In medizinischen Registern werden wertvolle Daten von Patienten gesammelt, die die Qualität und Wirksamkeit von Behandlungen überprüfen bzw. kontrollieren. Es existieren nationale Register im Bereich der Amputationsmedizin und Patientenversorgung wie das Swedish Amputation and Prosthetics Registry (SwedeAmp) und das Limb Loss and Preservation Registry (LLPR) in den USA, die Informationen zu Prothesenarten, -materialien und -verfahren sowie patientenbezogene Ergebnisse wie Mobilität und Lebensqualität erheben. Seit 2011 konnte SwedeAmp wichtige Erkenntnisse zu Langzeitergebnissen nach Amputationen beitragen und die Versorgung in Schweden verbessern. Das LLPR in den USA erfasst Daten von klinischen bis zu psychosozialen Aspekten, was länderübergreifende Vergleiche und die Optimierung der Versorgung ermöglicht. In Deutschland leistet das AMP-Register bedeutende Beiträge, indem es u. a. Daten zu Prothesenpassform und -tragekomfort sowie Gründe für Revisionen dokumentiert. Ziel ist es, eine Evidenzbasis durch systematische Datenerhebung zu schaffen. Das Projekt umfasst den Aufbau einer benutzerfreundlichen IT-Struktur, eine Pilotphase zur Anwendungsevaluierung und die enge Zusammenarbeit mit Experten. Mithilfe standardisierter Datensätze sollen Versorgungsdefizite aufgedeckt und evidenzbasierte Ansätze entwickelt werden. Datenerfassung und -speicherung erfolgen gemäß der Datenschutz-Grundverordnung (DSGVO) und werden durch technische Maßnahmen abgesichert. Erste Ergebnisse am Studienzentrum Heidelberg zeigen das Potenzial des AMP-Registers. Subgruppenanalysen unterstützen die Versorgungsoptimierung und bestätigen die Relevanz regelmäßiger Assessments, um die Versorgungsqualität langfristig zu verbessern.

BACKGROUND:Medical registries are used to collect valuable patient data in order to check and control the quality and effectiveness of treatment approaches. National registries in the field of amputation and patient care, such as the Swedish Amputation and Prosthetics Registry (SwedeAmp) and the Limb Loss and Preservation Registry (LLPR) in the USA, gather information on prosthetic devices, materials, procedures and patient-related outcomes such as mobility and quality of life. Since 2011 SwedeAmp could generate significant insights into long-term outcomes after amputations and improve prosthetic care in Sweden. In the USA the LLPR collects data on aspects ranging from clinical to psychosocial aspects, enabling international comparisons and the optimization of care. MATERIAL AND METHODS:In Germany the AMP Registry makes significant contributions by documenting data on prosthetic fit, wearing comfort and the reasons for revisions. The aim of the AMP Registry is to create an evidence base through systematic data collection. The project includes the development of a user-friendly IT structure, a pilot phase for application evaluation and close collaboration with experts. Standardized datasets aim to identify deficits in care and develop evidence-based approaches. Data collection and storage are carried out in compliance with the General Data Protection Regulation (DSGVO) and secured through technical measures. RESULTS AND DISCUSSION:Initial results from the Heidelberg Study Center demonstrate the potential of the AMP Registry. Subgroup analyses support optimization of care and highlight the importance of regular assessments to improve long-term care.

Patients with musculoskeletal tumors who undergo amputation show reduced physical function. To give these patients better expectations of their future physical capabilities and to enhance the evaluation and development of postoperative rehabilitation, we investigated high-level activity and access to sport using objective measurements and questionnaires. We then compared the results to those of amputees who had undergone amputation due to trauma. In a prospective, monocentric study, we evaluated and correlated the results of the conventional mobility tests such as “timed-up-and-go” test (TUG), “2-Minute-Walk-Test” (2MWT), as well as the “10-Meter-Walk-Test” (10MWT) with a test for high-level activity. In this contribution, the Comprehensive High-Level Activity Mobility Predictor (CHAMP), originally developed for male servicemembers, was tested for feasibility in our cohort. We examined eleven patients who underwent amputation due to primary malignant bone or soft-tissue sarcomas and compared the results with ten patients who experienced traumatic amputation, along with seventeen patients in the healthy control group. Patients with lower leg amputations due to malignant musculoskeletal tumors exhibited superior outcomes in general mobility and high-level activity mobility compared to those with traumatic amputations. Using a questionnaire, we were able to demonstrate that patients suffering after amputation because of musculoskeletal tumor exhibited higher motivation and a greater sense of health and well-being compared to participants who had undergone traumatic amputation. The CHAMP can be utilized as a complementary tool in the rehabilitation of amputees to objectively assess high-level mobility and to guide targeted training and therapeutic interventions.

Background and Objectives: The experience of unpleasant sensory phenomena after lower limb amputations (LLAs), including phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP), impacts global healthcare and adversely affects outcomes post-amputation. This study aimed to describe the distribution of PLP, PLS, and RLP among patients with LLAs registered in the Heidelberg Amputation Registry. The primary objective was to determine the prevalence of sensory abnormalities across different amputation levels and causes. Materials and Methods: In this single-center, cross-sectional study, data from 459 patients registered in the Heidelberg Amputation Registry were analyzed for the occurrence of PLP, PLS and RLP. Subsequently, logistic regression models were used to identify the independent risk factors associated with sensory disturbances following LLAs. The mean age of the LLA patients (31% female, 69% male) was 58 years (SD ± 18). Results: The patients were, on average, 44 years old (SD ± 22) at the time of amputation, with a mean duration since amputation of 15 years (SD ± 17). Transtibial amputations were the most common (43%), followed by transfemoral (39%) and partial foot amputations (10%). Hip and knee disarticulations were observed in 3.7% and 3.5% of the cohort, respectively, with hemipelvectomies accounting for 1%. Traumatic injuries (32%) and neoplastic disorders (22%) were the leading causes of LLAs, while peripheral artery disease and diabetes were responsible for 12% and 6% of cases, respectively. Importantly, a significant proportion of participants (85%) reported experiencing abnormal sensations. The prevalence rates for phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) were 58%, 66%, and 46%, respectively. The occurrence of sensory disturbances, with the exception of RLP, was significantly affected by the level of amputation. Notably, the age at amputation emerged as an independent risk factor for developing abnormal sensations, including PLS. Conclusions: In conclusion, this study provides a comprehensive overview of sensory abnormalities in a diverse cohort of LLA patients, highlighting the age at amputation as an important factor. The findings emphasize the role of comprehensive registries in enhancing care for individuals with amputations and guiding targeted pain management strategies.

BACKGROUND:Foot drop is a common condition for patients with upper motor neuron syndrome such as cerebral palsy (CP). This study aimed to investigate the effects of functional electrical stimulation (FES) on gait function, quality of life, and FES satisfaction in adults with CP and foot drop. To analyze effects over time, an observational, longitudinal study was performed. METHODS:In this observational prospective cohort study, 8 adults with CP (median age of 22 years; range: 18.5-33.25) received a FES system for 12 weeks. 3D gait analysis was performed at beginning (T1) and end of the study period (T2). To detect effects of FES, ankle kinematics, kinetics, and spatiotemporal parameters were monitored for the conditions FES-OFF and -ON at each examination. RESULTS:Over time, walking speed increased significantly from T1ON (1.08 m/s) to T2OFF (1.21 m/s) with further improvement at T2ON. The ON-OFF difference of maximum dorsiflexion during swing tended to increase at T2 (2.49 degrees) compared with T1 (1.73 degrees) but with a more plantarflexed ankle position at T2 (range: -7.1 to 1.31 degrees) than T1 (range: -1.53 to 4.51 degrees) resulting in a significant decrease between T1ON and T2OFF. With FES, push-off energy tended to decrease for both examinations and lead to lower values over time. CONCLUSION:Positive therapeutic effects are represented in walking speed over time regardless of FES being OFF or ON even with a reduction in push-off energy. Despite no significant increase in maximum dorsiflexion in swing, over time, participants showed the tendency of an improvement in foot lift with FES-ON.

To assess the accessibility and content of query Interventional Radiology (IR) fellowship program websites and determine the impact of these websites on applicants.All IR fellowship programs were individually evaluated, and all IR fellowship applicants to our institution were surveyed.In 2015, 44.3% of programs had an appropriate functional link to the fellowship website. Most provided a program description and application information. In our survey, applicants reported that website quality was moderately important to their overall impression of a fellowship. The most important aspects were didactics and facilities information.Fellowship website content and quality are important to applicants.

Die Bewegungsanalyse hat in der Orthopädietechnik eine hohe Relevanz, da sie ein essenzieller Teil des Versorgungsprozesses ist. Die Dokumentation der Bewegung mittels Videos und anderen instrumentellen Methoden wird in der Orthopädietechnik immer bedeutsamer, da Gebrauchsvorteile von komplexen Versorgungen am besten durch eine strukturierte Beobachtung belegt werden können. Einer Bewegungsanalyse sollte immer eine Anamnese und klinische Untersuchung vorausgehen, um funktionelle Einschränkungen der untersuchten Person zu detektieren und dadurch Zusammenhänge zu Gangabweichungen herstellen zu können. Dazu gehört auch eine Überprüfung des vorhandenen Hilfsmittels. Neben dem Gehen in der Ebene ist bei Versorgungen mit Exoprothesen auch das Überwinden von Alltagshindernissen wie Treppen und Rampen von Interesse. Zur umfangreicheren Ermittlung des Funktionsstatus bieten sich funktionelle Test an. Bei speziellen Fragestellungen, insbesondere zu kinetischen Größen, ist eine instrumentelle 3‑D-Ganganalyse indiziert.

ABSTRACT Introduction Lower-limb orthoses are usually part of conservative therapy in patients with pathological gait due to neurological disorders. A modular design, defined as a detachable combination of different orthotic designs, offers the possibility to adapt orthosis functionality to individual needs. Currently, however, knowledge about the actual impact of modularity on wearing times is limited. The aim of the present study was therefore to examine the wearing time of modular and nonmodular orthoses to determine whether there are differences between the different orthotic concepts of the lower limb on weekdays and weekends and whether modularity affects wearing time. Material and Methods In this prospective clinical study, 53 patients with neurological gait disorder were included. All wore modular or nonmodular orthoses in one of these three groups: dynamic ankle-foot orthoses (DAFOs), ankle-foot orthoses (AFOs), and knee-ankle-foot orthoses (KAFOs). Wearing time was recorded by temperature sensors for 3 months. Data analysis included both descriptive and further parametric statistical testing (t-test for dependent and independent samples) as well as Pearson correlations. A univariate analysis of variance was used when comparing multiple groups. Results Participants wore DAFOs and AFOs, but not KAFOs, significantly longer on weekdays. Wearing time correlated significantly between weekdays and weekends for all groups. There is no significant difference in the mean daily wearing time between the groups. Modularity influenced the wearing time only for the DAFO/AFO combination. Conclusion Orthotic design and anatomic height affect the average daily wearing time. A change in wearing behavior between weekdays and weekends and influences by modularity can be found solely in DAFOs and AFOs.

The longitudinal relationship between psychotic-like experiences (PLEs) and short habitual sleep in adolescents remains to be investigated. We examined the effect of habitual sleep length (time-in-bed: TIB) on the risk of subsequent year PLEs and vice versa, in grade 7–12 students (ages: 12–18, n = 1,685) followed over 6 years. Yearly longitudinal data were analyzed using cross-lagged panel models. Shorter weekday TIB was associated with a higher risk of subsequent year PLEs; PLEs did not affect subsequent year TIB. Compared to a TIB of 8–9 h, 5–6 h increased PLEs likelihood 1.8 times; <5 h increased this 6-fold.

Background: Gait analysis is of high relevance in prosthetics as it is an essential part of the fitting process. The documentation of movement by means of videos and instrumented methods is becoming increasingly important in prosthetics as benefits of a complex prosthesis can best be shown by structured observation.Procedure: A movement analysis should always be preceded by an anamnesis and clinical examination in order to detect functional limitations of the examined person and thus to establish correlations to gait deviations. Additionally, the orthopaedic aid should be evaluated as well. In addition to walking on level ground, walking on everyday obstacles such as stairs and ramps is also of interest when observing people using prosthetic limbs. Functional tests can be used to determine the functional status more comprehensively. An instrumental-3D gait analysis is indicated for specific questions, especially regarding kinetic parameters.

Mobilität ist ein Grundbedürfnis eines jeden Menschen. Für Menschen mit Gliedmaßenverlusten der Beine sind hierfür regelhaft Körperersatzstücke (Exoprothesen) notwendig. Naturgemäß möchten die Betroffenen mit dem medizintechnischen Fortschritt mithalten, was nicht selten zu gerichtlichen Auseinandersetzungen mit den Kostenträgern führt. Der Grund für solche Rechtstreitigkeiten liegt vielfach im Konflikt zwischen patientenseitigem Wunsch nach (oftmals hochpreisiger) zeitgemäßer Versorgung und dem Wirtschaftlichkeitsgebot der gesetzlichen Krankenversicherer. Im Zuge dieser Streitigkeiten werden medizinische und/oder medizinisch-technische Sachverständigengutachten eingefordert, die den Gerichten z. B. gemäß §§ 402ff. Zivilprozessordnung (ZPO) als Beweismittel dienen. Für die Beweisfragen des Gerichts werden vom Sachverständigen aktuelles Fachwissen und ggf. technische Möglichkeiten zur Überprüfung etwaiger Gebrauchsvorteile erwartet.

Objective: To investigate the relationship of frontal plane ankle mobility with the effects of an ankle-foot orthosis (AFO) and a laterally wedged insole (LWI) on knee adduction moment (KAM) in the treatment of medial knee osteoarthritis. Design: Randomized, nonblinded crossover trial. Setting: Outpatient clinic of university hospital. Participants: Referred sample of 20 patients (N=20) with medial knee osteoarthritis stage 1-3 (Kellgren and Lawrence), aged 56.46.5 years; 58 patients were assessed, 21 were included, and 1 was a dropout. There were 14 healthy reference participants without knee osteoarthritis (conve-nience sample) who were matched by age. Interventions: Patients received AFO and LWI for 6 weeks each with gait analysis after each 6-week intervention. Patients underwent additional barefoot gait analysis, walking on even ground and on a cross slope of 5 degrees lateral elevation and standing on inclinations of 0 degrees, 5 degrees, 10 degrees, and 20 degrees. Main Outcome Measures: Spearman correlation between the immediate change in first peak of KAM with each aid and the change in hindfoot varus on the cross slope relative to level ground. Results: The KAM reduction with AFO correlated significantly with hindfoot varus reaction to the cross slope during walking: the greater the hindfoot valgization on the cross slope, the greater the KAM reduction with AFO (Spearman r=0.53, P=.02). The KAM reduction with LWI correlated moderately negatively with the change in hindfoot varus: the greater the hindfoot valgization on the cross slope, the smaller the KAM reduction with LWI (r=-0.31 P=.18). Conclusions: LWI may be suitable for patients with limited to normal frontal plane ankle mobility. Patients with greater frontal plane ankle mobil-ity benefit most from frontal plane ankle bridging with AFO. Studies with larger samples are necessary. (C) 2022 by the American Congress of Rehabilitation Medicine.

Objective: To investigate the impact of varus malalignment of the knee on pain reduction achieved by an ankle-foot orthosis and a laterally wedged insole in patients with medial knee osteoarthritis. Design: Secondary analysis of a randomized, clinically prospective cross-over study. Patients: Twenty-eight participants with medial knee osteoarthritis. Methods: All participants wore a 5-mm laterally wedged insole and an ankle-foot orthosis for a period of 6 weeks each in a randomized order. Pain was reported on a numerical rating scale and was correlated with limb alignment, as defined by the mechanical axis deviation in full-leg standing radiographs. Results: Insole and orthosis use reduced pain compared with baseline (median knee pain change: insole –0.5 (–5 to +6), orthosis –1.5 (–7 to +5). A higher mechanical axis deviation (greater varus) correlated significantly with smaller pain reduction for both aids (insole p = 0.003, orthosis p < 0.001). A cut-off to predict pain response was found at a mechanical axis deviation of 14–15 mm for both aids, i.e. > 3° knee varus. Conclusion: There is a correlation between varus malalignment and pain reduction. There seems to be a mechanical axis deviation cut-off that predicts the response to treatment with the aids with good sensitivity. LAY ABSTRACT Osteoarthritis of the knee can be treated using orthoses and insoles to unload the most damaged and painful inner (medial) part of the knee. However, patients do not benefit equally from these devices and there is not enough scientific data to predict which patients will benefit from an orthosis or insole. This study investigated whether the genu varum (degree of bow-leggedness) correlates with pain reduction when using an insole or an ankle-foot orthosis. A total of 28 patients with knee osteoarthritis received both aids, each for a period of 6 weeks, in random order. They documented knee pain before and after using the devices. Radiographs of the leg were analysed to determine the degree of genu varum. Statistical analysis showed that patients with straighter legs experienced better pain reduction with both aids than did bow-legged patients. In conclusion, ankle-foot orthoses and insoles are less effective in bow-legged patients.

Objective: To compare biomechanical and clinical outcome of laterally wedged insoles (LWI) and an ankle-foot orthosis (AFO) in patients with medial knee osteoarthritis. Design: Single-centre, block-randomized, cross-over controlled trial. Setting: Outpatient clinic. Subjects: About 39 patients with symptomatic medial knee osteoarthritis. Interventions: Patients started with either LWI or AFO, determined randomly, and six weeks later changed to the alternative. Main measures: Change in the 1st maximum of external knee adduction moment (eKAM) was assessed with gait analysis. Additional outcomes were other kinetic and kinematic changes and the patient-reported outcomes EQ-5D-5L, Oxford Knee Score (OKS), American Knee Society Clinical Rating System (AKSS), Hannover Functional Ability Questionnaire – Osteoarthritis and knee pain. Results: Mean age (SD) of the study population was 58 (8) years, mean BMI 30 (5). Both aids significantly improved OKS (LWI P = 0.003, AFO P = 0.001), AKSS Knee Score (LWI P = 0.01, AFO P = 0.004) and EQ-5D-5L Index (LWI P = 0.001, AFO P = 0.002). AFO reduced the 1st maximum of eKAM by 18% ( P < 0.001). The LWI reduced both maxima by 6% ( P = 0.02, P = 0.03). Both AFO and LWI reduced the knee adduction angular impulse (KAAI) by 11% ( P < 0.001) and 5% ( P = 0.05) respectively. The eKAM (1st maximum) and KAAI reduction was significantly larger with AFO than with LWI ( P = 0.001, P = 0.004). Conclusions: AFO reduces medial knee load more than LWI. Nevertheless, no clinical superiority of either of the two aids could be shown.

In this study, an acoustical-based macrotexture measurement method that uses the friction-induced mechanism of tire/road noise has been proposed. This mechanism influences the frequencies above 1 KHz and is the dominant mechanism for frequencies above 3 KHz. The airflow due to this mechanism passes through the macrotexture which can be represented using convolution in the time-domain of the airflow, which is viewed as the input signal, and macrotexture, which is considered as the transmission channel. Using the Cepstral processing method, the related features to macrotexture airflow can be extracted and the macrotexture can be evaluated. To investigate the proposed method, interaction noise was measured for six uniform non-porous asphaltic test tracks with different macrotextures. The tire/road noise signal is passed through a bandpass filter (3–5 KHz). By liftering the cepstrum components in the range of 2–50, the feature vector has been obtained and then used as input to a multiclass SVM, resulting in a precision error of 4%.

Wenngleich die Anzahl an Majoramputationen bundesweit rückläufig ist, finden weiterhin mehr als 57.000 amputationschirurgische Eingriffe statt. Auch aufgrund hoher prothetischer Versorgungskosten resultieren daher weiterhin eine Vielzahl sozialgerichtlicher Auseinandersetzungen, in denen medizinische Sachverständigengutachten angefordert werden. Unter Kenntnis der juristischen Normen kann der Gutachtenauftrag erfüllt werden. Der Gutachter beginnt mit der Auswertung der Patientenakte und der streitgegenständlichen Passteile. Die Untersuchung umfasst eine Anamnese sowie eine körperliche Untersuchung, um zu den streitigen Gebrauchsvorteilen der Hilfsmittel Stellung nehmen und die Beweisfragen beantworten zu können. Fragebögen können hilfreich sein.