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Limb amputation is a life-altering procedure used to treat certain cancer patients. The influence of psychosocial factors (such as marital status) on outcomes is poorly understood, hindering the development of targeted resources for the specific needs of these patients. This study was conducted to characterize the influence of marital status on survival after cancer-related amputation. Retrospective cohort study. 1,516 patients with cancer-related amputation were studied from the Surveillance, Epidemiology and End Results database. Patients were grouped by marital status as single, married or divorced/separated/widowed and survival was compared using multivariate cox regression adjusted for demographic, tumor and treatment factors. Adjusted analysis showed that single (HR, 1.213; p =.044) patients had a significantly higher overall mortality-risk, while divorced/separated/widowed patients had both a significantly higher overall (HR, 1.397; p <.001) and cause-specific mortality-risk (HR, 1.381; p =.003) compared to married patients. We posit that the increased psychosocial support available to married cancer patients may play a key role in improving survival. These findings provide new insight about the psychosocial needs of cancer amputees and the prognostic implications for those lacking social support of a spouse. [ABSTRACT FROM AUTHOR]

Background. Berg Balance Scale (BBS) can be considered the standard for assessment of functional balance but has a noted ceiling effect in active transtibial amputees (TTAs). Development of ceiling-free measures based on quantitative measurement techniques that is suitable for patients in any experience levels, yet sensitive enough to capture improvements in any stage of prosthetic rehabilitation, is needed. Research Question. Does a scoring scheme based on Multiattribute Utility (MAU) theory assess balance abilities of multileveled TTAs comparable to BBS? Methods. A case-control study including 28 participants (8 novice TTAs, 10 experienced TTAs, and 10 healthy controls) was conducted. Guided by MAU theory, a novel balance model was developed and initially validated by Spearman correlation between index-generated scores and expert assigned scores, providing preliminary evidence of validity. Floor/ceiling effects were tested, and between-group comparisons of static/dynamic balance were conducted by paired t -test or Wilcoxon signed-rank test depending on data distribution normality. Results. BBS score was correlated with computed balance index (r = 0.847 , p < 0.001). The BBS score of novice/experienced TTAs was 39/54, and the computed balance index was 38/75. A ceiling effect of BBS (30%) was observed in the experienced TTA group, whereas no ceiling effects were found for the computed index in any combination of TTA groups. Group differences between novice and experienced TTAs were observed in center of pressure (COP) ellipse shift area, COP path length, COP average velocity, gait speed, and cadence (all p < 0.05). Significance. Evidence from first stage validation of the proposed MAU balance model indicated that the model performed well. This proposed method can monitor the progress of balance for varied experience-leveled TTAs and provide clinicians with useful information for assessing the rehabilitation training. [ABSTRACT FROM AUTHOR]

Objectives: Several studies indicate that limb amputations have a negative influence in the quality of life of those individuals who underwent amputation surgery. The aims of this study were to evaluate the quality of life in Mexican individuals with limb amputations compared with a control group, to identify demographic and clinical differences related to the etiology of the amputation, and to determine if they are associated with the quality of life observed in these patients. Methods: All participants were recruited from the Hospital "Dr Gustavo A. Rovirosa Pérez". The quality of life of all participants was evaluated using SF-36. Results: Individuals with amputations of vascular or trauma etiology, showed a diminished health-related quality of life when compared with the control group (p <.001). We observed that individuals with amputations due to trauma were younger, mostly single, with more upper limb amputations and with a shorter period since amputation at the current assessment in comparison to individuals with amputations. Conclusions: Although limb amputation represents a surgical procedure necessary to preserve the life of a person, our results support that it negatively impacts the health-related quality of life of these individuals. Regardless of the etiology of the amputation, rehabilitation programs are primarily focused on reintegrating individuals to their everyday life. However, these programs may have poor results when patients have a poor quality of life. Therefore, quality of life assessment and early inclusion in programs that aim to improve the quality of life of individuals with amputations should be always taken into consideration. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the physical, psychological and social wellbeing of veterans who have experienced limb-loss and to ascertain the factors that contribute to the ability of veterans to maintain their independence at various stages in their lives. Methods: Sixty two life-story interviews were conducted with 32 veterans (aged between 40 and 95) who had experienced limb-loss either during or after military service. Results: Three overarching superordinate themes and related sub-themes were generated from a detailed Framework Analysis "Barriers to transition" describes issues related to employment, legal support and compensation, stigma and loss of identity. "Disparity of care" highlights the issues related to military and civilian care and prosthetics service user experience. The final superordinate theme, "Enduring challenge of limb loss," considers stoicism, dealing with pain, mobility, physical isolation and social networks. Conclusions: The outcomes offer an opportunity to shape future health and social care policy around the requirements of veterans who have experienced limb-loss by understanding the complexity, and ascertaining the factors that contribute to, maintaining long-term independence. [ABSTRACT FROM AUTHOR]

Rates of prosthetic device abandonment are dramatically high; however, the reasons behind abandonment are less understood. A scoping review was conducted to explore the current state of the literature on why individuals abandon upper limb prosthetic devices and consider how these reasons have evolved historically. A systematic search of the literature identified 123 articles. After reviewing the articles using predetermined inclusion and exclusion criteria, nine relevant articles were included in the final review. The included articles covered passive, body-powered and myoelectric prosthetic devices. Across time, reasons for abandonment could be broadly categorized into comfort and function. Weight, temperature and perspiration were among the most common and persistent comfort-related reasons for abandonment. Regarding function, studies-reported abandonment was attributed to key concerns about control and sensory feedback, whereby participants may feel more functional without their device. In agreement with the previous literature, lack of comfort and function remain persistent reasons for upper limb prosthesis abandonment. Up-to-date research on reasons for abandonment of upper limb prosthetic devices is lacking, and recent prosthesis advancements have not been included in studies of device use, adoption and abandonment. Therefore, future work should explore reasons for abandonment in contemporary upper limb prosthetic devices. By understanding the reasons for prosthetic device abandonment, clinicians, therapists and researchers can use this information to proactively mitigate future upper limb prosthetic device abandonment. Findings from this review can be used to guide future prosthetic device development to improve these areas of concern and satisfy user needs. By understanding the reasons for prosthetic device abandonment, clinicians, therapists and researchers can use this information to proactively mitigate future upper limb prosthetic device abandonment. The findings from this review can be used to guide future prosthetic device development to improve areas of concern and satisfy user needs. [ABSTRACT FROM AUTHOR]

Introduction: An avoidance behavior is an inhibitive response to normal activities of daily life based on actions taken to escape movement in tasks that one considers challenging. In persons with lower-limb amputation, pain catastrophizing, the tendency to ruminate and magnify painful sensations, is a risk factor for mobility apprehension, an avoidance behavior. Avoidance behavior leads to physical deconditioning of the muscles. The purpose of this study was to link the psychological trait of avoidance to physiological traits of strength for the purpose of understanding balance. It was hypothesized that in persons with lower-limb amputation, poor balance will correlate directly with mobility apprehension and indirectly with muscular strength. Materials and Methods: Adult participants who had a well-fitting prosthesis and had the ability to ambulate at least 10 ft were asked to participate in the study. Participants completed questionnaires regarding demographic information and self-report instruments measuring mobility apprehension. Mobility apprehension was measured using the Tampa Scale for Kinesiophobia (TSK). Balance was measured using the Berg Balance Scale. A handheld dynamometer was used to assess isometric strength of the left and right hip extension, trunk flexors, and trunk extensors. Hip strength was defined as themean value of the strength of the left and right hip extensors. Core strength was defined as the mean strength value between the trunk flexors and extensor muscles. Results: Of the participants, 80% reported comorbidities (e.g., diabetes, high blood pressure, and heart disease). The mean (SD) TSK score was 38.65 (6.68), where a score of 39 or higher indicates a high level ofmobility apprehension. Themean (SD) hip and core strengths were 15.78 (9.29) lb and 5.60 (3.17) lb, respectively. The mean (SD) Berg Balance score was 46.25 (6.74). There was amoderate direct correlation between balance and hip strength (r = 0.45, p = 0.046). Core strength approached a significant direct correlation with balance (r = 0.39, p = 0.085). However, mobility apprehension was not related to balance. Conclusion: Results may assist clinicians in aiming exercise programs toward increasing hip and potentially core strength, thus improving balance to promote better mobility for individuals with a lower-limb amputation. [ABSTRACT FROM AUTHOR]

The loss of a limb places a significant physical and emotional burden on the child and their family. Limb loss in children can be congenital or acquired due to trauma or disease and its complications. Regardless of the cause, children have unique considerations for managing limb loss, which are not always straightforward and effectively lifelong. They require a multidisciplinary and forward-looking approach to address the child's needs now and into the future. Education and anticipatory guidance to parents are paramount in the child's treatment efforts. Children with congenital limb deficiency are generally good at figuring out ways to complete tasks regardless of their limb deficiency. There is a difference in acceptance of upper vs lower limb prostheses, as upper limb prosthesis does not replace the missing part in the same way as a prosthetic leg can. Prosthetic replacement should enhance the child's function, or it will get rejected. Attention to detail, use of developmentally appropriate componentry and timely follow up are essential for effective prosthetic rehabilitation. Society has come a long way to accept and promote exposure to limb loss, and these children can grow up to live a full and productive life. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the different meanings of the experience of lower-limb amputation due to vascular causes in the time period from the fifth to twelfth week post-amputation. A phenomenological study involving semi-structured interviews was carried out. Data collection took place in a Public Hospital in Spain and included a convenience sample of 20 patients who had undergone amputation. The study highlighted patients' fears related to mobility, pain, dependence, and autonomy. Moreover, patients experience of the rehabilitation process and resources for adaptation were described as well as all the changes related to the social environment. The figure of a nurse was considered essential after amputation by the patients. This study provides a deep understanding of their experiences at the immediate time after amputation considering patients demographical associations and the etiology of the vascular pathology. This could be the starting point to understand patients' immediate needs upon discharge. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative phenomenological study was to explore the adaptation process of support group participants who are survivors of lower limb amputation (LLA) experiencing phantom limb pain (PLP). The study followed a qualitative, descriptive phenomenological design. Ten adult participants with LLA met inclusion criteria and through semi-structured interviews shared their lived experience. A qualitative descriptive methodology was used to analyze the data collected from interview transcriptions. Analysis involved coding and theme development. Three themes emerged: PLP interrupted but does not prevent participation, adapting to PLP allowed for continued participation in meaningful occupations, and education to promote self-management of PLP. Themes identified highlight the importance of social support and early education on PLP to facilitate the adaption process and promote occupational participation. The finding underscores the value of empowering survivors to self-manage pain through their own personal and unique ways. [ABSTRACT FROM AUTHOR]

A systematic review was conducted to provide an overview of the current state of research regarding sexuality and sexual health in adults with limb loss. Five databases (Medline, CINAHL, Scopus, Web of Science and PsycINFO) were searched between January 1, 2000 and April 14, 2019. Two reviewers independently screened all titles and abstracts for primary inclusion and full texts for secondary inclusion. The inclusion criteria were peer-reviewed journal articles that were published in English, that addressed at least one aspect of sexuality or sexual health and included adults (18 years and older) who acquired a major limb amputation. A modified Sackett Scale was used to assign levels of evidence to each study. A total of 29 articles met the inclusion criteria. With regard to sexuality, the most common topics investigated were body image (n = 21), sexual desire (n = 6) and sexual activity (n = 4). The Amputee Body Image Scale was the most commonly used outcome measure to assess body image (n = 10). In terms of sexual health, the most frequently studied issues were sexual functioning (n = 5) and sexual counselling (n = 2). Sexuality and sexual health issues affect the health and wellbeing of adults with limb loss. The majority of studies were low in evidence; indicating that more robust intervention studies are needed to help people cope with limb loss as it relates to their sexual health and sexuality. In particular, more targeted efforts for women and individuals with upper limb loss are needed. [ABSTRACT FROM AUTHOR]

Objective The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA. Methods Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30–60, 60–90, and >90 minutes), standing (0–1, 1–5, and >5 minutes), and stepping (0–1, 1–5, and >5 minutes) was also calculated. Results Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}–quartile 3 {Q3} = 67%–84%]), followed by standing (median = 16% [Q1–Q3 = 12%–27%]) and stepping (median = 6% [Q1–Q3 = 4%–9%]). One-quarter (median = 25% [Q1–Q3 = 16%–38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1–Q3 = 34%–54%]; stepping: median = 98% [Q1–Q3 = 95%–99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1–Q3 = 59%–78%]; dysvascular: median = 79% [Q1–Q3 = 73%–86%]) and standing (traumatic: median = 23% [Q1–Q3 = 16%–32%]; dysvascular: median = 15% [Q1–Q3 = 11%–20%]). Conclusion Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute. Impact High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA. [ABSTRACT FROM AUTHOR]

Hand amputation significantly challenges one's independence in carrying out daily activities. With the UK and Italy recoding circa 5200 and 3500 upper limb (UL) amputations (ULAs) yearly, respectively, and about 541,000 Americans losing ULs in 2005, incidence victims constitute a considerable proportion of our population and should be adequately supported. The use of upper limb prosthesis (ULP) offers amputees a new opportunity of living a quality life - but poses challenges on the physically and psychologically traumatised. With reports that up to 20% of adult UL amputees choose not to use a prosthesis, roughly 26% of adults and 45% of children and adolescents are dissatisfied with their devices and abandon them with reasons of poor solution to basic needs, a review of ULP for suitability has become crucial. These include, to review UL prosthetic technology (PT), the materials used in the manufacturing of ULP, challenges in research and development of ULP, and to advise on the suitability of different devices to the needs of amputees. They involve an extensive review of relevant literature and application of statistics to analyse data obtained from literature. ULAs are characterised to show affected bones in seven types of amputations. The characterisation depicts key causes of incidences that lead to amputations while advising on device suitability. PT is classified in terms of cost, nature, functions/operations of each type of device while providing the design challenges. Users' opinions on PT materials are analysed and used to suggest new materials for the next generation of the devices. R&D challenges hindering future developments of PT is reviewed and results used to identify characteristics for the next generation of the technology. To increase user satisfaction and reduce device abandonment, amputees need useful information on the trend in PT and engineers need information about device field performance for improvements. The use of better performing ULP will improve users' everyday lives. [ABSTRACT FROM AUTHOR]

Purpose: Although peer support has received research attention within different health related contexts, there is limited research considering individuals who have experienced an amputation. In particular, the peer mentoring role is under-explored. Therefore, this research aimed to explore the experiences of participants delivering peer support interventions to individuals with lower limb loss. Methods: Eight people who acted as peer mentors for people with limb loss took part in semi-structured interviews. Data were analyzed using Interpretative Phenomenological Analysis (IPA). Results: Two overarching themes were identified from the data: "Developing a Helpful Self", in which the personal value and meaning of being a peer mentor is presented, and "Connecting with Vulnerability", which addresses the emotional challenges of peer mentoring and the impact of these on wellbeing. Conclusions: Findings suggest positive experiences of providing support, including increased hope, resilience and a sense of belonging and connection to others. However, peer mentors experienced challenges related to uncertainty and doubt about their mentoring abilities and with developing and maintaining resilience in the role. Recommendations include the development of training packages and increased clarity for volunteers of the peer mentor role. It is important to define clearly the role of a peer mentor and the responsibilities this involves. Peer mentors should be provided with support and training to increase their confidence and ability to act appropriately when encountering distress. It is important to provide transparent guidelines and procedures to support peer mentors to minimize concerns over risk and safety. Feedback regarding how effective the support offered is and how it could be improved should be provided. [ABSTRACT FROM AUTHOR]

Purpose: To explore barriers and enablers to community walking perceived by people with lower limb amputation. Materials and methods: Three focus groups (n = 14 participants), using purposive sampling, were conducted with people with lower limb amputation who used a prosthesis to walk in the community. Three investigators analyzed transcripts using thematic content analysis. Results: Themes aligned with the International Classification of Functioning, Disability and Health domains. Barriers related to body function and structure included prosthetic function, residual limb integrity, phantom limb pain and other medical issues, with optimal prosthetic function and adequate fitness identified as enablers. Personal barriers included challenges adjusting to change, whereas personal enablers included being able to adjust to change, having a positive attitude, goal setting and a purpose for community walking. Environmental barriers included physical (e.g., terrain, crowds, climate) and social (e.g., unwanted attention and finances). Environmental enablers included aids, transport, preparation, social support and finances. Community walking was essential to participation in work, leisure, social activities and family roles. Conclusion: Walking in the community for people with a lower limb amputation presents many barriers, but enablers have also been identified. Targeted assessments and interventions, and appropriate environmental planning may assist in minimizing barriers to community walking. Although rehabilitation for people with lower limb amputation should continue to optimise body function and structure (such as strength, fitness, pain and prosthetic function) to help prepare individuals for walking in the community, personal and environmental factors should also be addressed. Optimising an individual's personal enablers may facilitate community walking; this may include strategies to assist with adjusting to change, setting goals, instilling a positive attitude towards walking, and seeing a purpose for walking in the community. Enhancing environmental (physical and social) enablers and minimising environmental barriers to walking in the community may be possible through environmental planning (e.g. infrastructure such as lifts), social awareness and education. [ABSTRACT FROM AUTHOR]

Objective: The lower limb amputation is one of the major concerns for the amputee's daily life and the trans-femoral (TF) amputation is being paid a lot of attention because of its functional requirement in flexion-extension motion. Though significant progress has been made for the development of high end prosthetic knee joint, the affordability of the same is still a great concern. Thus, a passive polycentric knee joint was developed and the health related quality of life (HRQL) before and after the fixation of the prosthesis, and performance of the same were studied. Design: After 6 months of fixation, the HRQL and performance of the prosthetic device were evaluated. Results: The HRQL after the fixation was found to be increased, where the improvement on the physical and mental score was found to be 49 and 46%, respectively, in comparison with pre-fixation stage. The global score (G) for the prosthetic function was found to be 63, which confirmed the increased performance of the prosthesis. Conclusions: The improved HRQL and G of prosthetic performance confirmed the enhanced performance of the prosthesis. It is concluded that the developed passive polycentric knee joint could be explored in large scale for the TF amputees. The above knee (AK) amputation is a surgical interference that severs the thigh segment between the knee and hip joints. The above knee prosthesis consists of a socket, knee joint, pylon and foot. The artificial prosthetic knee joint imitates the functions of human knee to achieve the flexion-extension motion of the above knee amputee. The satisfaction of the amputees with the usage of the existing artificial prosthetic knee joint is still a concern. Hence, a passive prosthetic knee joint was developed and its effect on the quality of life of trans-femoral amputee was evaluated using health related quality of life (HRQL) before and after the fixation of the prosthesis The HRQL after the fixation was found to be increased in comparison with pre-fixation stage. The global score for the prosthetic function was also found to be increased which confirmed the increased performance of the prosthesis. It is anticipated that the developed knee joint is expected to make huge impact due to its function, performance and affordability. [ABSTRACT FROM AUTHOR]

Qualitative study. An amputation injury to the hand may lead to not only impaired hand function but also psychosocial consequences. The purpose of the study was to explore personal experiences of social participation for persons provided with an esthetic prosthesis after acquired upper limb amputation. Thirteen persons with acquired upper limb amputation, who were in need of and had received an esthetic prosthesis, were interviewed. The transcribed text was subjected to content analysis. The emotional reactions to a visibly different hand were linked to a changed appearance and a feeling of being exposed. Recollecting the accident could result in nightmares and sleeping disorders. A change of personality, due to sadness after the amputation was expressed, as well as social insecurity and impact on relations and life roles. Adapting to social challenges comprised hiding or exposing the hand, using personal internal resources and receiving support from others. The esthetic prosthesis contributed to an intact appearance and could serve as a facilitator for initial or long-term social participation. The time that had passed since the injury made it easier to deal with the consequences or in achieving acceptance. Coping with emotions and social relations after an acquired amputation can be difficult and complex. Individual needs must be considered and questions about appearance and how it may affect social participation must be asked. An esthetic prosthesis can normalize the appearance and offer the confidence needed to facilitate social participation in those struggling with appearance-related concerns. • Thirteen upper limb amputees, who had received an aesthetic prosthesis, were interviewed. • Individual variations concerning the experienced emotional consequences were identified. • Adaptation strategies and the role of the prosthesis were described. [ABSTRACT FROM AUTHOR]

Purpose: Falls are prevalent among people with lower extremity amputations. A knowledge of risk factors is important in preventing falls, though no research has evaluated patient understanding of falls in this population. The study objective was to evaluate knowledge of falls risk factors and falls prevention strategies at discharge and 4-months after inpatient prosthetic rehabilitation. Methods: Participants completed a falls questionnaires with four sections: (1) falls during rehabilitation and after discharge, (2) falls self-efficacy using the Activities-specific Balance Confidence scale, (3) knowledge of falls risk factors, and (4) falls prevention strategies. Questionnaire responses were quantified using means and standard deviations or frequencies and percentages. Data were analyzed using paired t-tests for the Activities-specific Balance Confidence scale and the knowledge of falls risk factors, and using chi-square analyses for fall prevention strategies. Results: Twenty-seven individuals (aged 62.6 ± 8.4; 55.6% male) were included. Unsafe or risky behaviours and not paying attention to surroundings were perceived as the top two falls risk factors. Although these factors are modifiable, only 5.9% of participants listed preventative behavioural modifications. No significant differences were found in Activities-specific Balance Confidence scale scores (p = 0.404) or knowledge of falls risk factors (p = 0.361) between discharge and follow-up. Conclusion: This study highlights a gap between knowledge of falls risk factors and the application of knowledge to prevent falls. Follow-up data suggest that lived experience does not affect the knowledge of falls risk factors. Falls and falls prevention are an important health concern for those with lower extremityamputations and should be addressed during the rehabilitation process. Balance confidence among individuals with lower extremity amputations is low, indicating that this population is at an increased falls risk and may require intervention to prevent falls. Rehabilitation programs should encourage all forms of falls prevention modifications and strategies, such as behavioural modifications, physical activity and environmental modifications. There is a gap between knowledge of falls risk factors and how to apply this to prevent falls, which may be a target for rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To gain insight into determinants of physical activity in wheelchair users with spinal cord injury or lower limb amputation, from the perspective of both wheelchair users and rehabilitation professionals. Methods: Seven focus groups were conducted: five with wheelchair users (n = 25) and two with rehabilitation professionals (n = 11). The transcripts were analysed using a sequential coding strategy, in which the reported determinants of physical activity were categorized using the Physical Activity for people with a Disability (PAD) model. Results: Reported personal determinants of physical activity were age, general health status, stage of life, demotivation due to difficulty burning calories, available time and energy, balance in daily life, attitude, and history of a physically active lifestyle. Reported environmental determinants were professional guidance, inconvenient exercise times, accessibility of facilities, costs, transportation difficulties, equipment difficulties, and social support. Conclusions: Important, changeable determinants of physical activity that might be influenced in future lifestyle interventions for wheelchair users are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities (providing information on how and where to find accessible facilities), and social support (learning how to get this). A physically active lifestyle improves everyday functioning, and decreases disability and the risk of secondary health problems in wheelchair users with spinal cord injury or lower limb amputation. After inpatient rehabilitation, it is difficult for wheelchair users to maintain or further enhance their physical activity, a lifestyle intervention can help them in this. To be effective, lifestyle interventions should address important, changeable determinants of physical activity. Important, changeable determinants of physical activity reported by wheelchair users and rehabilitation professionals are: balance in daily life leading to more time and energy to exercise, attitude towards physical activity, professional guidance, accessibility of facilities, and social support. [ABSTRACT FROM AUTHOR]

Background: Adjustment to amputation is a complex process because it encompasses physical and psychosocial aspects as well as satisfaction with the artificial limb. Purpose: To review the scientific production on psychosocial and physical adjustments to amputation and prosthesis use as well as prosthetic satisfaction in people with lower limb amputation in the last 10 years. Methods: This review was conducted on the MEDLINE via Pubmed, Web of Science and Scopus databases. Original and observational studies published in the last 10 years were included, with topics related to adjustment to amputation and prosthesis use as well as prosthetic satisfaction in people with lower limb amputations. Results: A total of 1042 articles were identified in the initial search, but after analysing the criteria 16 articles were used for analysis in their entirety. Regarding psychosocial adjustments, higher rates of depression, anxiety and body image disorders were observed among people with amputations. Phantom and residual limb pain, gender, employment status and daily hours of prosthesis use may influence psychosocial adjustment. Physical adjustment may be influenced by the level of amputation, educational background, age, daily prosthesis use, ambulatory assistive devices and presence of comorbidities. The areas of greatest prosthetic dissatisfaction were colour and weight. Conclusion: Considering that most of the studies related to the satisfaction and adjustment of the prosthesis are cross-sectional studies, longitudinal studies should be conducted, since monitoring individuals over the years and verifying how these variables change over time may contribute to obtaining more data on the factors that influence prosthetic fitting and satisfaction. Adjustment to amputation and prosthesis use involves both physical and psychosocial issues, it is important that besides physical rehabilitation, psychological interventions and education and communication activities between the patient and the health professionals are carried out. The adaptation to the prosthesis and the recovery of walking capacity are important goals in the rehabilitation process and the knowledge of the physical and psychosocial factors associated with amputation and the use of the prosthesis can help the health team to provide better care to these subjects. Well-adjusted, comfortable and easy-to-use prostheses are of great importance as they enable the patient to perform their daily activities and maintain their independence. It is important to encourage the participation of the individual in both rehabilitation and choice of prosthesis. [ABSTRACT FROM AUTHOR]

In our country, outcome measures are needed to evaluate the results of occupational therapy in amputees. This study aimed to cross-culturally adapt the Reintegration to Normal Living Index (RNLI) and to evaluate the reliability and validity of a Turkish version of the RNLI. The Turkish version of the RNLI was applied to 120 amputees. Cronbach's alpha coefficient and the intraclass correlation coefficient (ICC) were used to determine internal consistency and test–retest reliability, respectively. Criterion validity was assessed using Short Form 36 (SF-36). The Turkish version of the RNLI presented reliable results in repeated assessments (ICC =.88), and the internal consistency of the RNLI was high (Cronbach's α coefficient =.89). A statistically significant relationship was found between RNLI and SF-36 (p <.05). The Turkish RNLI is a reliable and valid tool to evaluate the level of reintegration to normal living for amputees. [ABSTRACT FROM AUTHOR]

Purpose: To assess the test–retest reliability of the Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics, better known as SIGAM/WAP mobility scale, in persons with a lower-limb amputation. Method: Longitudinal study at the outpatient departments of a rehabilitation center and a university medical center. Persons with a lower-limb amputation, wearing a prosthesis, were assessed at the end of their multidisciplinary rehabilitation treatment twice, with a 3-week interval, by the same practitioner. Test–retest reliability was quantified using the intraclass correlation coefficient for agreement. Results: Eighty persons participated (mean age ± SD, 61 ± 15 years; 61% men; 76% vascular cause of amputation; 70% able to walk >50m). Fifty-one of them rated themselves to be stable with respect to their mobility and their intraclass correlation coefficient was 0.90 (95% confidence intervals 0.84–0.94). Conclusions: The Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics had, at the outpatient departments of a rehabilitation center and a university medical center, excellent test-retest reliability in persons wearing a prosthesis after a lower-limb amputation. The Special Interest Group on Amputation Medicine/Dutch Working Group on Amputations and Prosthetics Mobility Scale was developed to classify mobility after a lower-limb amputation and wearing a prosthesis. The Dutch translation of this mobility scale has excellent test–retest reliability. [ABSTRACT FROM AUTHOR]

Objective This study preliminarily characterizes and compares the impact of lower limb loss and development of chronic low back pain (cLBP) on psychosocial factors, as well as the relationship between these factors and low back pain–related functional disability. Design Cross-sectional study. Methods Participants were adults, active duty or retired military, with traumatic lower limb loss with and without chronic low back pain. Psychosocial factors and low back pain–related functional disability were measured using common clinical self-report questionnaires. The presence of psychosocial factors was compared between those with and without cLBP using multivariate analysis of covariance (P  <   0.05), and correlations determined relationships between psychosocial factors and cLBP-related functional disability. Results There were no statistically significant differences among psychosocial factors between those with vs without cLBP (F (4, 13) = 0.81, P  =   0.54, η2 = 0.19). Employment status (ρ  = 0.43, P  =   0.02), anxiety (ρ  = 0.45, P  =   0.04), and kinesiophobia (ρ  = 0.47, P  =   0.04) were moderately associated with low back pain–related disability. Conclusions Psychological (i.e., anxiety) and social (i.e., employment status) factors may influence how persons with traumatic lower limb loss respond to self-reported measures of low back pain–related disability. The findings suggest that the Modified Oswestry Disability Index identifies cLBP-related functional disability in the context of lower limb loss. These results support the interdependence among biological, psychological, and social factors, which should be collectively considered during the development of rehabilitative strategies to treat secondary musculoskeletal conditions within this population. [ABSTRACT FROM AUTHOR]

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Introduction: The Amputee Mobility Predictor (AMP) is an instrument designed to evaluate ambulatory capacity with and without a prosthesis in persons with lower-limb amputation. The purpose of the study is to cross-culturally adapt and translate the AMP into French (AMP-F), and to determine the reliability and construct validity of AMP-F. Materials and Methods: The AMP was translated and cross-culturally adapted to French following standardized procedures. Thereafter, the AMP-F was subjected to psychometric evaluation with 30 participants with lower-limb amputation. Each participant completed the AMP-F three times: once with each of the two raters on the day of the first evaluation (interrater reliability) and a third time at the second evaluation by one of the two raters, held within 9 days of the first (intrarater reliability). Other tests completed at the second evaluation include the Locomotor Capabilities Index questionnaire and the 6-minute walk test, administered to measure construct validity. Results: The AMP-F was developed as a result of the translation process. It showed excellent intrarater (intraclass correlation coefficient [ICC] = 0.97; MDC90, 7.0) and interrater (ICC = 0.95; MDC90, 6.3) reliability. Correlations were high between the AMP-F and the 6-minute walk test (r = 0.71) as well as the Locomotor Capabilities Index in persons with amputation (r = 0.88). Conclusions: The AMP-F is a reliable and valid instrument for the evaluation of ambulatory capacity in individuals with lower-limb amputation. The AMP-F will allow clinicians residing in a francophone country to have access to a valid and reliable instrument for the evaluation of ambulatory capacity with and without prosthesis in individuals with lower-limb amputation. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F). Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach's α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was −3.90 with limits of agreement from −18.71 to 10.92. For ABIS-R-F, the mean difference was −2.12 with limits of agreement from −8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F). Conclusions: The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible. The quality of life of amputees is impacted by their satisfaction with body image The Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputees The Standard Errors of Measurement proposed could be useful for clinical and research purposes Both ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliability The shortened version has a better response structure and is more readily feasible. [ABSTRACT FROM AUTHOR]

Introduction: Powered prostheses are a promising new technology that may help people with lower-limb loss improve their ability to perform locomotion tasks. Developing active prostheses requires robust design methodologies and intelligent controllers to appropriately provide assistance to the user for varied tasks in different environments. The purpose of this study was to validate an impedance control strategy for a powered knee and ankle prosthesis using an embedded sensor suite of encoders and a six-axis load cell that would aid an individual in performing common locomotion tasks, such as level walking and ascending/descending slopes.Materials and Methods: Three amputees walked on a treadmill and four amputees walked on a ramp circuit to test whether a dual powered knee and ankle prosthesis could generate appropriate device joint kinematics across users.Results: Investigators found that tuning 2-3 subject-specific parameters per ambulation mode was necessary to render individualized assistance. Furthermore, the kinematic profiles demonstrate invariance to walking speeds ranging from 0.63 to 1.07 m/s and incline/decline angles ranging from 7.8° to 14°.Conclusion: This work presents a strategy that requires minimal tuning for a powered knee & ankle prosthesis that scales across a nominal range of both walking speeds and ramp slopes. [ABSTRACT FROM AUTHOR]

Purpose: What are the characteristics of people with lower limb amputation at admission to, and discharge from, subacute rehabilitation? Have these characteristics changed over time? Methods: A total of 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission characteristics, including aetiology, gender, age, amputation level, cognition (Mini-Mental State Examination (MMSE)), indoor mobility aid, motor function (Functional Independence Measure motor subscale) and number and type of comorbidities, and discharge characteristics, including prosthetic prescription, motor function, discharge mobility aid, and destination were compared by admission date and year. Results: Proportion of people with lower limb amputation with nonvascular aetiology increased over time (2004, 15% to 2011, 24%) (ß = −181.836, p < 0.001). Admission cognition increased over time (ß = 9.296, p < 0.001). Motor function worsened over time; median admission (IQR) Functional Independence Measure motor 70 (59–77) in 2005 to 67 (51.5–73.25) in 2011 (ß = −1.937, p < 0.001) and discharge from 81 in 2005 to 79 in 2011 (ß = −1.267, p < 0.001). Prosthetic prescription rates were highest in 2005 (68%) decreasing to 47% in 2010 (ß = −200.473, p < 0.001). Conclusions: Total numbers of people with lower limb amputation did not change over the seven-year study period. Changes were observed in aetiology, cognition and motor function. Prosthetic prescription rates decreased over time. Rehabilitation should account for the changing characteristics of people with lower limb amputation. Motor function should be addressed as part of rehabilitation to optimise the patient's ability to return home and to the community. Prescription rates for lower limb prostheses reduced across time, indicating more specific selection processes and refined clinical decision making; this decision is best informed by a multi-disciplinary approach. [ABSTRACT FROM AUTHOR]

Purpose: Identifying factors associated with physical activity after dysvascular lower limb amputation (LLA) could provide targets for improving rehabilitation outcomes. The purpose of this meta-synthesis was to identify modifiable factors that may influence physical activity after LLA, a condition characterized by amputation in the setting of older age, diabetes mellitus (DM), and/or peripheral artery disease (PAD). Methods: A systematic search of the literature identified qualitative studies exploring the perceptions of physical activity in people with lower limb amputation, older age, DM, or PAD. Qualitative rigor was assessed using the McMaster University's Guidelines for Qualitative Review. Meta-synthesis was undertaken to analyze the findings of included studies. Results: Fourteen studies of variable methodological quality were included for analysis. Three overarching factors that may influence physical activity after LLA emerged: 1) educational experiences and motivation, 2) support and self-efficacy, and 3) special concerns after lower limb amputation (e.g., prosthesis, equipment, and environment). Conclusions: Physical activity after LLA is influenced by relationships among health understanding, motivation, support, and self-efficacy in the presence of disability. Themes from this meta-synthesis can be used to develop and test behavior-based interventions to improve physical activity after LLA. Physical activity participation after dysvascular lower limb amputation is complicated by the presence of chronic conditions, severe disability, and unaddressed psychosocial factors. Addressing a patient's self-efficacy, social support, motivation, and understanding during physically focused rehabilitation may improve participation in physical activity after dysvascular lower limb amputation. Rehabilitation professionals can address self-efficacy, motivation, and understanding by using collaborative, empathetic communication strategies known to enhance a patient's sense of support. [ABSTRACT FROM AUTHOR]

Background: Mobility clinics are designed to extend gait and mobility training beyond rehabilitation programmes. No research has been undertaken into participants' experiences of attending these multidisciplinary, experience-based clinics. Research in this area is needed to ensure clinics meet intended goals, including understanding the motivation and experience of attendees. Insights may improve mobility clinics and inform strategies to encourage greater participation.Objectives: To explore the motivation of people with limb loss to attend a mobility clinic, the experience of participation and their perception of the clinic's benefits.Study Design: Qualitative methodology, naturalistic enquiry.Methods: Semi-structured interviews were conducted with nine clinic attendees during the clinic. Interviews were transcribed verbatim, data thematically analysed and emergent themes underwent member checking.Results: Three themes emerged from the data: facing the challenge captured how participants' have adapted to amputation, valuing peers highlights the important role of peers in learning and support and improving mobility described the ongoing quest to improve mobility.Conclusion: The mobility clinic was attractive to those who liked challenges and was an invaluable source of learning for those wishing to improve their mobility. Future clinics should ensure that peer education is supported, and activities cater for a range of skills and fitness levels.Clinical Relevance: Findings of this study indicate that those who attended the mobility clinic liked to challenge themselves. Participation with peers was an important source of learning and support. Those participants who had previously attended a mobility clinic reported improvements in their overall daily function. [ABSTRACT FROM AUTHOR]

Purpose: To provide an understanding of the everyday experiences of individuals with a limb amputation. Methods: Twenty-two participants (14 female, 8 male) with a mean-age of 42 years (SD = 10 years) were recruited to take part in two focus groups. The participants reported a range of lower-limb amputations (i.e., congenital, acquired, transfemoral, trantibial, unilateral, and bilateral) and on an average were 5 years post-surgery (SD = 7 years). Each focus group comprised of 11 participants and was moderated by either the first or second author. The moderator asked participants to discuss their everyday experiences of life with an amputation using Charmaz's good day/bad day approach. Focus groups were transcribed verbatim and analyzed using an inductive thematic analysis. Results: Four themes were identified: pain, organization and planning, the embodied experience after amputation, and interactions with others. Conclusions: These themes provide a key resource for understanding daily fluctuations in physical, social, and psychological functioning. Lower limb amputation can result in daily fluctuations in physical, social, and psychological functioning. These fluctuations can be illustrated through experiences of pain, planning and organization, embodied experiences, and interactions with others. At a policy level, evaluations of daily living after an amputation should be based on a longitudinal assessment. [ABSTRACT FROM AUTHOR]

The impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans' families calls for further research to address these important issues. [ABSTRACT FROM AUTHOR]

This study describes a newly developed prosthetic leg socket design for a below-knee amputation. Excessive heat and the resulted perspiration within a prosthetic socket were the most common causes for reporting a reduced quality of life for prosthetic users. The product namely AirCirc means air circulation and it has been designed by approach of medical device design process in providing the amputees to maintain the skin temperature inside the socket. This device has been designed to provide the amputees with comfort and ultimate breathable. In order to design the device, the small hole was made in prosthetic socket surface since it has a function as air circulation. Four types of proposed sockets namely P1, P2, P3 and P4 and one control socket were compared on a single patient to determine the best design of prosthetic socket. The result successfully reveals that by using holes can be maintain the temperature inside prosthetic socket. In addition to the eco-friendly material, the woven kenaf was used as material that provides good strength as compared to glass fibre and offer sustainable and biodegradable product yet provides unique and aesthetic surface as came from woven kenaf itself. The objective of this paper is to provide the airflow prosthetic socket design and optimize the use of natural fibre in prostheses field. Thus, with the use of the environmental friendly material, functionality device and heat removal capability make the device suitable for maintaining a comfortable and healthy environment for prosthesis. Newly developed prosthetic leg socket design for a below-knee amputation Device has been designed to provide the amputees with comfort and ultimate breathable Woven kenaf was used as material that provides good strength as compared to glass fibre for sustainable and biodegradable product Results show that by using holes can be maintain the temperature inside prosthetic socket [ABSTRACT FROM AUTHOR]

Background: Alongside physical impairment, psychosocial health issues may arise after amputation, impacting quality of life. Traditional psychosocial care models provide services in a linear fashion, with limited supports upon discharge. A novel program entitled Amputees Unanimous is a 12-step program provided for amputees by amputees.Objective: To shape the final content of Amputees Unanimous by identifying personal beliefs and opinions of healthcare professionals and amputees.Study Design: Qualitative design utilizing a phenomenological approach.Method: Five focus groups were held: four with amputees and one with healthcare providers. A phenomenological approach shaped the inquiry of the lived experience of limb loss in relation to the content of Amputees Unanimous.Results: Three themes emerged: (1) accepting limb loss, (2) peer inspiration, and (3) regaining prior level of function.Conclusion: Limb loss may alter one's self-image, both physically and psychologically, having a profound effect on how an individual copes throughout his or her lifetime. The content and delivery format of Amputees Unanimous could be tested for effectiveness as a program tailored to facilitate coping after limb loss and to provide encouragement, support, and hope for the future of amputees.Clinical Relevance: A dynamic, amputee-led, mutual help program may provide individuals with limb loss a place for encouragement, support, and optimism for the future. [ABSTRACT FROM AUTHOR]

Phantom limb pain (PLP) is a widespread and challenging neuropathic pain problem, occurring after both surgical and traumatic amputation of a limb. It may occur immediately after surgery or some months later, however, most cases it presents within the first 7 postoperative days. Patients report a range of pain characteristics in the absent limb, including burning, cramping, tingling and electric shock sensation. The incidence of PLP has been reported to be between 50% and 85% following amputation. Its management is notoriously difficult, with no clear consensus on optimal treatment. It is often resistant to classic balanced analgesia and typical neuropathic pain medications. Taking into account these issues, the authors aimed to improve the management of patients undergoing amputation at their institution, by ensuring accurate and holistic assessment, the selection of suitable interventions through critical analysis and synthesis of available evidence, and the appropriate evaluation and adaptation of treatment plans, to ensure patients achieved their individualised goals. [ABSTRACT FROM AUTHOR]

A variety of prescribed accommodation periods have been used in published prosthesis intervention studies that have examined biomechanical outcomes. Few investigators included repeated measurements in their study design, leaving questions as to how measured outcomes change as amputees acclimate to a new prosthesis. This paper is the product of our investigation as to whether measured gait variables were affected by the duration of accommodation period, and to assess the relationship between measured outcomes and the subjective perception of the participants. A sample of transtibial amputees were recruited for this study. Gait data was collected by wearable sensor repeatedly, starting immediately after fitting the interventional foot and extending over a subsequent four days. Participants indicated their perceived accommodation quality on a visual analog scale (VAS). A total of twelve commonly used spatiotemporal gait parameters were analyzed. Friedman tests were used to determine overall differences across time points in both early (one hour) and late (day two through five) accommodation phases, for each gait variable. Statistically significant changes across the early phase were found for variables gait speed χ2(2)=8.000, p=0.018, cadence χ2(2)=7.185, p=0.028, and double support time on the sound side χ2(2)=8.615, p=0.013. Across days two through five, no gait variable significantly changed. VAS scores correlated strongly with step count (r=1.000, p<0.001) and cadence (r=0.857, p=0.014). Longer accommodation periods resulted in less deviations of gait variables for the clinical assessment in the process of prosthetic rehabilitation. Trying out prosthetic interventions for less than one hour has yielded unreliable outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To describe the rehabilitation experience and outcome of treatment with bone-anchored prostheses in individuals with bilateral transfemoral amputations (TFAs) treated in Sweden over a period of 25 years. Method: Hospital records were reviewed for all patients with traumatic bilateral TFAs treated until 2015. The use of prostheses, walking aids and wheelchairs was noted. Results: The cohort comprised 12 patients (nine men and three women with a mean age 35 years at treatment) and the median follow-up time was seven years (1–20). At baseline, 9/12 used prostheses and 3/12 did not. The main means of locomotion was in a wheelchair without wearing prostheses (n = 8/12) or in a wheelchair in combination with prosthetic walking supported by walking aids (n = 4/12). All prosthetic users had problems with sitting comfort. At follow-up, 11/12 patients used prostheses, while one did not. The means of locomotion was prosthetic walking in 3/12 cases, a combination of a wheelchair and prosthetic walking in 4/12, a wheelchair while wearing prostheses but not walking in 4/12 and a wheelchair without wearing prostheses in 1/12. Three patients walked unsupported by walking aids. Seven patients had no problem with prosthetic sitting comfort (n = 3 had small problems). Conclusions: Bone-anchored prostheses in patients with bilateral TFAs resulted in more prosthesis use during everyday locomotion, due hypothetically to improved comfort while wearing prostheses. The results further underline the importance of other assistive devices such as wheelchairs and walking aids used in combination with prostheses in this group of patients facing severe functional limitations. This study provides an insight into the details of the rehabilitation and outcome in patients with traumatic bilateral transfemoral amputations treated with bone-anchored prostheses in Sweden. The treatment can lead to a large amount of prosthetic use, but most patients will also use a range of assistive devices including full-length prostheses, stubbies, walking aids and wheelchairs after treatment. The importance of sitting in comfort while wearing prostheses should not be underestimated in patients with bilateral transfemoral amputations. [ABSTRACT FROM AUTHOR]

Purpose: To examine physical activity participation amongst individuals with lower limb amputation. Method: Adults with lower limb amputation were convenience-sampled from a major metropolitan hospital outpatient amputee service and completed the International Physical Activity Questionnaire. Results: Seventy-two individuals (65% male), mean age 53.6 (SD = 16.8) years, who were 10.8 (SD = 12.6) years post amputation (60% transtibial) participated in the study. Thirty-eight percent of participants (n = 27) undertook "high" levels, 26% (n = 19) undertook "moderate" levels, and 36% (n = 26) undertook "low" levels of physical activity but cumulative activity levels were low. Participants most commonly undertook domestic-related activities (n = 53, 74%) and moderate-intensity activities (n = 54, 75%). Physical activity levels were found to be significantly lower amongst individuals who did not work, individuals with dysvascular amputation and individuals who lived with others. Physical activity levels showed a weak, significant, correlation to age (rs (70) = −0.259, p = 0.028) and time post amputation (rs (70) = 0.237, p = 0.049). Conclusion: This study provides clinicians with information about physical activity participation amongst individuals with lower limb amputation. The majority of participants in this study (n = 44, 61%) did not accumulate sufficient "total physical activity" to be classified as "sufficiently active" and 33% (n = 24) of participants were classified as "sedentary". Regular physical activity participation is associated with many health benefits. This study found the majority of individuals with lower limb amputation (61%) did not undertake sufficient total physical activity to be classified as "sufficiently active". Health professionals working in rehabilitation can play an important role in encouraging individuals to increase physical activity participation. The study's findings may guide health professionals on where to direct their focus to promote increased physical activity participation amongst individuals with lower limb amputation. [ABSTRACT FROM AUTHOR]

Introduction: Many different prosthetic feet are available to meet the diverse needs of people with lower-limb amputation. Current methods used to assess comparative effectiveness of prosthetic feet may not align with outcomes that are most important to people with lower-limb amputation. User participation in qualitative research is one approach to guide selection of outcome measures for clinical practice and quantitative research studies. This pilot study examined outcomes of importance to people who have used both energy storing and crossover prosthetic feet. Materials and Methods: An in-person focus group of people with lower-limb amputation was conducted. Inclusion criteria were as follows: 18 years of age or older, lower-limb amputation, previous use of an energy storing foot and crossover foot, and a minimum of 1 year prosthesis use. Results: Five participants with lower-limb amputation (4 males/1 female), aged 41 to 59 years (mean, 45.6 ± 7.7 years), participated in the focus group. Three participants had unilateral transtibial amputations; one had bilateral transtibial amputations; and another had bilateral involvement with a transtibial and partial-foot amputation. All participants reported daily use of a prosthesis (mean, 15.2 ± 1.1 hours). Three categories of themes arose from this focus group: direct outcomes, external influences, and indirect outcomes. Direct outcomes included balance and stability, endurance and sustained gait quality, and naturalness. External influences included peer and prosthetist interactions. Indirect outcomes included increased confidence and expanded mobility. Outcome measures available to assess identified constructs were suggested. Conclusions: Engagement of prosthesis users through qualitative research methods can inform the choice of outcome measures used to assess clinical outcomes or evaluate the effectiveness of prosthetic devices. [ABSTRACT FROM AUTHOR]

Introduction: Upper-limb prostheses are divided into three groups: cosmetic (passive), mechanical, and powered. Each of these groups has specific characteristics and would be prescribed for special purposes. Some studies have separately examined function and quality of mechanical and cosmetic prostheses. Using the Trinity Amputation and Prosthesis Experience Scales (TAPES), the present research was aimed to compare and evaluate the quality of life and function of individuals with medium-length below-elbow amputation using mechanical and cosmetic prostheses. Materials and Methods: Fifty-two individuals with medium-length below-elbow amputation voluntarily participated in this study. The TAPES questionnaire was used in this study. Results: Regarding the general adjustment subscale, social adjustment subscale, functional activity subscale, social activity, appearance, satisfaction of weight, and functional satisfaction, significant differences were seen between two groups (P < 0.05). No significant difference was experienced between the groups in adjustment with restrictions subscale, sociopsychological adjustment, professional activity subscale, activity scale, and prosthesis satisfaction. Conclusions: It was found out that each of these two types of prosthesis is suitable for special activities and tasks, and each has a specific function that potentially could improve an individual's quality of life. Because both cosmetic and mechanical prostheses have their own strengths and weaknesses, they can both together be used by one individual with amputation, complement each other, and fulfill the needs of the person with amputation. [ABSTRACT FROM AUTHOR]

Purpose: Describe and quantify how people with transfemoral amputations (TFA) maintain stable gait over a variety of surfaces; including, downhill and uphill, top and bottom-cross-slopes, medial-lateral translations, rolling hills and simulated rocky surfaces. Methods: Ten TFA and ten matched people without amputations (NA) walked in a virtual environment with level, sloped and simulated uneven surfaces on a self-paced treadmill. Stability was quantified using medial-lateral margin of stability (ML-MoS), step parameters, and gait variability (standard deviations for speed, temporal-spatial parameters, foot clearance and root-mean-square of medial-lateral trunk acceleration). Results and conclusions: TFA and NA adapted to non-level conditions by changing their walking speed, step width, and foot clearance. Variability for most parameters increased across conditions, compared to level. TFA walked slower than NA with shorter, wider and longer duration steps (most differences related to speed). ML-MoS did not change compared to level; however, ML-MoS was greater on the prosthetic side than both intact side and NA limbs. Foot clearance and root-mean-square of medial-lateral trunk acceleration were greater on the prosthetic side than the intact side and NA limbs. This research provides a comprehensive analysis of the different adaptations made by people without amputations compared to people with transfemoral amputations over non-level conditions and establishes significant differences between slopes and simulated uneven surfaces for TFA. Transfemoral amputation and no amputation groups adapted walking biomechanics when traversing non-level surfaces. Greatest temporal-spatial gait adaptations were walking speed, step width and foot clearance. Gait parameter variability typically increased from the level condition in both groups. Transfemoral amputation group walked slower than no amputation group with shorter, wider steps and longer duration steps. This was related to speed. Transfemoral amputation group had more trunk motion variability on the prosthetic side than no amputation group; could be related to prosthetic fit. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Physical Medicine & Rehabilitation Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A number of studies have investigated the role of coping and social support as protective factors for psychosocial adjustment after amputation. In contrast, few have focused on the role of attachment styles. Therefore, the purpose of this study was to examine the relationship between attachment insecurity, social support, coping strategies and negative emotions, such as anxiety and depression, in adult amputees. Sixty-two amputated adults (71% males, 29% females), recruited from the Prosthetic Centre of the Italian Workers’ Compensation Authority, completed the Attachment Style Questionnaire, the Coping Inventory for Stressful Situations, the Multidimensional Scale of Perceived Social Support, the Beck Depression Inventory II and the State-Trait Anxiety Inventory Y. Based on Pearson’s correlations results, we conducted a mediation analysis to examine whether the association between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and negative emotion (i.e. depression, state anxiety and trait anxiety) variables was mediated by emotion-oriented coping. Analyses revealed the role of insecure attachment styles in influencing the use of an emotion-oriented coping strategy in particular. The latter mediated the relationship between attachment insecurity, depression and anxiety in adult amputees. [ABSTRACT FROM AUTHOR]

Purpose: Despite the importance of the evaluation process in lower limb prosthetic rehabilitation, prostheses are rarely evaluated properly in the Arab world. This is partly due to the absence of any suitable Arabic evaluative tool. The aim of this study is to translate TAPES-R (a standardised evaluative questionnaire) into Arabic and to investigate its psychometric properties on lower limb amputees. Such a tool would ultimately be of benefit for clinical follow-up and research purposes. Method: International standards were followed for the forward- and back-translation of the TAPES-R questionnaire. A sample of 111 Arabic-speaking volunteers with lower limb amputation completed the translated version of the questionnaire. The responses were then statistically analysed using factor analysis and Cronbach's α to assess the content and construct validity, and internal consistency (reliability) respectively. Results: Factor analysis showed that the questionnaire's items (included in the analysis) can be divided into three distinct dimensions as was originally suggested. The distribution of the items within the three dimensions is comparable with the original questionnaire. All three parts of TAPES-R showed high reliability; where Cronbach's α were .892, .894, and .873 respectively. Conclusion: This study found that the Arabic version of TAPES-R represents a valid and reliable tool. Limitations: The questionnaire is designed to be emailed or posted, but the majority of the amputee population in Jordan did not have these services, so direct contact with each participant was necessary. [ABSTRACT FROM AUTHOR]

Purpose: Although the DEKA Arm promises new abilities, it is unclear if women with upper limb amputation are willing to avail themselves of this new technology. The study purpose was to understand key factors and tradeoffs that shape women's attitudes towards the DEKA Arm. Methods: This case series includes three women with transradial amputation. Structured surveys and semi-guided interviews were administered after completion of in-laboratory training and a home trial of the DEKA Arm. A constant comparative method with a grounded theory approach was used to generate a model describing women's decision-making related to the DEKA Arm. Quantitative data on prosthetic satisfaction was used to triangulate findings. Results: Factors that enhanced desirability of the DEKA Arm were improved functionality, increased abilities and the availability of someone to service the prosthesis. Factors that detracted from desirability of the device were its appearance, conspicuousness, lifestyle incompatibility, weight, need for service and difficulty of use. Each woman weighted these factors within the larger context of the capabilities of and satisfaction with her personal prostheses, her self-concept and lifestyle needs. Situational demands, particularly the desire to appear feminine and professional or need to perform certain activities, also altered the valuation of these priorities. Conclusion: Findings strongly suggest that advanced upper limb prosthetic technologies, like the DEKA Arm, will be better accepted by women if appropriately gendered in appearance and designed with women's priorities in mind. Women should be able to derive the functional benefits of advances in upper limb technology without needing to compromise their feminine identity and lifestyle preferences. Advanced upper limb prosthetic technologies will be better accepted by women if they are appropriately gendered. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the impact of balance ability, activities-specific balance confidence, and other self-reported and clinical factors on incidence of falls among people with lower limb loss. Design: This is a cross-sectional study (N = 305) with multivariable logistic regression analysis. Results: Participants included 68.3% men with an age of 55.5 ± 14.9, with 50% dysvascular and 56.8% transtibial amputations. The mean ± SD activities-specific balance confidence is 2.1/4 ± 1.1, balance ability is 2.9/4 ± 1.3, and walking speed is 0.766 ± 0.387 m/sec. The final model showed fall risk was heightened for people with vascular comorbidities (odds ratio = 3.46, 95% confidence interval = 1.40-8.54) and better balance (odds ratio = 23.29, confidence interval = 3.19-170.23), but attenuated for people with transfemoral (odds ratio = 0.08, confidence interval = 0.01-0.82) and vascular amputations (odds ratio = 0.38, confidence interval = 0.15-0.95). Significant interactions existed between age and amputation level (odds ratio = 1.06, confidence interval = 1.02-1.11) and between balance confidence and balance ability (odds ratio = 0.27, confidence interval = 0.13-0.57). Conclusions: Although people with vascular amputations were less likely to fall than those with nonvascular amputations, people with concurrent vascular comorbidities were more likely to fall than those without. People with transfemoral amputations were less likely to fall; however, fall risk increased with each year of age compared with people with transtibial amputations. People with balance ability of 3.5 or greater fell more often than those with lower ability, but people with lower balance ability and mismatched confidence in their balance ability had 3.7 times greater fall risk. [ABSTRACT FROM AUTHOR]

Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report's purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight bearing and total contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science. [ABSTRACT FROM AUTHOR]

The purpose of this study was to administer clinical balance measures in community-dwelling adults with unilateral lower extremity (LE) amputations and determine optimal cut-off scores for identifying fallers. A cross-sectional study was conducted on a convenience sample of 40 independently ambulatory participants with unilateral LE amputations and a prosthetic device (20 fallers and 20 nonfallers) who were tested during a single session using: the Amputee Mobility Predictor with Prosthesis (AMP PRO), Functional Reach (FR), Single Limb Stance (SLS) and the Timed-Up-and-GO (TUG). There was a statistically significant difference on the AMP PRO (4.75 points.; 95% CI 1.10-8.40) for fallers (36.95 out of 47, SD 7.43) compared with nonfallers (41.70 out of 47, SD 3.13) and on the TUG (4.17 s., 95% CI 0.65-7.69) for fallers (14.84 s, SD 7.33) versus nonfallers (10.67 s, SD 2.64). The AMP PRO had a moderate Area Under the Curve (AUC) predictive value of 0.70 with an optimal cut-off score of 39.5 out of 47 total points (sensitivity 80%, specificity 60%) for identification of fallers. For the TUG, there was a moderate AUC value of 0.68 (sensitivity 70%, specificity 60%) when using a cut-off score of 10.03 s. There was a moderate to high correlation between the AMP PRO and TUG both between (r = −0.77) and within (r = −0.68) groups indicating that they measure similar constructs. Limitations included a heterogeneous sample and self-report of fall history. Both the AMP PRO and the TUG provide acceptable sensitivity and specificity for identifying fallers among community-dwelling adults with LE amputation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study was to evaluate and compare clinical and demographic characteristics, functional status and quality of life among patients who underwent amputation for the most common reason in our region. METHODS: Demographic data, level of and reasons for undergoing amputation and clinical data on the use of prostheses in 126 patients were recorded. The amputees were divided into three groups: vascular, trauma and landmine. Variables related to clinical and demographic characteristics, daily life activities and quality of life were investigated. Duration of prosthesis use, daily walking distance with prosthesis, 10-m walking speed with the prosthesis and 6-min walking distance of the amputees were recorded. The Short Form-36, Turkish version of the Trinity Amputation and Prosthesis Experience Scales and Beck Depression Inventory were used to evaluate the patients' quality of life. The residual limb pain scale was used to evaluate the severity of pain. RESULTS: Comparison between the amputees in the trauma and vascular groups showed highly significant results (P < 0.001) in amputees in the trauma group with respect to all parameters of daily life activities, functional status and quality of life. Comparison between the vascular and landmine amputees showed significant results (P < 0.001) in the landmine amputees with respect to all parameters except emotional role functioning, social functioning and mental health. Comparison between the amputees in the trauma and landmine groups showed no significant results (P > 0.05) with respect to all parameters expect emotional role functioning and mental health. CONCLUSIONS: While the clinical and demographic characteristics, functional status and quality of life parameters were similar in the amputees in the trauma and landmine groups, they showed statistically significant differences in almost all parameters compared with those in vascular amputees. [ABSTRACT FROM AUTHOR]

Aim: The study examined the relationships between psychological variables and sexual functioning in persons with lower limb amputations. Method: Sixty-five participants (n = 49 males, n = 16 females) with lower limb amputations completed a battery of self-report questionnaires regarding their current psychological well-being and their current sexual activity. Measures included the anxiety items on the Hospital Anxiety and Depression Scale, the Beck Depression Inventory - Second Edition, Body Image Quality of Life Inventory, Body Exposure Self-Consciousness during Intimate Situations and the Golombok-Rust Inventory of Sexual Satisfaction. Results: Half of all participants with lower limb amputations were not currently sexually active. Approximately 60% of those who were sexually active scored within the clinical range for overall sexual dysfunction. Overall levels of sexual dysfunction were associated with significantly higher levels of anxiety (r = 0.40, p < 0.005), depression (r = 0.41, p < 0.015) and body exposure self-consciousness during sexual activities (r = 0.56, p < 0.005). Body image self-consciousness during sexual activities was the strongest predictor of sexual dysfunction. Conclusions: Psychological challenges following limb loss are strongly associated with levels of sexual dysfunction. The study highlights the need for psychological and psychosexual assessment and intervention following limb loss to enhance sexual functioning and overall quality of life. Implications for Rehabilitation: Only half of the participants with a lower limb amputation were sexually active. Over 60% of those who were sexually active reported clinical levels of sexual dysfunction. One third of the entire sample scored within the clinical range for depression and for anxiety. Depression, anxiety and body image issues were significantly associated with sexual dysfunction in the current sample of individuals with lower limb amputation. There is a need for psychosexual assessment following limb loss to ensure that appropriate and timely interventions are made available. Interventions that target the psychological factors related to sexual dysfunction are likely to improve overall quality of life for these individuals [ABSTRACT FROM AUTHOR]