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.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study.

OBJECTIVE: The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR. METHODS: Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR. RESULTS: Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance. CONCLUSION: Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified. IMPACT: According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population. LAY SUMMARY: With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

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.

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.

Residual limb claudication after vascular transfemoral amputation.

BACKGROUND: In all, 68% of all lower limb amputees experience residual limb pain. More than 95% of all lower limb amputations in developed countries are due to peripheral artery occlusive disease in combination with diabetes mellitus. Therefore, claudication, which is one of the most common manifestations of peripheral artery occlusive disease, should be taken into consideration in making a differential diagnosis of residual limb pain. Case description and methods: We present a case study of a 60-year-old diabetic patient who underwent a transfemoral amputation due to peripheral artery occlusive disease and who experiences residual limb pain. A computed tomography angiography was performed, and we searched for relevant literature on claudication pain after lower limb amputation. CONCLUSION: Little research has explored claudication as a cause of residual limb pain. More research will lead to a decrease in unnecessary prosthetic fittings and adjustments give more insight into the treatment and management of residual limb pain and prevent a decrease in mobility in amputees. Clinical relevance Claudication due to peripheral artery occlusive disease should be included as a possible cause of residual limb pain to prevent unnecessary prosthetic fittings and adjustments and to minimize psychological effects and limitations in activities and participation.

Functional outcome of hip disarticulation and hemipelvectomy: a cross-sectional national descriptive study in the Netherlands.

OBJECTIVE: To describe characteristics of hip disarticulation and hemipelvectomy amputees, to assess their level of activities, participation and experienced limitations in mobility and to describe the amputation-related problems. DESIGN: A cross-sectional study. SETTING: Patients were mainly recruited via orthopaedic workshops in the Netherlands. SUBJECTS: Forty-six patients with an acquired unilateral hip disarticulation or hemipelvectomy at least one year post amputation. MAIN OUTCOME MEASURES: Sickness Impact Profile 68 (SIP 68) to assess the level of activity and participation and the questionnaire Rising and Sitting Down, Walking and Climbing Stairs to assess perceived limitations in mobility. RESULTS: The 46 patients (31 with hip disarticulation and 15 with hemipelvectomy) had a mean age of 55.8 years (SD 12.1). In 78% of cases the reason for amputation was a tumour. Mean SIP 68 was low, 10.5 (SD 6.9). Hip disarticulation amputees had significantly poorer emotional stability than the hemipelvectomy amputees (P = 0.04). All amputees experienced considerable limitations in their mobility according to the Rising and Sitting Down, Walking and Climbing Stairs scores. CONCLUSIONS: Hip disarticulation and hemipelvectomy amputees have a relatively high level of activity and participation (SIP scores) but at the same time experience limitations in walking, rising and sitting down and climbing stairs.