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Background: Upper extremity physical function is an essential health domain in the rehabilitation care for patients with upper limb amputation or absence. The PROMIS-9 UE Physical Function short form is a recently established instrument designed for individuals with upper limb amputation or absence. The instrument's responsiveness to changes after receiving a prosthesis has not been investigated. The current study aimed to evaluate the ability of the PROMIS-9 UE to detect changes in bimanual (two-handed) functional capacity after patients' receipt of a prosthesis., Methodology: A retrospective chart review was conducted on the longitudinal PROMIS-9 UE outcome measure scores completed between April 2016 and February 2024. Participants included individuals with an outcome collected before and after prosthesis receipt., Results: The final sample size included 124 individuals (91 male, 33 female; 43.4 ± 15.0 years old, 34.4 ± 103.0 months since amputation, and 62.9% injury etiology). Analyses found significant improvement across all patients in the PROMIS-9 UE scores from baseline to post prosthesis intervention (baseline: 25.3 ± 8.6, post: 29.5 ± 9.6; p < 0.001). The PROMIS-9 UE demonstrated a moderate responsiveness (Standardized Response Mean = 0.6) to prosthetic intervention. This was a directional change consistent with subjective patient reports of increased functionality. Furthermore, findings from the linear mixed model demonstrated significant responsiveness for the PROMIS-9 UE instrument to detect post-intervention changes after controlling for potential confounding effects (p < 0.001)., Conclusions: These findings suggest the PROMIS-9 UE Physical Function instrument demonstrates moderate clinical utility in capturing patient progress following upper limb prosthesis intervention., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval for this retrospective study was obtained from the IRB Western Copernicus Group Institutional Review Board (protocol number 20170059). The study adhered to the ethical standards outlined in the Declaration of Helsinki. Consent for publication: Not applicable. Conflict of interest: The authors declare no conflict of interest with this work. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (© 2025. The Author(s).)

The rates of prosthetic abandonment are not extensively understood especially in resource-limited countries. A scoping review was conducted to examine the literature on the satisfaction with and barriers to using specifically upper limb prostheses. A systematic search of the literature identified 425 studies. After reviewing the articles using predetermined inclusion and exclusion criteria, 7 cross-sectional studies were included in the final review. Barriers to the use of upper limb prostheses include the characteristics of the prosthesis (type, comfort, weight, functionality, price, and availability) and individual patient factors (recent prosthetic user, level of amputation, congenital and accidental limb loss, pain, and duration between amputation and prosthetic fitting). Considering tailored prosthetic design and funding may result in improved prosthetic adherence., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: People with lower limb loss (LLL) have reduced physical activity (PA). There is evidence of physical and psychosocial predictors of PA in older adults with limb loss. However, these 2 areas (physical/psychosocial) have not been evaluated in the same analysis., Objectives: To describe and identify predictors of PA in individuals with LLL., Study Design: Cross-sectional study., Methods: Secondary analysis of data from a multisite Canadian randomized control trial involving community-dwelling prosthetic ambulators with unilateral transtibial or transfemoral amputation (N = 72). The dependent variable was the Physical Activity Scale for the Elderly. Potential predictors were four step square test, 2-minute walk test, Short Physical Performance Battery, Life Space Assessment, walking while talking test, and Activities-specific Balance Confidence scale., Results: Seventy-two community-dwelling lower limb prosthesis users were enrolled. The sample included 62 male participants (86%), and 58 participants (81%) had transtibial amputation. The average age of participants was 65 (8.9) years, and for 49 participants (70%), the amputation was over 24 months ago. The total mean Standard Deviation (SD) Physical Activity Scale for the Elderly score was 153.2 (88.3), with scores of 148.1 (11.4) and 184.5 (24.7) for male and female participants, respectively. Regression analysis identified Life Space Assessment (β = 1.15, p = 0.007) and Short Physical Performance Battery (β = 3.51, p = 0.043) as statistically significant predictors accounting for 25% of the variance in PA., Conclusions: Community mobility and physical performance are the most meaningful predictors of PA. Future research should examine additional factors (e.g., environment, motivation). Understanding the predictors for PA after LLL would improve clinical practice as clinicians would have increased knowledge to modify and improve training., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Purpose: In this study, we sought to examine how lower limb prosthesis users define success, what constructs they associate with success, and what barriers and facilitators contribute to achieving success., Materials and Methods: Purposively sampled lower limb prosthesis users were recruited to participate in a focus group study. Verbatim transcripts from focus groups were analyzed using inductive thematic analysis. Identified constructs were mapped to existing outcome measures, and a conceptual framework for success with a lower limb prosthesis was proposed., Results: Thirty-one lower limb prosthesis users participated in one of five focus groups. Five themes were developed: keep moving forward, despite ups and downs; being able to live MY normal life and do the things I want to do with ease; learning what works for me and how to manage my prosthesis; only I can define my success; and what about my mental health? Several constructs that do not align with existing measures were identified, including prosthetic attention, grief/loss after amputation, and trust in prosthesis. Facilitators for success described by participants included peer connection, finding the right prosthetist, and mental health support., Conclusions: According to lower limb prosthesis users, success must be patient-driven, individually defined, and continually reassessed.

Background: Safe and efficient locomotion is a frequently stated goal of lower limb prosthesis users, for which hip strength may play a central yet poorly understood role. Additional research to identify associations between hip strength, balance, and mobility among transtibial and transfemoral prosthesis users is required., Objective: To test whether residual and/or intact limb isometric hip strength was associated with lower limb prosthesis users' walking speed, endurance, and balance., Design: Cross-sectional study., Setting: Research laboratory., Participants: Convivence sample of 14 transtibial and 14 transfemoral prosthesis users., Methods: Multiple linear regression was used to evaluate the relationship between isometric measures of residual and intact limb hip strength and walking and balance performance., Main Outcome Measurements: Measures of isometric hip muscle strength, including peak torque, average torque, torque impulse, and torque steadiness (i.e. consistency with which an isometric torque can be sustained) were derived from maximum voluntary hip flexion, extension, abduction and adduction torque signals collected with a motor-driven dynamometer. Walking speed, endurance, and balance were assessed by administering the 10-meter walk test, 2-minute walk test, Four Square Step Test, and Narrowing Beam Walking Test, respectively., Results: Residual limb hip extensor max torque and abductor torque steadiness explained between 51% and 69% of the variance in transtibial prosthesis users' walking speed, endurance, and balance. In contrast, intact limb hip abductor torque impulse explained between 33% and 48% of the variance in transfemoral prosthesis users' walking speed, endurance, and balance., Conclusions: Our results suggest that unilateral transtibial and transfemoral prosthesis users' walking and balance performance may depend on different hip muscles, and different facets of hip strength. Amputation level-specific hip strength interventions may therefore be required to improve walking and balance performance in unilateral transtibial and transfemoral prosthesis users. The "intact leg strategy" adopted by transfemoral prosthesis users may be due to a variety of prosthesis and biomechanical factors that limit the efficiency with which transfemoral prosthesis users can exploit the strength of their residual limb hip muscles while walking., (© 2024 The Author(s). PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Background: Returning to work is a key outcome of rehabilitation and social re-integration after lower limb amputation. It is important to understand what biopsychosocial factors contribute to returning to work after dysvascular amputation., Objective: Examining relative contributions of functional and contextual predictors of returning to work in participants with lower limb amputation due to diabetes and other dysvascular diseases., Study Design: Cross-sectional., Methods: Return-to-work outcome, biopsychosocial characteristics including physical functioning, self-efficacy & perceived ability, and socioeconomical support data were collected from a purposive sample (n = 57) in a multi-state collaborative research network. Grouped Weighted Quantile Sum model analysis was conducted to evaluate relative contributions of biopsychosocial predictors., Results: Less than 30% of the participants returned to work after their amputation. Physical functioning (odds ratio = 10.19; 95% CI 2.46-72.74) was the most important predictor group. Working before amputation, prosthetic mobility, and access to rehabilitation care were also identified as key factors associated with returning to work., Conclusions: Fewer than 1 in 3 participants with dysvascular amputation returned to work, despite an average age of only 54 years at the time of amputation. Physical functioning was shown to be the most important predictor, while socioeconomic factors such as a lack of access to care also contribute to not returning to work after dysvascular amputation., (Copyright © 2024 The Authors. Published by Wolters Kluwer incorporated on behalf of The International Society for Prosthetics and Orthotics.)

Background: Transmission of loads between the prosthetic socket and the residual limb is critical for the comfort and walking ability of people with transfemoral amputation. This transmission is mainly determined by the socket tightening, muscle forces, and socket ischial support. However, numerical investigations of the amputated gait, using modeling approaches such as MusculoSkeletal (MSK) modeling, ignore the weight-bearing role of the ischial support. This simplification may lead to errors in the muscle force estimation., Objective: This study aims to propose a MSK model of the amputated gait that accounts for the interaction between the body and the ischial support for the estimation of the muscle forces of 13 subjects with unilateral transfemoral amputation., Methods: Contrary to previous studies on the amputated gait which ignored the interaction with the ischial support, here, the contact on the ischial support was included in the external loads acting on the pelvis in a MSK model of the amputated gait., Results: Including the ischial support induced an increase in the activity of the main abductor muscles, while adductor muscles' activity was reduced. These results suggest that neglecting the interaction with the ischial support leads to erroneous muscle force distribution considering the gait of people with transfemoral amputation. Although subjects with various bone geometries, particularly femur lengths, were included in the study, similar results were obtained for all subjects., Conclusions: Eventually, the estimation of muscle forces from MSK models could be used in combination with finite element models to provide quantitative data for the design of prosthetic sockets., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Objective: This study focuses on how patients experience the time following amputation after primary limb salvage surgery due to musculoskeletal malignancies. Limb salvage is state of the art in the treatment of musculoskeletal tumours. Nonetheless, in some cases, limb salvage can become problematic over time, resulting in poorer limb function and septic outcomes. This raises the question of whether amputation is indicated sooner rather than later. Patients who have undergone secondary amputation might retrospectively prefer a different approach., Design: Interview study., Subjects/patients: Patients who underwent primary limb salvage surgery followed by later ablative sarcoma treatment., Methods: Semi-structured interviews and the standardized "Prosthetic Limb Users Survey of Mobility" questionnaire were conducted. Interviews were analysed according to Mayring content analysis method., Results: Amputation is perceived as an improvement after a long course of illness with little quality of life. By enhancing the amputation environment and providing detailed information regarding quality of life afterwards, emotional pressure could be reduced and patient satisfaction improved., Conclusion: Surgical options for ablation should be openly communicated earlier when consulting patients experiencing recurrent complications that might eventually lead to amputation. Supporting factors that subsequently may help to improve quality of life after amputation were further identified.

Purpose: To explore the factors that influence clinicians (occupational therapists, physiotherapists, vascular surgeons, and rehabilitation medicine physicians) when prescribing prosthetic rehabilitation. Additionally, the study aimed to gain insight into clinicians' perspectives regarding the role of patient cognition in prosthetic rehabilitation., Materials and Methods: This research constitutes one segment of a broader action research study which was undertaken in 2022. A total of thirty-four key clinicians involved in the amputation and prosthetic rehabilitation pathway within a local health district in Australia were engaged through a combination of group and individual interviews as well as surveys., Results: Five essential considerations when prescribing prosthetic rehabilitation emerged. These included patient's goals, medical history, quality of life, cognitive abilities, and the support available on discharge. This study also revealed variations in opinions among different disciplines concerning appropriateness of prosthetic rehabilitation for the patient cohort. Despite this, there was a desire to build a consensus around a shared approach of identification for patients and clinicians., Conclusion: The identification of these key pillars for clinician consideration has simplified a complex area of care. These pillars could be used to guide pertinent conversations regarding prosthetic rehabilitation and are closely linked with the patient's cognition.

Arteritis and trauma are the most frequent causes of amputation. Rehabilitation management is divided into three phases: the immediate post-operative phase, the pre-prosthetic phase and the prosthetic phase., Competing Interests: Déclaration de liens d’intérêts L’auteur déclare ne pas avoir de liens d’intérêts., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

In a rehabilitation department, different professionals are involved in the overall care of a person who has undergone an amputation. While some are more concerned with the patient's physical needs and others more with his or her psychological needs, each is a link in the rehabilitation chain, linked by the subject concerned and by certain more transversal caregivers, such as the nurse., Competing Interests: Déclaration de liens d’intérêts L’auteur déclare ne pas avoir de liens d’intérêts., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Lower limb amputation can have profound physical, psychological, and social effects on individuals. Assistive aids like prosthetic lower limbs can help an individual regain mobility and thereby affect their self-esteem and quality of life., Objective: To assess self-esteem and quality of life in patients with transtibial amputations who are using a transtibial prosthesis and explore the association between sociodemographic and amputation-related factors with self-esteem and prosthesis-related quality of life measures., Design: A cross-sectional study., Setting: An orthotics and prosthetics center (Bhagwan Mahaveer Viklang Sahayata Samiti) in Jaipur, Rajasthan., Participants: Patients with transtibial amputations using exoskeletal prostheses between July and September 2022, in Jaipur, Rajasthan., Main Outcome Measures: The study used Rosenberg self-esteem questionnaire and Prosthesis Evaluation Questionnaire (PEQ) for self-esteem and quality of life assessment, respectively. Descriptive analysis was used to present the demographic details, and nonparametric tests examined the relationship between PEQ dimensions and sociodemographic variables., Results: The study included 138 participants, primarily <40 years old (45.7%) and mostly engaged in high-activity occupations. Self-esteem mean score (SD) was 19.9 (3.9), with 89.1% exhibiting normal self-esteem. Prosthesis-related quality of life, showed high satisfaction across various domains, including ambulation, appearance, frustration, perceived response, residual limb health, social burden, sounds, utility, and well-being. No significant associations were found between sociodemographic factors, amputation-related variables, and self-esteem. However, PEQ scales showed associations with gender, age, occupation, type of amputation, and years of prosthesis use., Conclusion: These results highlight the potential advantages of exoskeletal prostheses in improving the standard of living for people with transtibial amputations. Further research is essential to develop targeted interventions for improving their overall quality of life., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

After an amputation, the person concerned will receive support from the doctor and the prosthetist: there is a wide range of prostheses available, and it's important to choose one that meets the patient's needs, i.e. the one best suited to his or her lifestyle and activities., (Copyright © 2024. Publié par Elsevier Masson SAS.)

EMG feedback improves force control of a myoelectric hand prosthesis by conveying the magnitude of the myoelectric signal back to the users via tactile stimulation. The present study aimed to test if this method can be used by a participant with a high-level amputation, and whose muscle used for prosthesis control (pectoralis major) was not intuitively related to hand function. Vibrotactile feedback was delivered to the participant's torso, while the control was tested using EMG from three different muscles. The participant completed four experimental sessions of a force-matching task with a prosthesis. The performance was evaluated by computing the target force success rate. The results of session 1 showed that the participant could effectively employ EMG feedback after only brief training. Session 2 demonstrated that EMG feedback benefited force control, increasing the success rate by approx. 30%. Finally, after proper training (sessions 3 and 4), the participant's performance when using the muscle on the amputated side was similar to that achieved with the muscles on the contralateral side. Overall, the study results indicate that EMG feedback can be used in high-level amputations, despite the extent of the injury and non-intuitive control., Competing Interests: Declarations. Competing interests: None of the authors have any competing interests to report., (© 2024. The Author(s).)

People with lower limb loss often experience psychological concerns related to falling. A concern for falling (CFF) includes four subdomains: fear of falling, self-efficacy, consequences of falling, and perceptions of falls. Limited research exists on how these subdomains are influenced by clinical factors and falls history. This cross-sectional online survey evaluated: (1) associations among CFF outcome measures; (2) relationships between falls history and outcome measures; and (3) clinical and demographic factors related with outcome measures. Inclusion criteria: ≥18 years old, unilateral transtibial amputation and ambulating with a prosthesis. Eight measures assessed CFF: visual analog scale fear of falling, Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Activities-specific Balance Confidence (ABC), Falls Efficacy Scale International (FES-I), Prosthetic Limb Users Survey - Mobility (PLUS-M), Locomotor Capabilities Index, Consequences of Falling Scale, and Perceived Ability to Manage Falls. Pearson bivariate correlation analysis assessed associations among outcome measures. T tests evaluated the association of falls status on outcome scores. Multiple linear regression modelled the clinical and demographic factors related to each measure. Sixty-eight adults (mean 61.8 ± 12.0) participated. Moderate statistically significant ( P < 0.001) correlations were found across most outcome measures, with the strongest between PLUS-M and mSAFFE ( r  = -0.841), and ABC and FES-I ( r  = -0.821). Faller status was not associated with any measure ( P  > 0.05). Quality of life was associated with fear of falling, activity avoidance, self-efficacy, and certainty to managing falls ( R2 ranged from 0.27 to 0.47). CFF should be evaluated independently of falls history., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Prosthetic embodiment is the perception of the prosthesis as a part of the body, and it is important for acceptance and adequate and effective use of the prosthesis., Objective: The aim of this study was to investigate the validity and reliability of the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees., Methods: This cross-sectional study included a total of 88 lower limb amputees. Internal consistency was evaluated using Cronbach α coefficient. The test-retest reliability of the scale, which was reapplied after 7-10 d, was evaluated using intraclass correlation coefficient. Principal component analysis with Varimax rotation was used to analyze the factor structure. Spearman correlation coefficient with Trinity Amputation and Prosthesis Experience Scale subscales was calculated for concurrent validity., Results: The mean age of the participants was 45.13 ± 15.05 years, and 76.1% were male. Internal consistency (Cronbach α = 0.905) and test-retest reliability (intraclass correlation coefficient = 0.822) were high. 76.1% of the total variance could be explained by the 3 dimensions. Significant correlation was found with the Trinity Amputation and Prosthesis Experience Scale subscales (r = 0.542 for psychosocial adjustment subscale, r = -0.452 for activity restriction subscale, r = 0.490 for prosthesis satisfaction subscale, p < 0.001)., Conclusions: The results of this study showed that the Turkish version of the Prosthesis Embodiment Scale for Lower Limb Amputees is a valid and reliable tool that can be used to evaluate prosthetic rehabilitation outcomes., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Purpose: To explore the rehabilitation preferences and experiences of clinicians and patients for education after lower limb loss to facilitate the development of an online self-management program., Methods: A qualitative descriptive approach was used. Thirty-one clinicians (physiotherapists, occupational therapists, and prosthetists), and 26 patients with lower limb loss (transtibial and transfemoral amputation; mean age (SD) of 63.3 (9.1), years) were recruited. We used semi-structured focus groups and one-on-one interviews, and audio recorded the interviews. Data were analyzed using conventional content analysis., Results: Three themes were identified: (1) Needing education in rehabilitation described the education in current practice as one-on-one discussion and booklets and highlighted the limitations of education such as its length, static nature, and inaccessible for patients living in remote areas. (2) Getting back to activities prior to amputation emphasized how goal setting and social support could assist patients and facilitate self-management. (3) Augmenting learning highlighted the need for an accessible complementary source for education and potential solutions to overcome the barriers of online delivery., Conclusions: Our findings underscore the importance of education in the rehabilitation of patients to help them get back to their activities. An online accessible tool may improve education by providing information and peer support.

Purpose: To mitigate future health risks and improve body image coping strategies among individuals who experienced amputation due to the 2023 Kahramanmaraş earthquake, through an early rehabilitation program., Methods: A semi-experimental prospective study was conducted with 18 individuals who experienced amputation due to the earthquake. Data were collected using the "Individual Identification Form" "Amputee Body Image Scale" and "Body Image Coping Strategies Scale". The earthquake survivors included in the study were provided with a 5-day online interactive rehabilitation training program developed based on expert opinions. Prior to the training, participants were sent healthcare materials to be used during the sessions, interactive practices were conducted throughout the training to enhance individual self-care through interaction with peers and the trainer., Results: The average age of individuals who experienced amputation earthquake survivors was 38.72 ± 14.53 years, with 72.2% being male and 55.6% being married. Among them, 44.4% had leg amputations, and one survivor had lost three extremities. The average scores on the Body Image Coping Strategies Scale showed a statistically significantly increase after the training and at one month post-training compared to before the training (p < 0.05). Conversely, the average scores on the Amputee Body Image Scale showed a statistically significant decrease after the training at one month post-training compared to before the training (p < 0.05)., Conclusion: The development of early rehabilitation models is essential for improving psychological well-being among individuals who experience amputation following an earthquake., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Purpose: Rehabilitation experiences of lower limb amputees with poorer physical health have not been fully explored. This study aimed to qualitatively explore experiences of rehabilitation amongst patients who had recently undergone amputation due to complications of vascular disease., Methods: Semi-structured, face-to-face interviews were conducted with 14 patients participating in the PLACEMENT randomised controlled feasibility trial (ISRCTN: 85710690; EudraCT: 2016-003544-37), which investigated the effectiveness of using a perineural catheter for postoperative pain relief following major lower limb amputation. Framework analysis was used to identify key themes and compare participant data., Findings: Three main themes and corresponding sub-themes were identified: (i) other patients as inspiration; (ii) other patients as competition; and (iii) imagined futures. Perceptions relating to other patients played a key role in rehabilitation, providing a source of motivation, support, and competition. Participants' imagined futures were uncertain, and this was compounded by a lack of information and delays in equipment and/or adaptations., Conclusions: Findings highlight the importance of fellow patients in supporting rehabilitation following lower limb amputation. Enabling contact with other patients should thus be a key consideration when planning rehabilitation. There is a clear unmet need for realistic information relating to post-amputation recovery, tailored to the needs of individual patients.

Background: Few studies have been published on the prosthetic management of bilateral upper limb amputees. Of particular interest is to study how a patient's use of his upper limb protheses had evolved over a 6-year period in the aim to decrease their rejection rate., Case Description and Methods: Mr. D had undergone a bilateral upper limb amputation and had been fitted with 7 different prostheses in the past 6 years. Multiple validate instruments and analyses were then used to monitor the patient's fitting and choices., Findings and Outcomes: Initially, the left prosthesis was regarded as the dominant hand and the right one as the assistive power grip hand. However, the observational results showed that wearing only a left Greifer enabled the prosthetic user to perform the same tasks as with 2 prostheses. He has gained greater satisfaction and quality of life without losing his independence., Conclusion: The patient seemed to make a functional choice over his worrying about his physical appearance in favor of the efficiency of his prosthesis, which was essential for his everyday life, when he decided to wear only nonanthropomorphic prosthesis., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Objectives: Individuals with lower-limb amputations (LLA) often have deficits in balance and community walking ability. As a result, people with LLA are often sedentary. The aim of this study was to explore perceptions of physical activity from the perspective of people with LLA., Methods: A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semistructured interviews were held by telephone or in person with adults living with major LLAs recruited from rehabilitation hospitals and advertisements on social media. Individuals were included if they were age 18 years and older with a major LLA. Purposive sampling was used to ensure variation by sex, cause, and level of amputation., Results: Thirty-three people with LLA participated (22 men/11 women; median age 63 years). The majority of individuals had a unilateral, transtibial amputation (∼50% dysvascular LLA). Three main themes were developed to characterize participants' perceptions of physical activity: (1) physical activity is perceived as important but can be challenging after amputation; (2) physical activity has physical and mental health benefits; and (3) physical activity is a means to maintain independence and engagement in community and social life., Conclusions: Obtaining the perspectives of individuals with LLA about physical activity helps us understand how they think about it, what motivates them, and how we can optimize physical activity levels. Future research is needed to evaluate the effectiveness of interventions to enhance physical activity in this population., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

This study aimed to investigate whether belt electrode skeletal muscle electrical stimulation (B-SES) would improve postoperative lower limb function and walking ability in patients with diabetes who have undergone minor amputations. Diabetic patients who had undergone minor amputations were assigned randomly to a B-SES or control group. The B-SES group underwent conventional physical therapy for 20 min and B-SES for 20 min. The control group underwent only the 20-min conventional physical therapy. In both groups, rehabilitation was introduced by the physical therapists for 14 days from postoperative day 1. The outcome measures were range of motion in the ankle joint, knee extension muscle strength, ambulation status, and quality of life score. All these were evaluated before the intervention and 2 and 4 weeks after the intervention. From the 84 patients initially assessed, 32 were assigned to either the B-SES ( N  = 16) or control ( N  = 16) group. Preoperatively, there were no significant differences in all endpoints. The B-SES group showed significant improvement in the ankle dorsiflexion angle at 2 weeks postoperatively and knee joint extension strength at 4 weeks postoperatively. Postoperative B-SES with standard physical therapy might improve the range of motion of dorsiflexion of the ankle joint and extensor strength of the knee joint in patients with diabetes who have undergone minor amputations. B-SES is a useful tool to improve postoperative physical function in diabetic patients who have undergone minor amputations. A multicenter study is needed to determine the effective B-SES combined with regular physiotherapy for minor amputation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Although postoperative complications of lower limb amputations and complications related to prosthetics are well known, complications before prosthetic fitting are less often emphasized in literature. There are no Saudi studies documenting the complications before prosthetic fitting where there is high rise in dysvascular amputation, and early prosthetic provision remains a challenge., Objectives: To investigate the complications following major lower limb amputations (MLLAs)., Study Design: Retrospective study., Methods: One hundred thirty-six electronic files for individuals with major lower limb amputations were reviewed. Individuals visiting the primary limb loss clinic for the first time, who have not been fitted with a prosthesis before, were included., Results: Muscle weakness was the most common complication (55.1%), followed by edema (52.9%), while infection was found to be the least frequent (5.1%). Age was significantly associated with etiology ( p value < 0.001), usage of assistive device ( p value = 0.002), and complications ( p value = 0.013). Complications were also significantly associated with time since amputation ( p value = 0.001). In addition, etiology was significantly associated with the usage of assistive device ( p value = 0.012)., Conclusions: Muscle weakness and edema were the most common complications after MLLA in a cohort of patients with median onset of 8.5 ± 6.8 months since amputation. Presence of various complications in MLLAs before prosthetic evaluation reflect gaps of care including delayed prosthetic evaluation. National strategies need to be introduced to promote early rehabilitation interventions, prevent complications, and improve quality of life of individuals with MLLAs., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services., Objective: To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry., Study Design: Retrospective study., Methods: A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed., Results: A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment., Conclusions: These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: This study explored how inpatient exercise rehabilitation affected prosthetic mobility, function, and ambulation in persons with lower limb loss., Methods: In this explorative prospective nonrandomized intervention study, experienced (EXP-INT, n = 20) and new prosthetic users (NEW-INT, n = 18) completed a 4-week rehabilitation intervention. A control group of experienced prosthetic users (n = 19) received no intervention. Tests were performed at baseline (pretest) and after 4 weeks (posttest). A step-monitoring device recorded ambulatory activity., Results: For the primary outcome measure, Prosthetic Limb Users Survey of Mobility, the between-group analysis revealed significant differences (χ 2 = 10.91, df = 2, p < 0.01). Within-group Prosthetic Limb Users Survey of Mobility T-scores improved by 8.1% for the EXP-INT ( p < 0.01) and 15.1% for NEW-INT ( p < 0.01). Significant between-group differences were observed for the Amputee Mobility Predictor, L-test, 2-minute walk test, and 10-meter walk test. Within-group analysis demonstrated nonsignificant changes for the EXP-INT except for Prosthetic Limb Users Survey of Mobility, while the NEW-INT improved by 24.1% ( p < 0.001), 34.0% ( p < 0.01), 46.5% ( p < 0.05), and 31.0% ( p < 0.01), respectively. The number of steps during the last 7 d of rehabilitation showed significant differences between the groups (χ 2 = 13.99, df = 2, p < 0.001). The NEW-INT improved by 138% ( p < 0.05) compared with the first 7 d of rehabilitation, while the EXP-INT had nonsignificant changes., Conclusions: A 4-week rehabilitation intervention substantially increased prosthetic mobility, function, and ambulation activity for new prosthetic users but less so for experienced users. The results of the NEW-INT at discharge signify a considerable functional improvement., (Copyright © 2023 International Society for Prosthetics and Orthotics.)

Background: Direct skeletal fixation, a surgical technique enabling the attachment of an external prosthesis directly to the bone through a percutaneous implant, offers an enticing solution for patients with lower limb amputations facing socket-related issues. However, understanding of its impact on musculoskeletal function remains limited., Methods: This study compares pre- and 1-year post-osseointegration surgery outcomes, focusing on patient-reported measures and musculoskeletal system function during level-ground walking. Two participants with unilateral transfemoral amputations and two participants with bilateral transfemoral amputations completed the questionnaire for transfemoral amputations (Q-TFA) and underwent gait analysis. Musculoskeletal modelling simulations were conducted., Results: Results showed improved Q-TFA scores for all participants. Participants showed reduced amputated limb peak hip extension angles, flexion torques and contact forces at the push-off phase of the gait cycle. Post-operatively, hip adduction angles and abduction moments increased, indicating more natural gait patterns. Whilst one participant demonstrated increased post-operative walking speed, others walked more slowly., Conclusions: The study revealed diverse adaptation patterns after one year in individuals with transfemoral amputations transitioning to bone-anchored prostheses. Additional longer-term data is necessary to enable generalization and clinical implications of these results., Competing Interests: Declarations. Ethical approval, consent to participate and for publication: Ethical approval was obtained from the Imperial College Science, Engineering and Technology Research Ethics Committee (Reference 22IC7601, 20IC6268). Written informed consent for publication was obtained from all study participants. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Limb amputation often results in a change of profession or withdrawal from the workforce. Occupational rehabilitation plays a key role in assisting individuals with finding, maintaining, and advancing in employment. The aim of this review was to determine the precise number of amputations performed in Poland from January 2014 to June 2022 and to present selected available rehabilitation programs aimed at the social reintegration of individuals after amputations, with a particular focus on vocational rehabilitation. The analysis was conducted in 2 stages. First, the team reviewed data obtained from the central IT system of the National Health Fund and analyzed it. Then, a literature review was conducted using English-language databases: PubMed, Scopus, Science Direct, Medline, and websites searched through Google Scholar and Google. A total of 29 sources (from the years 2006-2024) out of 75 found were analyzed. Articles were searched using the following keywords: "rehabilitation programs," "amputations," "occupational rehabilitation," "disability," "vocational activation," and "rehabilitation effectiveness." A significant number of amputations are performed in Poland. Individuals who undergo such procedures can benefit from occupational rehabilitation programs that facilitate a faster return to professional activity. It is crucial to develop and implement preventive measures aimed at reducing the incidence of amputations in Poland, as well as to introduce new vocational rehabilitation programs that will enable individuals with disabilities to return to professional activity more effectively and efficiently. Med Pr Work Health Saf. 2024;75(5):445-454., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Major upper and lower extremity amputations are increasingly being performed for peripheral vascular disease, infectious etiologies, trauma, and oncologic purposes. Attention to technique and emerging treatments for the residual peripheral nerve is critical to prosthetic wear and quality of life following these life changing events. Here, we detail advancements in amputation surgery including targeted muscle reinnervation, regenerative peripheral nerve interface, and the use of osseointegrated implants., Competing Interests: Disclosure The authors have no financial disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Reintegration back into one's life following limb loss is heavily influenced by the interaction among the individual's mental health, environment, and physical factors (eg, pain and prostheses). While many patients experience posttraumatic growth and successfully reintegrate back into their lives, others have a more difficult adjustment. Interdisciplinary teams can best facilitate reintegration through early screening for barriers to reintegration such as depression, pain, body image, and inaccessible environments, to intervene early after amputation. With these barriers addressed, amputees may be able to return to driving and other valued activities more quickly, resulting in improved reintegration across life domains., Competing Interests: Disclosure The authors declare that they have no relevant or material financial interests that relate to the research described in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This article reviews emerging surgical techniques and prosthetic innovations related to amputation rehabilitation. Osseointegration is discussed from conception to modern implant designs. Motor and sensory reinnervation techniques are reviewed and compared. Prosthetic socket casting, interface, and design innovations are discussed, including direct molded sockets, water casting, adjustable sockets, and magnetic suspension. Advanced components with hydraulic and microprocessor control, power and crossover prosthetic feet are described., Competing Interests: Disclosure The contents of this article and opinions expressed do not represent the views of the Department of Veterans Affairs or United States Government. The authors have no relevant financial relationships., (Published by Elsevier Inc.)

Most research on people undergoing lower limb amputations for dysvascular disease summarizes average patient outcome risks and average associations between patient factors and these outcomes. More recently, the importance of predicting patient-specific outcomes based on individual factors (ie, personalized rehabilitation) has become evident. This article reviews the evidence and discusses the importance of the following: (1) predicting outcomes to facilitate amputation-level and prosthesis prescription decisions and (2) how prediction models can be leveraged to develop decision support tools to facilitate provider/patient shared decision-making to ensure decisions considering each individual patient's priorities and preferences. Examples of these tools are discussed and referenced., Competing Interests: Disclosure No authors have any commercial or financial conflicts of interest nor any funding sources to report at the time of this submission., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Postamputation pain is one of the most common and challenging pain conditions to treat and includes residual limb pain and phantom limb pain. Residual limb pain is present at the amputation site or proximal to the amputation site and may be caused by poor wound healing, poor prosthetic fitting, or neuropathic pain. Phantom limb pain is experienced distal to the amputation site and may be caused by maladaptive supraspinal reorganization. Treatment for post amputation pain should be multimodal and multidisciplinary, including pharmacologic agents, rehabilitation, psychosocial support, and integrative therapies. Surgical interventions including neuromodulation may be considered for refractory cases., Competing Interests: Disclosure None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The aim of this review is to synthesise the experiences and needs of people who had undergone dysvascular lower extremity amputations. Given the increasing global prevalence of vascular diseases like diabetes mellitus and peripheral arterial disease, the risk of requiring an amputation remains high., Materials and Methods: This systematic review follows the PRISMA and ENTREQ reporting guidelines. Seven databases were searched for qualitative studies from January 2011 to October 2023. In total 6435 studies were obtained, where 1146 were duplicates and 5271 studies failed to meet the eligibility criteria. The remaining 18 studies were synthesised using Sandelowski and Barroso's approach and appraised using the CASP checklist., Results: Four themes emerged from the meta-synthesis: (1) making the decision to amputate, (2) difficulties in the physical adaptation to limb loss, (3) psychosocial consequences of living with an amputation, and (4) regaining control and building hope., Conclusions: Having dysvascular lower extremity amputations is a complicated experience as not only was the pre-amputation pain relieved, but a new set of physical, emotional and social challenges would surface after the amputation. These synthesised findings serve as a platform to explore the factors behind the various experiences faced by these people and how healthcare professionals can help them in their adjustment.

Limb-loss is a significant medical event with lifelong consequences, impacting various aspects of a patient's well-being. Care for these often-complex patients involves providers from many different specialties working toward a set of patient-centered goals. This article aims to highlight the important role of physiatrists in directing the interdisciplinary care for these patients. Through evidence-based concepts, the authors aim to lay a roadmap for comprehensive, longitudinal management of these patients from pre-amputation assessment through lifelong care., Competing Interests: Disclosures None of the authors have any commercial or financial conflicts of interest and any funding sources., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The study aimed to compare the effects of home exercise alone and telerehabilitation combined with home exercise in individuals with transtibial amputation., Materials and Methods: The telerehabilitation group ( n  = 24) received telerehabilitation combined with home exercise, while the control group ( n  = 24) received home exercise alone. Outcomes included the timed up-and-go (TUG) test and the 30-second chair-stand test (30CST), the Activities-specific Balance Confidence (ABC) Scale, the Trinity Amputation and Prosthesis Experience Scales (TAPES), the Amputee Body Image Scale (ABIS), and the Nottingham Health Profile (NHP). The analysis used a 2 × 2 mixed repeated measures ANOVA., Results: The group-by-time interactions were significant for TUG ( p  = 0.002, F [1;41] = 10.74) and 30CST ( p  = 0.001, F [1;41] = 11.48). The mean difference (6th week-baseline) was -0.49 for TUG and 0.95 for 30CST in the telerehabilitation group and -0.14 for TUG and 0.13 for 30CST in the control group. There were statistically meaningful group-by-time interactions on the ABC ( p  = 0.0004, F [1;41] = 14.47), the TAPES-activity restriction ( p  = 0.0001, F [1;41] = 28.96), TAPES-prosthesis satisfaction ( p  = 0.004, F [1;41] = 9.19), and the NHP ( p  = 0.0002, F [1;41] = 16.07) favoring the telerehabilitation group., Conclusions: Telerehabilitation combined with home exercise can offer greater benefits in improving gait, muscle strength, balance confidence, activity restriction, prosthesis satisfaction, and quality of life compared to home exercise alone for individuals with transtibial amputation.Implications for rehabilitationExercise helps individuals with lower limb amputation overcome their physical limitations and enables them to use their prostheses effectively.Physiotherapy and rehabilitation after amputation are not at the desired level, and individuals with lower limb amputation encounter various difficulties in accessing physiotherapy.Telerehabilitation has great potential to facilitate access to physiotherapy for individuals with amputation and reduce resource utilization.In a relatively small sample of amputees, this study shows that telerehabilitation-based exercise improves physical health and quality of life.

Purpose: To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss., Materials and Methods: A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating., Results: Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants' perspectives on the factors impacting patients' transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care., Conclusion: This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care.

Competing Interests: Disclosures The authors have no conflicts of interest to disclose.

This report describes the decision-making, surgical management, and rehabilitation plan for an amputation at the level of the proximal radius in a 75-kilogram goat. The information provided in our report may aid veterinarians in educating and reassuring pet-goat owners about the different aspects involved with amputation, helping to better inform their decisions for the associated intensive postoperative care and rehabilitation time. Key clinical message: Amputation of a front limb in a large-sized goat can be perceived by pet-goat owners as a positive outcome and associated with good quality of life. Client support before surgery is key to aiding in a good outcome., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)

Purpose: Outcome measurement provides clinicians, services and funders with useful information. However, little is known about the experience of participating in outcome measurement during lower limb prosthetic rehabilitation from the patient's perspective., Materials and Methods: Thirty-two participants who underwent lower limb amputation within 5 years, and had experience of taking part in outcome measurement during prosthetic rehabilitation, were recruited from UK limb fitting centers and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis., Results: Four themes were identified. (1) How does participating in outcome measurement make me feel? (2) Do the outcome measures used in routine clinical care capture an accurate picture of my recovery? (3) Who is outcome measurement for? and (4) are prosthetic services measuring what is meaningful? These themes suggest outcome measurement is not a neutral activity for patients following lower limb amputation., Conclusions: Harnessing the positive impacts of measuring outcomes could be used for motivation, to support adjustment and recovery, to improve communication and to support shared decision-making. This could make outcome measurement more meaningful and patient-centered. However, there may be potential for patients to respond negatively to outcome measures and clinicians should consider their impact on psychosocial factors.

Objective: Upper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss., Methods: A volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores., Results: DASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group., Conclusion: People with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years., Impact: For the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Background: After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user's needs, values, and preferences., Objective: To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility., Study Design: Exploratory mixed methods., Methods: PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10., Results: The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users., Discussion: The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users' informational needs. Future iterations of the PDA should undergo beta testing in clinical settings., Conclusions: A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Objective: To perform the translation, cross-cultural adaptation and validation the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) for the Brazilian Portuguese in a sample of people with lower limb amputation., Methods: This is a methodological study with cross-sectional design. Translation and cross-cultural adaptation of the scale were initially carried out in accordance with international guidelines. After its psychometric properties were evaluated, in addition to the presence of floor and ceiling effect, the standard error of measurement and the minimal detectable change., Results: The Brazilian version of PASIPD presented face and content validity and correlated significantly with International Physical Activity Questionnaire ( rs : 0.71/p = 0.001). The degree of inter-examiner agreement ranged from 0.29 to 0.75, and the intra-examiner from 0.13 to 0.72. The inter-examiner was 0.71, and the intra-examiner was 0.78. The internal consistency measure (Cronbach's α) was 0.75. No floor or ceiling effect were observed. The standard error of measurement was 0.36 and the minimal detectable change was 1.66., Conclusions: The Brazilian version of PASIPD is valid, reliable and has internal consistency among its items, and can be used by researchers and health professionals to evaluate the physical activity of Brazilians with lower limb amputation., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Buerger disease is a nonatherosclerotic, segmental inflammatory disease of the occlusive tract, often involving medium-sized muscular and small-diameter arteries and veins of the extremities. If medical treatment is not successful, amputation is inevitable. The aim of this study was to investigate the effect of different kinesiological taping techniques on walking parameters of transtibial amputee with knee extension limitation. Two different kinesiological taping methods (Kinesio Tape and Dynamic Tape) were applied to the transtibial patient with knee extension limitation. Walking performance of patients was assessed with The Biodex Gait Trainer 2. Gait parameters without tape were as follows: average walking speed 0.38 m/s, average step cycle 0.48 cyl/s, average left step length 50 cm, average right step length 43 cm, coefficient of variation 9% at the left, and coefficient of variation 9% at the right. After applying Kinesio Tape and Dynamic Tape, these values were measured as follows: average walking speed 0.50.56 m/s, average step cycle 0.51.56 cyl/s, average left step length 61-60 cm, average right step length 53-54 cm, coefficient of variation 6%-5% at the left, and coefficient of variation 6%-4% at the right side. Dynamic Tape and Kinesio Tape both had positive effects on active joint motion and walking parameters. Regarding walking speed and step length, Dynamic Tape was found to be more effective than Kinesio Tape. Taping methods applied to amputees have positive effects on range of motion, which in return causes improvements on walking parameters., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: After amputation, people face challenges including wound healing and decreased functional mobility. Early mobilization in acute hospital care has proved safe, improved function, and sped discharge. Still, loss of a leg complicates standing and early mobilization after amputation. Approaches to early mobilization and rehabilitation after amputation surgery have not been widely studied., Objectives: To map the evidence regarding early postoperative mobilization after dysvascular amputation. Specific aims included identifying research designs and populations, describing rehabilitation approaches, and identifying gaps within the literature., Study Design: Scoping review following PRISMA-Sc guidelines., Methods: The a priori scoping review methodology conducted in June 2022 with English language and 20-year limits used the OVID Medline, OVID Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane databases, and Journal of Prosthetics and Orthotics archive. Reviewer pairs used Covidence software to screen for inclusion (subjects with major lower limb dysvascular amputations, seen immediately postoperatively for hospital-based rehabilitation) with decisions by concurrence. Data for best practice scoping reviews were synthesized for analysis., Results: Two hundred ninety-six citations were screened, 13 full texts reviewed, and 8 articles included: 2 cohort studies, 3 case-control studies, 2 single-group interventional studies, and 1 case study. There were no randomized control trials or prospective comparison group trials., Conclusions: Few studies were identified regarding acute rehabilitation after major lower extremity amputation. The limited evidence in this review suggested that early mobilization in the days after amputation was safe with or without use of temporary prostheses, although further research is certainly warranted., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Objective: To gather preliminary evidence on short- and long-term care priorities for people with lower extremity amputations., Design: A three-round modified Delphi study using semi-structured interviews., Participants: A convenience sample of 20 adult participants who had undergone lower extremity amputations at a tertiary public hospital., Main Measure: Consensus on each care priority was defined a priori as an agreement of more than 50%. Semi-structured interviews were conducted to understand the rationales for endorsing the care priorities., Results: Consensus was reached on 24 short-term care priorities and 12 long-term care priorities in the biomedical, practical and psychological and spiritual domains. The rationales for endorsing each of the care priorities generated three themes: preparedness; mental health, psychological and spiritual well-being; and participating in life, with respect and dignity., Conclusions: Our results highlight the substantial need to improve patient access to education and planning support prior to undergoing limb amputation, and optimising post-amputation rehabilitation programmes, enabling people with amputations to participate in meaningful life roles that provide them with purpose, dignity, and self-respect. The knowledge of care priorities revealed in this study may promote effective patient-centred care and improve clinical outcomes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: A systematic review and meta-analysis investigating the duration and frequency of lower extremity prosthesis use and what factors were associated with changes in their use., Materials and Methods: A search of PubMed, CINAHL, and Scopus over 20 years revealed 2409 articles. After review, 29 studies remained, representing 4814 participants with lower limb loss. Quality, funding, publication, and quantitative analyses were addressed., Results: The mean prosthesis use was 9.6 (5.3) hours/day and 6.4 (1.9) days/week. Distal amputation sites averaged more hours/day of prostheses use than proximal amputations (13.2 [3.2] vs. 10.8 [5.0], p  < .001). After hemipelvectomy or hip dislocations, average prostheses use was less hours/day (6.0 [4.7]) than after transfemoral (12.9 [4.8]) or transtibial amputations (14.0 [4.5]) ( p  < .05). Pooled effects revealed an association between comorbidities and abandonment (OR 0.35, p  = .03). The data supported six empirical evidence statements concerning age, sex, social support, amputation proximity, balance, skin condition, comorbidities, pain, falls, and fitness in association with changes in prosthesis utilization., Conclusions: The study provided systematic data on lower-extremity prosthesis use, thus helping to inform clinical decision-making and patient education. It also elucidated a path for future studies focused on modifiable factors related to prosthesis use and related outcomes.Implications for rehabilitationLower limb loss can trigger costly and debilitating sequela, which could be mitigated by increased prosthesis use and functionality, but there is no consensus on how often prostheses are being used and what affects changes in their use.When counseling patients on what they can expect after a lower extremity amputation and to set goals, the aggregated means of 9.6 (5.3) hours per day and 6.4 (1.9) days per week can be informative.Individuals who use a lower extremity prosthesis or may have to use one in the future can increase their prosthesis use and mobility by limiting further health deterioration.Rehabilitative care involving the multidisciplinary prioritization of proper socket fit, fitness training, gait training, and social support is associated with increased prosthetic device usage.

Background: In people with lower limb amputation (LLA), the loss of limb structures and peripheral motor and sensory systems result in significant mobility challenges, including impaired postural stability., Objective: The primary objective of this study was to evaluate the dual-task interference (DTI) on postural control and dual-task interference on cognition during static and dynamic balance in people with LLA and compare the same with controls. The secondary objective of this study was to compare the DTI on postural control and DTI on cognition between LLA of different etiology., Design: Cross-sectional observational study METHODOLOGY: Fifteen people with unilateral LLA and 15 age and gender-matched controls participated in this study at a tertiary care hospital. The outcome measures used were anterior-posterior stability index (APSI), medial-lateral stability index, and overall stability index (OSI) using Biodex Balance System and a cognitive task parameter, namely correct response rate in serial seven subtraction test. Quantitative variables were compared using a Wilcoxon rank-sum test. Spearman's correlation test was used to establish the correlation between the DTI on cognition and the DTI on postural control., Results: DTI on postural control during static balance was significantly higher in people with LLA than controls (APSI, OSI). No significant difference was observed in DTI on postural control during dynamic balance. No significant difference was observed in DTI on cognition during static and dynamic balance. A significant negative correlation was observed between DTI on cognition and DTI on postural control (APSI) during static balance people with LLA., Significance: In people with unilateral LLA, the addition of a cognitive task results in significant deterioration of sagittal plane postural control during static balance but not during dynamic balance due to the over-allocation of resources to a cognitive task., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: A bone-anchored limb (BAL) is an alternative to a traditional socket-type prosthesis for people with transfemoral amputation. Early laboratory-based evidence suggests improvement in joint and limb loading mechanics during walking with a BAL compared to socket prosthesis use. However, changes in cumulative joint and limb loading measures, which may be predictive of degenerative joint disease progression, remain unknown., Research Question: Do cumulative total limb and hip joint loading during walking change using a BAL for people with unilateral transfemoral amputation, compared to prior socket prosthesis use?, Methods: A case-series cohort of eight participants with prior unilateral transfemoral amputation who underwent BAL hardware implantation surgery were retrospectively analyzed (4 M/4 F; BMI: 27.7 ± 3.1 kg/m 2 ; age: 50.4 ± 10.2 years). Daily step count and whole-body motion capture data were collected before (using socket prosthesis) and one-year after BAL hardware implantation. Cumulative total limb and hip joint loading and between-limb loading symmetry metrics were calculated during overground walking at both time points and compared using Cohen's d effect sizes., Results: One year after BAL hardware implantation, participants demonstrated bilateral increases in cumulative total limb loading (amputated: d = -0.65; intact: d = -0.72) and frontal-plane hip moment (amputated: d = -1.29; intact: d = -1.68). Total limb loading and hip joint loading in all planes remained asymmetric over time, with relative overloading of the intact limb in all variables of interest at the one-year point., Significance: Despite increases in cumulative total limb and hip joint loading, between-limb loading asymmetries persist. Habitual loading asymmetry has been implicated in contributing to negative long-term joint health and onset or progression of degenerative joint diseases. Improved understanding of methods to address habitual loading asymmetries is needed to optimize rehabilitation and long-term joint health as people with transfemoral amputation increase physical activity when using a BAL., Competing Interests: Declaration of Competing Interest The authors declare that they have no known conflicting financial or personal interests that could have appeared to inappropriately influence the results presented in this work., (Published by Elsevier B.V.)

Postamputation pain is a common condition in patients with lower limb amputation (LLA), which compromises amputees' rehabilitation, use of the prosthesis, and quality of life. The aim of our study was to investigate the prevalence of phantom limb pain (PLP), residual limb pain (RLP), or both types of pain among individuals with LLA, and to identify the factors associated with the presence of one type of pain versus the other. Patients who underwent amputation for traumatic or vascular reasons and who reported on RLP or PLP were analyzed and divided into three groups: PLP, RLP, or a group of subjects that presented both pains. We searched for factors that affect the occurrence of limb pain using univariate analyses, followed by multinomial logistic regression. Among the 282 participants with transtibial and transfemoral amputations, 192 participants (150 male and 42 female) presented PLP, RLP, or both types of pain, while 90 participants declared to perceive no pain. The estimated prevalence of any type of pain after transfemoral and transtibial amputation was therefore 68% (27% PLP, 10% RLP, and 31% both). Among the studied characteristics, only amputation level was associated with the type of pain ( P  = 0.001). Multinomial logistic regression identified transfemoral amputation as the only statistically significant predictor for PLP (odds ratio = 2.8; P  = 0.002). Hence, it was estimated that individuals with transfemoral amputation have nearly three times higher odds of experiencing PLP compared with those with transtibial amputation., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)