BACKGROUND:Amputation leads not only to limb loss but also to alterations in body representation, motor planning, and sensorimotor integration. Prosthesis use may help preserve these representations; however, its influence on cognitive motor processes such as laterality judgment and motor imagery remains unclear. OBJECTIVES:This study aimed to examine the effects of lower limb amputation (LLA) and prosthesis use on laterality judgment performance and motor imagery ability compared with able-bodied individuals. METHODS:Three groups participated: prosthesis users (PU) and nonprosthesis users (N-PU) with acquired unilateral LLA at or above the below-knee level, and normally limbed controls. Participants completed a laterality judgment task (reaction time and accuracy), the Vividness of Movement Imagery Questionnaire-2 (VMIQ-2), and the imagined Timed Up and Go (iTUG) test. Repeated measures ANOVAs, one-way ANOVAs, and independent samples t-test were conducted to analyze group differences. RESULTS:In the laterality task, N-PU participants demonstrated significantly longer reaction times than controls in the abstract condition for both the nonamputated (p = 0.001) and amputated sides (p = 0.004), along with lower overall accuracy (p = 0.035), whereas PU participants performed comparably with controls (p > 0.05). In the VMIQ-2, both amputee groups showed significantly reduced imagery vividness across all subscales compared with controls (p < 0.05); however, PU participants exhibited significantly greater kinesthetic imagery vividness than N-PU participants (p = 0.001). No significant difference was found between PU and controls in iTUG performance (p = 0.051). CONCLUSIONS:Prosthesis use appears to support the preservation of motor imagery ability and spatial representation in individuals with LLA. These findings emphasize the potential cognitive-motor benefits of prosthetic integration and support the inclusion of imagery-based assessments in rehabilitation programs.
Background Individuals with unilateral transfemoral amputation (TFA) commonly experience gait-related loading asymmetries, elevating their risks of lower limb injuries and degenerative changes. To evaluate the effects of interventions on these asymmetries, it is crucial to assess test-retest reliability and establish minimum detectable changes (MDCs) for loading-related measures. Determining them for these measures would help distinguish meaningful interventional effects from daily variability. This study evaluated test-retest reliability and established MDC values for ground reaction force (GRF) during treadmill walking in individuals with TFA and compared GRF outcomes between the amputated and intact limbs. Methods Ten participants underwent 2 study visits, 1 month apart. Ground reaction force data were collected during treadmill walking at a self-selected speed. Outcome measures included loading rates, unloading rates, braking impulses, and propulsive impulses, normalized by body weight. Intersession reliability and MDC values were computed with intraclass correlation analysis. Side-to-side differences were analyzed using repeated-measures ANOVAs. Ground reaction force time series were compared using statistical parametric mapping (SPM-1d). Results Braking and propulsion impulses demonstrated good-to-excellent reliability (intraclass correlation coefficients >0.82) in both limbs, whereas intact limb loading rates showed poor reliability. Higher loading rate but lower propulsion impulses were detected in the amputated limb, with differences in propulsion impulses exceeding MDC values. SPM-1d analyses detected side-to-side differences in GRF waveforms at the beginning and the end of the stance phase in superior-inferior and anterior-posterior directions. Conclusion Impulse outcomes are reliable measures, promising for future investigation of treatment effectiveness in longitudinal gait studies in individuals with TFA.
Background: Stubby prostheses are nonarticulated prostheses used by persons with bilateral transfemoral/through-knee amputations (BTF) either exclusively or alongside full-length articulated prostheses. The implications of stubby prosthesis use on musculoskeletal function and movement patterns are unclear. This study aims to provide insights into the biomechanics of walking with stubbies. Methods: Gait data were collected using a 10-camera motion capture system from 4 male traumatic BTF who exclusively use stubbies and 4 male traumatic BTF who use multiple prostheses, including stubbies and full-length articulated prostheses. Both cohorts completed level-ground walking trials wearing stubby prostheses. Muscle parameters were quantified through high-resolution magnetic resonance imaging scans. Results: Compared with BTF who use multiple prostheses, stubbies-only users showed lower walking speeds by 15% (0.79 vs 0.93 m/s), lower cadence by 20% (91.2 vs 114.7 steps/min), lower peak hip flexion angles by 45% (19.7° vs 35.9°), and larger peak-to-peak anterior pelvic tilt by 103% (15.8° vs 7.8°). Stubbies-only users presented lower overall muscle volume and physiological cross-sectional area. Conclusion: In this small cohort, full-time stubby users presented signs of muscle weakness that were not observed in those using full-length articulated prostheses. This may affect current and future functional abilities.
Introduction: Ankle-foot orthosis (AFO) is the most common orthotic device for children with cerebral palsy (CP), improving stride length, walking speed, and stability. Although AFO use is highest in children ages 6-12 years, it often decreases with age, and little is known about how youth and parents perceive AFO use in daily life, particularly regarding activity and participation. Aim: To explore the perceptions and experiences of AFO use in daily life among youth with CP and their parents, with a focus on activity and participation. Method: This qualitative study included 18 interviews with 9 AFO users with CP (8-15 years) and their parents. Data were analyzed using a descriptive phenomenological approach. Results: Four closely related themes emerged. The first, “AFO use evokes emotions and feelings,” captured positive and negative emotional responses to wearing AFOs. The second, “AFO use requires adaptation in everyday life,” described practical adjustments needed to integrate AFOs into daily routines. The third, “Experience creates awareness of autonomy and usefulness,” reflected how youth and parents gradually develop focused knowledge of when and how AFOs support daily functioning. Finally, “Participation in the AFO provision process” highlighted the role of communication and collaboration between families and professionals. Conclusion: AFO use in youth with CP involves complex emotional, practical, and participatory dimensions. Active inclusion of families through collaborative goal-setting from the outset of the orthotic process, and throughout follow-up, alongside consideration of emotional and social factors, can optimize orthotic outcomes and psychosocial well-being.
This scoping review aims to establish an understanding of existing tools or methodologies to grade referral quality or appropriateness published in an orthotics, Allied Health Profession (AHP), or AHP-involved setting. All patients deserve equal access to NHS services, but without knowing if services accept and triage referrals in the same way, it is not possible to. The PRISMA (ScR) checklist was used to structure this scoping review. The search was performed on March 04th, 2025, and was restricted to publications in the English Language only. Publications were screened and extracted by a single reviewer. Further to the literature search a call for gray literature, unpublished service evaluations, or audits through the British Association of Prosthetists and Orthotists, 71 publications were found, and 19 of these were included in the review. No publications focused on an orthotics setting, and only 3 publications centered on AHP specific services. Large variations exist in the methodology used and the purpose of evaluating referrals, with the 2 key tests of appropriateness appearing to be clinicians’ judgment or on the outcome after a referral. There is a gap that appears to exist wider than the orthotics profession in what is considered an appropriate referral and an agreed upon methodology for measuring appropriateness. This could be a valuable topic for further research and consideration, with the initial steps being to establish an understanding of how orthotic departments receive and evaluate referrals and understanding if there are differences in experience or common problems that services face.
Introduction: Individuals with a transtibial amputation (iTTA) are usually fitted with a prosthetic leg. However, it does not prevent functional limitations or compensatory strategies during daily activities, such as sit-to-stand transition (STS). Compensatory strategies may be linked to higher risk of secondary joint conditions. Objective: This study aimed to assess compensatory strategies using kinetic asymmetry and trunk kinematics among iTTA compared with healthy counterparts during STS. Methods: Nine iTTA and 9 healthy subjects performed 5 STS. Kinematic and kinetic data were recorded using a motion capture system, an instrumented chair, and floor-embedded force platforms. Total support moment (TSM), joint contribution to the TSM, vertical ground reaction forces (vGRF), and trunk kinematics were assessed. The TSM was calculated during each STS phase (leaning, momentum, and extension). One-way ANOVA and Games-Howell post-hoc test were used to compare limb contribution. Between-limb symmetry index (SI), for TSM joint contribution and vGRF, and trunk kinematics were compared between groups using an independent Student t-test. Results: During the STS, higher TSM was found in the intact lower limb of iTTA compared with their amputated limb and healthy subjects’ dominant limb. Compared with healthy subjects, showing symmetrical TSM joint contribution, iTTA demonstrated higher asymmetries at each lower limb joint, along with higher vGRF asymmetry and trunk range of motion. Momentum and extension phases generated significant asymmetries at the knee between limbs of iTTA ( p < 0.05). Conclusion: Results support that iTTA rise from a chair with high joint asymmetry that might lead to disproportionate worn out of joints and secondary issues.
BACKGROUND:Telehealth was more widely utilized in various medical field over the world since the COVID-19 pandemic. It could be an option to meet the growing health service demand. Objectives: This study aims to identify patient's expectation and satisfaction in Telehealth as an alternative follow-up format. STUDY DESIGN:Fifty patients presenting Hospital Department of Prosthetics and Orthotics were recruited to complete a questionnaire. Methods: The questionnaire evaluated subject's expectation and satisfaction towards Telehealth in 5-point scale with result analysed with Fisher Exact test. RESULTS:Statistical analysis revealed that: (1) shorter travel time and waiting time greatly encouraged subject to attend Telehealth; (2) body part exposure to camera, risk of diagnosis error, network and technological issue; (3) No significant satisfaction difference between Telehealth and traditional face-to-face follow-up subjects. CONCLUSIONS:This is the first study in Hong Kong to evaluate patient's feedback to Telehealth service in orthotic treatment. The findings could speed up the implementation of Telehealth into P&O treatment and improve the overall service quality.
BACKGROUND:Clinical evidence substantiating the advantages multi-grip myoelectric hand prosthesis over conventional myoelectric hand prosthesis in daily life remains inconclusive. OBJECTIVES:The study aimed to assess the efficacy of using a multi-grip myoelectric hand prosthesis after utilizing a conventional myoelectric hand prosthesis. STUDY DESIGN:A before-and-after, multi-center, observational study included adults with complete hand amputation using a standard myoelectric hand prosthesis for more than 4 weeks. METHODS:Patients were assessed at T0 with their standard myoelectric hand prosthesis, after a 4 to 6 weeks training and trial period with a multi-grip myoelectric hand prosthesis (T1) and then after an 8 to 10 weeks period of wearing (T2). The primary outcome measure was the change of upper limb function via the Orthotics and Prosthetics Users' Survey (OPUS). Results: twenty-two participants were prescribed a definitive multi-grip hand myoelectric prosthesis. On average, the duration since amputation was 6.5 ± 11.4 years. Traumatic causes accounted for 77.3% (17/22) of the cases. The upper limb function component score of the OPUS exhibited a mean increase of 6.2 ± 10.8 points (95% CI 1.5 to 11.0) from T0 to T2. Statistically significant improvements were also noted in the quality-of-life component of OPUS, the Quick DASH score, and overall satisfaction with prosthesis. CONCLUSIONS:In this study, the transition from using daily living standard myoelectric hand prosthesis to using a multi-grip myoelectric hand prosthesis yielded improvements in functionality, quality of life, and overall satisfaction (self-drafted) among individuals with complete hand amputation.
INTRODUCTION:Gait asymmetries and compensatory strategies are common among individuals with unilateral transfemoral (TF) and transtibial (TT) amputation. Although these characteristics have been widely described in the prosthetic gait literature, comparative evidence directly examining differences between the 2 amputation levels, particularly using large-scale clinical data derived from long-term databases, remains limited. This study aimed to clarify gait asymmetry characteristics in individuals with unilateral lower limb amputation by comparing spatiotemporal gait parameters between TF amputees and TT amputees. METHODS:A retrospective analysis was conducted on clinical gait data collected between 2013 and 2024 from 66 individuals at a Japanese rehabilitation center using a pressure-sensitive walkway system. Spatiotemporal parameters and symmetry indices (symmetry indices; a quantitative measure expressing interlimb differences as a normalized percentage difference between limbs) were calculated for each limb. Intergroup comparisons were conducted using the Mann-Whitney U test, and within-group comparisons of amputated vs. nonamputated limbs were performed using the Wilcoxon signed-rank test. RESULTS:TT amputees exhibited significantly greater walking speed, cadence, and stride length than TF amputees. Temporal asymmetries were more pronounced in TF amputees, whereas spatial and support-related asymmetries were more evident in TT amputees. Stride length asymmetry was also identified in the TF group. Symmetry indices for stance and swing phase durations were significantly greater in the TF group, whereas those for step width and double support time were greater in the TT group. CONCLUSIONS:Gait asymmetry patterns in lower limb amputees differ according to amputation level. TF amputees showed predominantly temporal asymmetry, whereas TT amputees demonstrated more marked spatial and support-related asymmetries. These findings support the clinical utility of symmetry indices in prosthetic gait assessment.
BACKGROUND:In individuals with lower extremity amputation, a certain degree of gait asymmetry is biomechanically unavoidable and has been associated with reduced energy efficiency, secondary musculoskeletal complications, and diminished quality of life. The aim of this study was to investigate the effects of surface type, walking speed, and slope on gait symmetry in unilateral transtibial prosthesis users. STUDY DESIGN AND METHODS:: Ten male individuals with unilateral transtibial amputation (mean age 36.5 ± 10.3 years) who had been using prostheses for at least 1 year participated. Participants walked under 7 conditions varying in surface type, speed, and slope. Lower extremity spatiotemporal parameters and joint angular kinematics were recorded using an inertial motion analysis system. Symmetry indices were calculated for each parameter and analyzed. RESULTS:Knee frontal-plane range of motion (RoM) was more asymmetrical on uneven ground than on level ground (p=0.004). Step length was more asymmetrical during slow walking compared with fast walking (p=0.015). Swing phase duration (p=0.002) and ankle sagittal-plane RoM (p=0.002) were more asymmetrical during ramp ascent. CONCLUSION:Changes in walking surface, speed, or slope affect gait symmetry in unilateral transtibial prosthesis users, with effects varying by condition. The findings revealed that gait asymmetry in this population is not a fixed characteristic but a dynamic, condition-dependent response to the demands of the walking environment.
BACKGROUND:Falling is a concern for both older persons and transtibial prosthesis users (TTPUs), with older TTPUs potentially facing compounded risk. Older adults and TTPUs display foot clearance (FC) behavior that may contribute to increased tripping risk. Further, a person's knowledge of their leg orientation in space (ie proprioception) plays a role in managing FC and is affected by age and prosthesis use. OBJECTIVE:To examine the effect of walking speed on FC of older TTPUs and the relationship between FC and leg proprioception. STUDY DESIGN:Twelve unilateral TTPUs and 10 age-matched able-bodied controls participated in this observational study. METHODS:Proprioception was assessed through knee joint angle replication ability. FC was recorded with optical motion capture while participants walked at self-selected normal and fast speeds. Average FC between groups was assessed using an independent t-test. A repeated-measures ANOVA assessed the effects of speed by limb on FC for each group separately. Linear regression controlling for speed assessed the association between FC and proprioception. RESULTS:At both speeds, older TTPUs showed no difference in FC on their prosthetic limb compared with the nondominant limbs of controls. Both groups exhibited reduced FC when walking faster. Worse proprioception on the prosthetic side of TTPUs was associated with lower sound limb FC. CONCLUSIONS:These behaviors may reflect a protective strategy of TTPUs to avoid foot collision during swing, including a desire to keep the sound limb close to the ground with poorer prosthetic limb position awareness.
BACKGROUND:Fukuyama congenital muscular dystrophy (FCMD) is a rare neuromuscular disorder associated with severe muscle weakness and a high risk of hip displacement. Surgical management of hip dislocation is challenging because of cardiopulmonary risks, and the role of hip bracing in FCMD has not been established. OBJECTIVE:To explore the feasibility and radiographic outcomes of hip bracing in nonambulatory children with FCMD. STUDY DESIGN:Case series. METHODS:Three nonambulatory children with genetically confirmed FCMD underwent hip bracing for 6 months. Radiographic parameters, including Reimer migration percentage (MP), femoral head-shaft angle, and acetabular index, were evaluated at baseline and follow-up. For contextual reference, radiographic changes in 3 age- and sex-matched historical FCMD cases without bracing were descriptively reviewed. RESULTS:Individual responses to hip bracing were heterogeneous. Two patients demonstrated stabilization or slight improvement in MP, whereas 1 patient showed progression. In contrast, all historical nonbraced cases showed worsening of MP over a comparable follow-up period. CONCLUSIONS:This case series suggests that hip bracing is feasible in nonambulatory children with FCMD and may be associated with stabilization of hip displacement in selected cases. However, responses were variable, and effectiveness cannot be determined from this small series. Larger prospective studies are needed to clarify clinical relevance and identify patients most likely to benefit.
BACKGROUND:Trapeziometacarpal osteoarthritis (rhizarthrosis) is often managed with orthopedic orthoses that are prefabricated in various sizes and may be manipulated to be adapted to the patient's anatomy. Advances in three-dimensional scanning and printing now allow fabrication of anatomically matched custom-made orthoses. OBJECTIVES:To assess the feasibility and effectiveness of a 3D-printed orthosis compared with custom-fitted orthoses in the conservative treatment of rhizarthrosis. STUDY DESIGN:Feasibility randomized controlled study. METHODS:Thirty-nine patients (42 hands) without prior treatment were randomized into 2 groups: custom-fitted orthoses (n = 21 hands) and 3D-printed orthoses (n = 21 hands). Data on sociodemographic characteristics, pain (measured by visual analog scale), grip and pinch strength (using a dynamometer), and functional outcomes (DASH score) were collected at baseline, 1 month, and 3 months. Treatment adherence and patient satisfaction were also evaluated. RESULTS:Pain levels decreased in both groups, with a more pronounced improvement in the 3D-printed group at 1 month (between-group difference -1.14, 95% CI -2.25 to -0.33, p < 0.05). Patients using 3D-printed orthoses also reported higher satisfaction (45.0 ± 6.97 vs 35.5 ± 9.36, p < 0.001). Both groups showed improvements in DASH scores, with greater gains in the 3D-printed group. Treatment adherence also tended to be higher in the 3D-printed group. No significant differences were observed in grip or pinch strength. CONCLUSIONS:3D-printed orthoses are an effective and promising option for conservative management of rhizarthrosis, with potential benefits in pain relief, patient satisfaction, and adherence compared with conventional custom-fitted orthoses.
BACKGROUND:Population-level data on people with limb loss (PwLL) are needed for effective prosthetic provision and rehabilitation. These data are rare in low- and middle-income countries, and low- and middle-income countries are routinely dealt with as homogenous entities. OBJECTIVES:Here, we investigate intranational variation in PwLL populations in Sri Lanka using long-term routinely collected data from prosthetic and orthotic (P&O) clinics. STUDY DESIGN:Retrospective study. METHODS:Until 2009, Sri Lanka experienced a 26-year civil war affecting primarily northern/eastern districts. Published data from 2 P&O centers in northern (Jaffna Jaipur Centre for Disability Rehabilitation, JJCDR; 1987-2018) and central (Centre for Handicapped, CFH; 1987-2024) districts were compared to investigate intranational variation in PwLL demographics and temporal trends. Summative statistics, χ2, and Mann-Whitney U tests (α < 0.05) were used to quantify differences. RESULTS:Major differences included a larger population of males at the CFH (88.8%) compared with the JJCDR (77.4%) and-although war-related amputations were most common at both clinics-there were relatively more war-related amputees at the JJCDR (CFH: 44.8%; JJCDR: 62.7%). In addition, the JJCDR had a higher proportion of patients registered and injured in the same district (CFH: 62.22%; JJCDR: 66.11%). CONCLUSIONS:Intranational variation in PwLL populations exists in Sri Lanka as evidenced by differences in populations between northern and central P&O clinics. This points toward differences in provisional needs and temporal health/societal trends underlying limb loss, which must be considered when provisioning health services.
Neuromas are aberrant axonal growths that may develop after amputations and contribute to residual-limb and/or phantom-limb pain. Burgeoning surgical approaches for treating neuroma pain include targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) surgery. However, little is known regarding functional outcomes postoperatively. The scoping review aimed to examine prosthesis outcomes among individuals with acquired amputations who have undergone TMR and/or RPNI surgery for neuromas. The study protocol was published on Open Science Framework. A search was conducted across MEDLINE (OVID), EMBASE (OVID), CINAHL Plus (EBSCO), Cochrane Library, and Web of Science. An ascendancy approach was used to assess citation lists of select articles. Two reviewers screened abstracts and full texts after pilot testing, with input from a senior reviewer. Nineteen studies were included. The studies predominantly assessed: TMR only (n = 15), upper extremity amputation only (n = 13), traumatic amputation only (n = 8), and many were case reports or case series (n = 13). Thirteen studies reported prosthesis use pre- and postoperatively. Eleven studies indicated positive change in prosthesis use postoperatively. Two studies indicated no change. Variable outcome measures were used to describe prosthetic use post-TMR/RPNI surgery. In conclusion, literature regarding prosthesis outcomes post-TMR/RPNI surgery is insufficient to support a systematic review. Observations regarding prosthesis use must be interpreted within the context of multiple limitations. Minimal information is available regarding timing of prosthesis wear initiation, prosthesis tolerance, and barriers to prosthesis use. Larger studies are required to support the development of postsurgical rehabilitation protocols.
BACKGROUND:Postamputation pain (PAP) is common and can disrupt the rehabilitation process. OBECTIVE:The current study's purpose was to examine the associations among early PAP, general and perceived health, during adaptation to prosthetic use through analysis of existing clinical records. STUDY DESIGN:Retrospective chart review. METHODS:In this retrospective chart review, 536 eligible records of patients who were referred for prosthetic rehabilitation at the Portsmouth Enablement Centre were examined. Data were extracted and analyzed from the medical records of 44 patients, encompassing a primary assessment (baseline) after amputation and a 9-month follow-up. Analyses were performed to examine the predictive properties of baseline levels of EQ5D health scores, perceived health, and visual analog scale (VAS) pain ratings, and age, diabetes status, level of amputation, and sex on EQ5D health scores and perceived health at follow-up. RESULTS:Higher VAS pain intensity ratings at baseline were significantly associated with worse EQ5D health scores and perceived health 9 months later. After accounting for baseline EQ5D health scores and perceived health, VAS pain remained a significant predictor of 9-month EQ5D health scores. CONCLUSIONS:Early PAP is a risk factor for poorer health, suggesting a possible target for future research investigating multimodal interventions aimed at reducing pain. These interventions and the associated reductions in pain could potentially help facilitate engagement in rehabilitation exercises and prosthesis use to improve functional, psychological, and pain-related outcomes, thereby improving health. Nevertheless, complete data were available for only 44 of 536 eligible records, highlighting a substantial risk of selection bias.
INTRODUCTION:In the 2022/2023 training cycle, the VA Prosthetic Orthotic Residency (VAPOR) Program was unable to fill all funded residency positions. Initial debriefing with residency directors revealed a likely cause to be lack of competitiveness of the VAPOR training stipend value, particularly for second-year residents. This demonstrated a need to conduct a training stipend analysis for the VAPOR program. METHODS:A five-part analysis was conducted including review of the program's stipend history, review of the impact of inflation, and surveys of residency directors and current and former residents. RESULTS:Cumulatively, the analysis revealed that the current stipend was no longer competitive and that the profession was compensating second-year residents more than first-year residents. To effectively compete for top residency candidates, the VA must increase the current training stipend. Ultimately, 4 evidence-based recommendations were derived from the analysis as follows: (1) VAPOR Year 2 (Y2) stipends should be greater than the Year 1 (Y1) stipends; (2) VAPOR Y1 residents should receive a base stipend of $41,620 in addition to a locality adjustment based on the site location; and (3) VAPOR Y2 residents should receive a nonadjusted base stipend valued at 9.3% more than the Y1 stipend or $45,491 to be increased with a locality adjustment based on the site location. CONCLUSIONS:A cost-of-living adjustment should be applied to VAPOR program stipends at a minimum of every 3 to 5 years at an increase of 3-5% based on cost-of-living data from other government resources. VA bolstered resident compensation because of these findings.
BACKGROUND:Burnout is a phenomenon that has been extensively documented across health care professions, but empirical investigation within orthotics and prosthetics (O&P) remains limited. This leaves a critical gap in understanding clinician well-being in a field defined by distinct clinical, technical, and organizational demands. OBJECTIVE:This study aimed to quantify burnout levels in O&P clinicians and explore the factors contributing to this phenomenon. STUDY DESIGN:This study used a convergent parallel mixed-methods approach: a survey incorporating the Abbreviated Maslach Burnout Inventory (aMBI) to gather burnout incidence, and semi-structured interviews to assess burnout experiences, personal and professional factors, and possible prevention strategies among orthotics and prosthetics clinicians. METHODS:Participants first completed a survey incorporating the aMBI to assess burnout incidence as it correlates to the 3 domains of burnout-emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Survey participants could then elect to participate in semi-structured interviews for qualitative insight and thematic analysis. Data were analyzed for correlations between survey responses and personal factors gathered from the interviews. RESULTS:Approximately 78.3% of respondents experienced burnout in at least 1 domain, with emotional exhaustion being the most prevalent. Men experienced higher rates of depersonalization than women. From the semi-structured interviews, four overarching themes emerged: organizational and workload pressures, financial and career strain, individual coping and protective strategies, and burnout experience and trajectory. CONCLUSIONS:Burnout was highly prevalent among O&P clinicians, with emotional exhaustion representing the most prominent domain. Qualitative findings highlighted the contribution of organizational or workload pressures, financial and career strain, coping strategies, and the progressive nature of burnout. These results underscore burnout as a multidimensional phenomenon influenced by both individual and systemic factors, and further research into interventions addressing this issue is critical for clinician well-being and the sustainability of the profession.
BACKGROUND:Lower limb amputees often experience low back pain (LBP), potentially due to altered spinal alignment and biomechanical challenges from prosthetic use. However, limited data exist on the role of spinopelvic parameters in this population. OBJECTIVE:To examine the relationship between sagittal spinopelvic alignment and LBP in individuals with unilateral lower extremity amputation. METHODS:This cross-sectional study was conducted in an inpatient rehabilitation unit of a tertiary university hospital. Thirty male participants aged 18-60 years with unilateral traumatic lower limb amputation were enrolled. They were divided into 2 groups: Group 1 (n = 13) without LBP and Group 2 (n = 17) with LBP. Pain was assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index. Radiographic evaluation included cervical lordosis, thoracic kyphosis, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and spinal vertical axis (SVA). Quality of life was assessed using the SF-36. RESULTS:Significant differences were found in cervical lordosis (P=0.045, 95% confidence interval [CI], 0.17-14.36), thoracic kyphosis (P = 0.009, 95% CI -19.23 to -2.98), and SVA (P = 0.003, 95% CI, 0.11-0.54) between groups. Lumbar lordosis showed a negative correlation with VAS-pain scores (P = 0.031, r = -0.395), while thoracic kyphosis (P = 0.009, r = 0.466) and SVA (P = 0.001, r = -0.561) had positive correlations. Amputees with LBP had lower SF-36 scores in emotional well-being (P = 0.041), pain (P = 0.001), and general health (P=0.014) domains. CONCLUSIONS:Spinopelvic misalignment is associated with LBP in lower limb amputees. Rehabilitation strategies aiming to improve sagittal balance may reduce pain and enhance quality of life in this population.
Unilateral transfemoral prosthesis users experience increased gait compensations, possibly because of their inability to produce sufficient knee flexion resistance during stance, ankle plantar flexion for forward progression, and leg shortening for toe clearance. This case study evaluates a novel kneeless prosthesis with powered length actuation (lengthening for push-off and shortening for toe clearance), which was hypothesized to result in greater stability, easier toe clearance, and assisted-forward progression, toward improving compensatory mechanisms of prosthesis users. Two persons with unilateral transfemoral amputation walked with both their habitual devices and the length-actuated prosthesis. Quantitative metrics of knee stability (thigh velocity and hip flexion/extension moment), mobility (ankle power, pelvis obliquity, hip abduction, toe clearance) and qualitative rankings were collected for both devices. Stability-related results showed increased confidence in the length-actuated prosthesis' knee buckling avoidance with decreased prosthetic-side early stance hip extension and swing hip flexion angle/velocity. Mobility-related metrics showed decreased confidence in the length-actuated prosthesis' toe clearance with increased frontal plane compensations and push-off ankle power (vaulting). Although both participants were encouraging of the overall concept, the user with higher mobility and a microprocessor knee preferred his own device, whereas the user with lower mobility and a passive knee preferred the length-actuated prosthesis. Both users had increased confidence (and decreased compensations) in knee stability during stance but continued to have compensations during swing to ease toe clearance. The device received positive feedback and was well received by the participant with a more recent amputation, knee buckling difficulty, and lower mobility level.
