Comparison of vacuum-formed removable rigid dressing with conventional rigid dressing after transtibial amputation: similar outcome in a randomized controlled trial involving 27 patients.

BACKGROUND AND PURPOSE: Following transtibial amputation, a rigid dressing of plaster of Paris has been reported to have advantages over a soft dressing regarding wound healing and reduction of edema, but use of the former may be limited by difficulties in application and in gaining access to the wound. An easily applicable and removable vacuum-formed rigid dressing (ORD) has recently been introduced. We compared the ORD with a conventional rigid plaster of Paris dressing with regard to wound healing, time to fitting of a prosthesis, and function with the prosthesis. METHOD: Patients undergoing transtibial amputation for peripheral vascular disease were randomized at surgery to receive ORD (O) or conventional rigid dressing (C) for 5 to 7 days, followed by compression therapy using silicone liner. The primary outcome measure was time to prosthetic fitting and secondary outcome measures included function with the prosthesis 3 months after amputation, measured with the Locomotor Capability Index (LCI) and the Timed "Up and Go" (TUG) test. All patients received prostheses with a total surface-bearing socket. RESULTS: Of 27 patients randomized to one or other dressing (15 O and 12 C), prosthetic fitting was achieved in 23 patients (mean age 76 (43-91) years; 13 (9 men) in the O group and 10 (5 men) in the C group). Wound healing was similar in both groups. Mean time to prosthetic fitting was 37 (26-54) days in the O group and 34 (21-47) days in the C group (adjusted mean difference 3, 95% CI: -3-9). At 3 months, mean LCI was 28 (6-42) in the O group and 25 (2-41) in the C group (mean difference -0.1, 95% CI: -8.5-8.2). Mean TUG was 41 (10-92) seconds and 29 (10-47) seconds, respectively (mean difference 14, 95% CI:-2-30). INTERPRETATION: The vacuum-formed rigid dressing appears to give results similar to those of the conventional rigid dressing regarding time to prosthetic fitting and patient's function with prosthesis.

Perceived contra observed physical work load in Swedish dentists.

In an earlier questionnaire study, dentists reported high experienced physical work load in their profession, but low to moderate complaints from their musculoskeletal system. The correlation between reported physical work load and pain from the musculoskeletal system was weak. This discrepancy could not be satisfactorily explained. Therefore, a second study was undertaken, in which the same 27 dentists who reported musculoskeletal problems were video recorded during one hour of clinical work, and the records were later analyzed using PEO (Portable Ergonomic Observation). PEO is a frequency analysis method which allows observation of work in real time using a portable computer or video recordings. PEO can be adjusted for registration of single or multiple work operations. Output data are presented as frequency, duration, and sequence of the various work operations. The aim of the present study was to investigate if there was a relation between observed work load recorded with PEO, and subjectively estimated work load and musculoskeletal complaints recorded with a questionnaire based on Visual Analogue Scales. Sitting and standing postures, and head, trunk and arm movements were analyzed. The PEO observations showed that dentists generally perform their clinical work in a sitting position, with the head bent forward almost half of the time. Only weak to moderate correlations (r =0.0-0.6) were found between observed physical work load and subjective estimations of experienced physical work load and musculoskeletal complaints. These findings support the results in our previous study, but they do not explain the large difference between the observed low work load and the subjectively experienced high work load. The study will be followed up by EMG measurements and free interviews, where both muscular load and psychosocial factors will be evaluated.

Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists.

In a previous study, dentists reported very high scores for perceived physical workload, but only low to moderate scores for the musculoskeletal system. This is difficult to explain when other occupational groups in the dental services are compared, and is the main reason why the present study was performed. To measure muscular activity, a surface electromyography (sEMG) study was done, and included the subjects who reported neck and shoulder complaints in the previous study. A portable sEMG system (MyoGuard) was used to collect a myoelectric signal on-line and analysis of the myoelectric signal in a computer. sEMG was recorded from both trapezius muscles for approximately 4 h during an ordinary working day. Twenty-seven dentists participated in the study. The results show accumulated rest% fairly close to that of female cashiers and supermarket employees and increased average rectified value percent (ARV%) during work that could contribute to the very high workload perceived by dentists.

Functional capacity after hip arthroplasty: a comparison between evaluation with three standard instruments and a personal interview.

The aim of the present study was to compare the information obtained from three standard instruments used in physiotherapy and occupational therapy and with information acquired from an unstructured interview. Ten patients with osteoarthritis of the hip were consecutively picked from the waiting list at an orthopedic clinic. All were examined before and six months after arthroplasty. The study layout is a mixture of quantitative and qualitative evaluation. The three instruments used were SF-36 (self-reported health-related quality of life), FAS (an instrument for evaluation of lower extremity dysfunction), and the COPM (for evaluation of self-experienced activity level). All patients were also interviewed in a free, unstructured interview, and data were analyzed with a phenomenological approach. All methods could describe function and activity status of the patients very well, and they were also responsive to postoperative improvement. Together the three instruments gave such good information that almost no extra information was obtained through the interviews. On the other hand, the interviews served as powerful validation of the three instruments. The information in the three separate instruments is qualitatively different, and one instrument cannot replace another. They cannot be replaced by the interview either, because the instruments provide the therapist with specific and structured information that is important for further treatment planning and follow-up.