Dijkstra, Pieter U.

Geertzen, Jan H.B.

Kees, Emmelot

English

ARTS repository - University of Groningen

   University of GroningenA randomised trial of rigid stump dressing following trans-tibial amputation for peripheralarterial insufficiency.Geertzen, Jan H.B.; Kees, Emmelot; Dijkstra, Pieter U.Published in:Prosthetics and orthotics internationalIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2004Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Geertzen, J. H. B., Kees, E., & Dijkstra, P. U. (2004). A randomised trial of rigid stump dressing followingtrans-tibial amputation for peripheral arterial insufficiency. Prosthetics and orthotics international, 28(2),192. https://www.scopus.com/record/display.uri?eid=2-s2.0-16644401450&origin=inward&txGid=9661578235e972f38d05d95de878c140CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.   University of GroningenAuthor's reply (to letter Woodburn et al. A randomised trial of rigid stump dressing followingtrans-tibial amputation for peripheral arterial insufficiency) (letter)Geertzen, J.H.B.; Emmelot, K.; Klinieken, I.; Dijkstra, P.U.Published in:Prosthetics and Orthotics InternationalIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2004Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Geertzen, J. H. B., Emmelot, K., Klinieken, I., & Dijkstra, P. U. (2004). Author's reply (to letter Woodburn etal. A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterialinsufficiency) (letter). Prosthetics and Orthotics International, 28(2), 192-192.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.This article was downloaded by:[University of Groningen]On: 18 March 2008Access Details: [subscription number 770299803]Publisher: Informa HealthcareInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UKProsthetics and OrthoticsInternationalPublication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t714595820Letter to the editorJan H.B. Geertzen a; Kees Emmelot b; Pieter U. Dijkstra ca Professor in Rehabilitation Medicine, University Hospital, Groningenb Doctor in Rehabilitation Medicine, Isala Klinieken, Zwollec Clinical Epidemiologist, University Hospital Groningen, The NetherlandsOnline Publication Date: 01 August 2004To cite this Article: Geertzen, Jan H.B., Emmelot, Kees and Dijkstra, Pieter U.(2004) 'Letter to the editor', Prosthetics and Orthotics International, 28:2, 192To link to this article: DOI: 10.1080/03093640408726705URL: http://dx.doi.org/10.1080/03093640408726705PLEASE SCROLL DOWN FOR ARTICLEFull terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdfThis article maybe used for research, teaching and private study purposes. Any substantial or systematic reproduction,re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expresslyforbidden.The publisher does not give any warranty express or implied or make any representation that the contents will becomplete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should beindependently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings,demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with orarising out of the use of this material.Downloaded By: [University of Groningen] At: 13:57 18 March 2008 Prosthetics and Orthotics International, 2004, 28, 192Letter to the EditorDear EditorFollowing the publication of the article "Arandomised trial of rigid stump dressingfollowing trans-tibial amputation for peripheralarterial insufficiency" by Woodburn,Sockalingham, Gilmore, Condie and Ruckley inthe April 2004 issue of Prosthetics and OrthoticsInternational we felt that a response wasnecessary. Our combined thoughts and opinionscan be found below.This is one of the few prospectiveinvestigations in rigid stump dressings followingamputations. It is well written but we would liketo comment on the paper and some statements inthe paper ask for some kind of clarification.Since 14 surgeons participated in this study itis clear that surgical skill and surgical preferenceof amputation (skew flap or long posterior flap)will introduce serious bias in the outcome of thisstudy. It is not clear from the text if and how theauthors have analysed the distribution of surgicalprocedures and the distribution of the surgeonsover the intervention group and the controlgroup. Besides, these surgeons were workingover 7 different centres. All these centres havetheir own influence on post-amputationrehabilitation determined by equipment of thehospital nursing staff, physiotherapy, householdfacilities, behaviour and professional skills etc.Again it is not clear from the text if and how theauthors have analysed the distribution of thedifferent centres over both groups. Apart fromthis no detailed information about therandomisation procedure was provided.The authors state that if the rigid dressing wasremoved after 7 days and the wound wasinspected and satisfactory plaster was thenreapplied. The authors do not describe criteriafor "satisfactory", further the procedures if thewound is not satisfactory are not described; inthat case it is unclear if the patient is consideredas a drop-out or not fitted (see Table 1)."At a time when the nursing andphysiotherapy staff felt that referring for limbfitting was appropriate, the final decision as tothe suitability of a limb for casting was made bythe local prosthetic team who were blinded tothe post-operative dressing regime employed".This procedure indicates that the decision wasbased upon clinical expertise and not upon strictcriteria in the research protocol provided forlimb fitting. It might be that the prosthetic teamwas kept blind for the postoperative stump carebut a prosthetist has to identify stump care bymeans of inspection and palpation andmeasuring. It is not clear from the text and thetables which patients completed the trial andwhich patients did not complete the trial.Finally it is not clear from Figure 2 what theactual numbers of days were to prosthetic fitting(mean, sd, range or median and interquartileranges). Therefore it is impossible to use thesedata for a meta analysis or future trial planning.We admit that it is very difficult to initiate amulticentre trial as described by Woodburn et al.However, we believe that the authors ought toshow some more detailed information especiallythe differences between the different surgeons,and/or different used procedure and/or thecomparability of the groups. As a result thisstudy is not repeatable. We hope the authors canclarify our questions and remarks and secondlywe hope that this letter invites other readers towrite to the editor and initiate discussion aboutpapers in general but especially on this subjectpublished in this journal.Yours sincerelyJan H.B.Geertzen, MD, PhDProfessor in Rehabilitation MedicineUniversity Hospital GroningenKees Emmelot MD, PhDDoctor in Rehabilitation MedicineIsala Klinieken, ZwollePieter U Dijkstra PT, MT, PhDClinical EpidemiologistUniversity Hospital GroningenThe Netherlands192

A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.

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A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.

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