Emmelot, C.H.

Geertzen, J.H.B.

English

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   University of GroningenRemovable rigid dressings versus soft dressings (letter)Emmelot, C.H.; Geertzen, J.H.B.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:2006Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Emmelot, C. H., & Geertzen, J. H. B. (2006). Removable rigid dressings versus soft dressings (letter).Prosthetics and Orthotics International, 30(1), 102-103.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.Download date: 06-06-2022This 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=t714595820Removable rigid dressings versus soft dressingsOnline Publication Date: 01 April 2006To cite this Article: (2006) 'Removable rigid dressings versus soft dressings',Prosthetics and Orthotics International, 30:1, 102 - 103To link to this article: DOI: 10.1080/03093640600554732URL: http://dx.doi.org/10.1080/03093640600554732PLEASE 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: 13:55 18 March 2008 LETTER TO THE EDITORRemovable rigid dressings versus soft dressingsDear Editor,It was with much interest we read the paper ‘Removable rigid dressings versus soft dressings:a randomized, controlled study with dysvascular, trans-tibial amputees’ by Anneke Deutschet al. (2005). As proponents of rigid dressings after trans-tibial amputation we admire theattempt to perform a randomized clinical trial. The results of the study may attribute to abetter understanding of optimal treatment after trans-tibial amputation. We would like toexpress some additional remarks about the way the study was set up and the conclusionsdrawn from the results.The difference in outcome between the two groups is attributed to the dressing type: softor rigid.However, the trial is basically a multi-centre study performed in 2 hospitals. This indicatesthat there are at least 2 levels of research: hospitals (level 2) and patients (level 1). In thestatistical analysis no multi-level analysis is performed probably because of the substantialamount of dropouts at the end of the study. For the analysis of wound healing only 31 patients(62%) were included. The hospital environment may have a considerable impact on theoutcome of the study. The authors do not provide information about the number of patientstreated in each hospital. Additionally, between the hospital level and patient level, the level ofthe surgeon is present when for each hospital different surgeons performed the amputations.No information about the number of surgeons is provided.Remarkably, the authors performed the statistical analysis with a one-sided significancelevel based on the assumption that the rigid dressing reduces time of wound healing and timeto prosthesis fit. Generally a two-sided significance test would be appropriate because theeffects could be contrary to what is believed. Moreover, detailed information is missing abouthow the rehabilitation was programmed.In particular, we can make the following further remarks:Firstly, we believe that the number of sockets required over a 6-month period is aninappropriate measurement to be conclusive for volume control.Secondly, comparing the outcome with the paper of Vigier et al. (1999) is inappropriate,because (besides from the use of a silicone liner) he treated open stumps by design (Nawijnet al. 2005).Finally, other than the benefits no other effects have been mentioned. We have someindications that a rigid dressing with a pylon makes moving in bed more difficult, causingadditional skin breakdown elsewhere (Van Velzen et al. 2005).In our opinion, the lack of benefits of the rigid dressing method might be attributed toconfounders, such as hospital, surgeon, post-amputation rehabilitation programme asmentioned above or inappropriate assessment instruments. Practically speaking, we believethat performing a randomized clinical trial in this sort of population is unfeasible.Prosthetics and Orthotics InternationalApril 2006; 30(1): 102 – 103ISSN 0309-3646 print/ISSN 1746-1553 online  2006 ISPODOI: 10.1080/03093640600554732Downloaded By: [University of Groningen] At: 13:55 18 March 2008 The beneficial effect on wound healing has a relationship with a rigid dressing and not withits removable properties which are not needed for wound healing or for early mobilization.Yours sincerelyCornelis H. Emmelot MD PhDDepartment of RehabilitationIsala ClinicsZwolleThe Netherlands.Jan H. B. Geertzen MD PhDCenter for RehabilitationUniversity Medical Center GroningenUniversity of GroningenThe Netherlands.ReferencesDeutsch A, English RD, Vermeer TC, Murray PS, Condous M. 2005. Removable rigid dresssings versussoft dressings: A randomized, controlled study with dysvascular, trans-tibial amputees. Prosthet Orthot Int 29:193 – 200.Nawijn SE, van der Linde H, Emmelot CH, Hofstad CJ. 2005. Stump management after trans-tibial amputation:A systematic review. Prosthet Orthot Int 29:13 – 26.Van Velzen AD, Nederhand MJ, Emmelot CH, Ijzerman MH. 2005. Early treatment of trans-tibial amputees:retrospective analysis of early fitting and elastic bandaging. Prosthet Orthot Int 29:3 – 12.Vigier S, Casillas JM, Dulieu V, Rouhier-Macer I, Dáthis P, Didier JP. 1999. Healing of open stumps after vascularbelow-knee amputation: Plaster cast socket with silicon sleeve versus elastic compression. Arch Phys MedRehabil 80:1327 – 1330.Letter to the Editor 103

Removable rigid dressings versus soft dressings (letter)

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Removable rigid dressings versus soft dressings (letter)

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