations in climbing stairs, according to the Climbing Stairs Questionnaire (range, 0-100, with higher scores indicating less limitations). Multivariate logistic regression analysis was used to investigate the associations between the ability to climb stairs and personal and clinical variables.</p><p>Results: Of the participants, 47% had to climb stairs. The ability to climb stairs was: (1) 62% independently climbed stairs with a handrail and (2) 21% without a handrail; (3) 32% didn't climb any stairs, 34% climbed half a floor or 1 floor, and 34% climbed >= 2 floors; (4) the median sum score (interquartile range) of the Climbing Stairs Questionnaire was 38 (19-63), indicating marked limitations. Older participants and women were less able to climb stairs with and without a handrail.</p><p>Conclusions: A considerable number of persons with an LLA have to climb stairs in their home environment. Many of them, especially older participants and women, are particularly hampered in their ability to climb stairs. Archives of Physical Medicine and Rehabilitation 2013;94:1573-9 (C) 2013 by the American Congress of Rehabilitation Medicine</p>

Validation of a clinically feasible activity monitor which measures body postures and movements in adults with lower-limb amputation who wear a prosthesis

Purpose: A simple single-unit activity monitor (Activ8), which is based on a tri-axial accelerometer, measures specific body postures and movements, and has potential for research and clinical practice to monitor and optimize physical behavior of people with chronic conditions. However, the validity of the Activ8 in people with lower-limb amputation is unknown. Studying validity in this specific group is needed because they often have postures and movements that differ from the normal population, and which might affect validity. Therefore our study aimed to validate the Activ8 to measure body postures and movements in people with a lower-limb amputation. Methods: Thirty people with a unilateral lower-limb amputation and who are able to walk with a prosthesis completed two activity protocols in a simulated home setting: one with basic activities (only one posture or movement) and one with functional activities from daily living. Outcomes of the Activ8 (used in thigh-fixed position and pocket position) were compared to outcomes of video observation (the reference method). Primary analyses focused on the agreement in duration of merged measures of physical activity (walking, running, cycling, standing) and sedentary behavior (lying/sitting) with the Activ8 used in thigh-fixed position. Additional analyses included the detection of specific types of physical activity, the effects of amputation level and cause, and the validity of the Activ8 in pocket position. Results: Overall percentage time differences between Activ8 (thigh-fixed position) and video observation for merged measures of physical activity and sedentary behavior outcomes were −2.7% and 2.3%, respectively. These percentages were −1.6% and 1.3% for the basic protocol, and −3.9% and 3.6% for the functional protocol, respectively. For specific postures and movements, differences were larger (ranging from −12.6% to 7.1%). Conclusion: The Activ8 activity monitor has acceptable validity to measure physical activity and sedentary behavior in people with a unilateral lower-limb amputation

Cosmetic effect of knee joint in a knee disarticulation prosthesis

Despite numerous advantages, knee disarticulations (KDs) are rarely performed because of the anticipated KD prosthesis fitting problems that include the positioning of the knee joint distally from the KD socket. This results in lengthening of the thigh and subsequent shortening of the shank. The objective of this study was to assess the cosmetic effect of the knee joint in a KD prosthesis by determining the extent of the lengthening of the thigh and the shortening of the shank. This lengthening and shortening were measured through an experimental setup using laser techniques. These measurements were made of 18 knee joints used in KD prostheses. Lengthening of the thigh varied between 23 and 92 mm, and shortening of the shank varied between 3 and 50 mm. The polycentric knees Medi KH6 and Medi KHF1 showed the least lengthening of the thigh, and the polycentric knees Teh Lin Prosthetic & Orthotic Co. Ltd Graph-Lite and Medi KP5 showed the least shortening of the shank

Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial

Background: Fatigue is a frequently reported and disabling symptom in multiple sclerosis (MS).Objective: To investigate the effectiveness of an individual energy conservation management (ECM) intervention on fatigue and participation in persons with primary MS-related fatigue.Methods: A total of 86 severely fatigued and ambulatory adults with a definite diagnosis of MS were randomized in a single-blind, two-parallel-arm randomized clinical trial to the ECM group or the information-only control group in outpatient rehabilitation departments. Blinded assessments were carried out at baseline and at 8, 16, 26 and 52 weeks after randomization. Primary outcomes were fatigue (fatigue subscale of Checklist Individual Strength - CIS20r) and participation (Impact on Participation and Autonomy scale - IPA).Results: Modified intention-to-treat analysis was based on 76 randomized patients (ECM, n = 36; MS nurse, n=40). No significant ECM effects were found for fatigue (overall difference CIS20r between the groups = -0.81; 95% confidence interval (CI), -3.71 to 2.11) or for four out of five IPA domains. An overall unfavourable effect was found in the ECM group for the IPA domain social relations (difference between the groups = 0.19; 95% CI, 0.03 to 0.35).Conclusion: The individual ECM format used in this study did not reduce MS-related fatigue and restrictions in participation more than an information-only control condition

A modified Gritti-Stokes amputation technique as a solution for recurring aseptic loosening of a knee arthroplasty:A single-patient case study

Case Description: A 56-year-old man with persistent knee pain and poor physical functioning due to recurring loosening of a (revised) total knee arthroplasty, was treated with a modified Gritti-Stokes amputation. Objectives: to describe the modified Gritti-Stokes amputation technique as an ultimate therapy for failed total knee arthroplasty and to assess the functional outcome for one patient 1 year post-surgery. Study design: a single patient case study. Treatment: a modified Gritti-Stokes amputation, with removal of the overlying cartilage and subchondral surfaces of both the patella and femur after removing the total knee arthroplasty. Outcomes: After rehabilitation, the patient has a fully end-bearing residual limb, is able to walk without pain (with a prosthesis) and perform his daily activities. Conclusions: In cases of recurring loosening of a (revised) total knee arthroplasty, a modified Gritti-Stokes amputation can create an end-bearing residual limb without pain and with good functional outcome

Energy Conservation Management for People With Multiple Sclerosis-Related Fatigue: Who Benefits?

OBJECTIVE: We investigated whether demographic, disease-related, or personal baseline determinants can predict a positive response to energy conservation management (ECM). METHOD: We conducted a secondary analysis of a single-blind, two-parallel-arms randomized controlled trial that included ambulatory adults with severe MS-related fatigue. Therapy responders and nonresponders were categorized by Checklist Individual Strength fatigue change scores between baseline and end of treatment. Logistic regression analyses were used to assess the determinants of response. RESULTS: Sixty-nine participants were included (ECM group, n = 34; control group, n = 35). In the ECM group, fatigue severity, perception of fatigue, illness cognitions about MS, and social support discrepancies were related to the probability of being a responder. CONCLUSION: The results suggest that people with MS-related fatigue who had a less negative perception of fatigue and who perceived fewer disease benefits and a higher discrepancy in social support had the best response to ECM treatment