Clinical usability, reliability, and repeatability of noncontact scanners in measuring residual limb volume in persons with transtibial amputation

BACKGROUND: In previous studies, noncontact 3D scanners were found to be the most reliable in measuring volume of the residual limb after a transtibial amputation (TTA). Meanwhile newly developed noncontact scanners became available to measure residual limb volume after TTA but should be tested for clinical usability and reliability.OBJECTIVE: To determine the clinical usability, reliability, and repeatability of noncontact scanners in measuring residual limb volume in persons with a TTA.STUDY DESIGN: Original research report; repeated measurements.METHODS: Three noncontact scanners (Rodin4D, Omega Tracer, and Biosculptor) were used to measure the residual limb volume on two occasions by two observers in 30 persons with an unilateral or bilateral TTA. Clinical usability was assessed as scores of the Post-Study System Usability Questionnaire, participant satisfaction (0-10 scale), and time to take the measurement.RESULTS: The usability score of the Omega Scanner 3D (123.4) and Rodin4D (121.3) was significantly better compared with the Biosculptor (117.8). Participant experience was equal for all. The residual variance was 8.4%, where participant and scanning system explained most of the error variance (80.7%). Repeatability coefficients of the systems were 16.5 cc (Omega Scanner 3D), 26.4 cc (Rodin4D), and 32.8 cc (Biosculptor). The time to perform the measurements was significantly longer (+80 seconds) for the Omega Scanner 3D.CONCLUSIONS: For measuring residual limb volume in TT amputees, Omega software (state version 12.2) combined with the Rodin4D scanner was more usable and reliable than the Rodin 4D or Biosculptor systems, when operated by staff with limited experience and training.</p

Discomfort and factual recollection in intensive care unit patients

INTRODUCTION: A stay in the intensive care unit (ICU), although potentially life-saving, may cause considerable discomfort to patients. However, retrospective assessment of discomfort is difficult because recollection of stressful events may be impaired by sedation and severe illness during the ICU stay. This study addresses the following questions. What is the incidence of discomfort reported by patients recently discharged from an ICU? What were the sources of discomfort reported? What was the degree of factual recollection during patients' stay in the ICU? Finally, was discomfort reported more often in patients with good factual recollection? METHODS: All ICU patients older than 18 years who had needed prolonged (>24 hour) admission with tracheal intubation and mechanical ventilation were consecutively included. Within three days after discharge from the ICU, a structured, in-person interview was conducted with each individual patient. All patients were asked to complete a questionnaire consisting of 14 questions specifically concerning the environment of the ICU they had stayed in. Furthermore, they were asked whether they remembered any discomfort during their stay; if they did then they were asked to specify which sources of discomfort they could recall. A reference group of surgical ward patients, matched by sex and age to the ICU group, was studied to validate the questionnaire. RESULTS: A total of 125 patients discharged from the ICU were included in this study. Data for 123 ICU patients and 48 surgical ward patients were analyzed. The prevalence of recollection of any type of discomfort in the ICU patients was 54% (n = 66). These 66 patients were asked to identify the sources of discomfort, and presence of an endotracheal tube, hallucinations and medical activities were identified as such sources. The median (min–max) score for factual recollection in the ICU patients was 15 (0–28). The median (min–max) score for factual recollection in the reference group was 25 (19–28). Analysis revealed that discomfort was positively related to factual recollection (odds ratio 1.1; P < 0.001), especially discomfort caused by the presence of an endotracheal tube, medical activities and noise. Hallucinations were reported more often with increasing age. Pain as a source of discomfort was predominantly reported by younger patients. CONCLUSION: Among postdischarge ICU patients, 54% recalled discomfort. However, memory was often impaired: the median factual recollection score of ICU patients was significantly lower than that of matched control patients. The presence of an endotracheal tube, hallucinations and medical activities were most frequently reported as sources of discomfort. Patients with a higher factual recollection score were at greater risk for remembering the stressful presence of an endotracheal tube, medical activities and noise. Younger patients were more likely to report pain as a source of discomfort

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study

Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). Main outcome measures: impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. Results: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL(IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. Conclusion: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap

Self-Management and Self-Efficacy in Patients With Acute Spinal Cord Injuries : Protocol for a Longitudinal Cohort Study

BACKGROUND: People with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI. OBJECTIVE: To describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment. METHODS: Multicenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI and of self-care). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI. RESULTS: The first results with the complete set of data are expected in June 2019. CONCLUSIONS: This protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient SCI rehabilitation. Second, associations will be investigated with SHCs, participation and psychological adjustment early after onset of SCI, until 1 year after discharge. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI

Gross mechanical efficiency of the combined arm–leg (Cruiser) ergometer

The combined arm-leg (Cruiser) ergometer is assumed to be a relevant testing and training instrument in the rehabilitation of patients with a lower limb amputation. The efficiency and submaximal strain have not been established and thus cannot be compared with alternative common modes of exercise. A total of 22 healthy able-bodied men (n=10) and women (n=12) were enrolled in four discontinuous submaximal graded exercise tests. Each test consisted of seven bouts of 3 min exercise ranging from 20 to 45 W and was performed on, respectively, the Cruiser ergometer, a bicycle ergometer, a handbike, and again the Cruiser ergometer. Cardiorespiratory parameters were measured and rate of perceived exertion was determined. Gross mechanical efficiency (GE) was determined from power output and submaximal steady-state energy cost. Repeated-measures analysis of variance (P<0.05) was used to evaluate the effects of exercise mode, exercise intensity, and sex. No differences in GE and cardiorespiratory strain were found between both Cruiser tests (GE 45 W: men 13.0%, women 15%) and the bicycle test (GE 45 W: men 13.2%, women 14.6%). GEs of handbiking (45 W: men 11.2%, women 12.2%) were lower compared with the Cruiser and bicycle test results, whereas cardiorespiratory strain in handbiking was consistently higher. Apart from a lower rate of perceived exertion at the second Cruiser test, no differences were found between the repeated Cruiser tests. It can be concluded that GE and cardiorespiratory strain in submaximal Cruiser exercise are comparable with leg cycling, the repeatability was good, and no obvious learning effects were observed. The results of this study form a base for further research in patients with a lower limb amputation