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Introduction: The C-Brace microprocessor stance and swing control orthosis was designed to overcome safety and functional limitations of traditional knee-ankle-foot orthoses (KAFOs) for individuals with lower limb paresis. However, a systematic comparison to established KAFO types has not been performed in a bigger sample. Methods: International multicenter, randomized, controlled, cross-over clinical trial. Legacy KAFO users at risk of falling were randomized to KAFO/C-Brace or C-Brace/KAFO use for three months with each orthosis. Primary outcome was balance assessed with the Berg Balance Scale (BBS). Secondary outcomes were falls, mobility, function, and quality of life. Results: Intention-to-treat analysis with 102 participants. With the C-Brace, the BBS improved by 3.3 ± 6.3 points (p < 0.0001). Significantly fewer participants presented BBS scores <40 indicative of increased fall risk (16 vs. 36, p = 0.018). Mean falls reduced from 4.0 ± 16.8 to 1.1 ± 3.3 (p = 0.002). Outcomes for function, mobility, and quality of life showed significant improvements with the C-Brace. Discussion: The improvements in fall risk and mobility can be attributed to the stumble recovery and controlled knee flexion during weight bearing of the C-Brace and have a positive impact on the quality of life of users. Conclusion: The C-Brace represents an option for KAFO users with increased fall risk and reduced mobility. IMPLICATIONS FOR REHABILITATION: When prescribing traditional knee-ankle-foot orthoses (KAFOs), their known limitations, such as limited function and mobility, and the requirement to walk with compensatory mechanisms, especially on non-level terrains, should be considered. For patients with compromised balance and increased risk of falling when using a traditional KAFO, a microprocessor stance and swing control orthosis (MP-SSCO) may be considered as an orthotic option to reduce their fall risk. For patients with mobility restrictions using a traditional KAFO, a MP-SSCO may be considered to improve function, mobility, reintegration into normal living, and quality of life. [ABSTRACT FROM AUTHOR]

As United States healthcare transitions from traditional fee-for-service models to value-based care, there is increased need to demonstrate quality care through clinical outcomes. Therefore, the purpose of this study was to create equations to calculate an expected mobility score for lower limb prosthesis users specific to their age, etiology, and amputation level to provide benchmarks to qualify good outcomes. A retrospective cross-sectional analysis of outcomes collected during clinical care was performed. Individuals were grouped based on amputation level (unilateral above-knee (AKA) or below-knee (BKA)) and etiology (trauma or diabetes/dysvascular (DV)). The mean mobility score (PLUS-M® T-score) for each year of age was calculated. AKAs were further stratified into having a microprocessor knee (MPK) or non-microprocessor (nMPK) for secondary analysis. As expected, average prosthetic mobility declined with age. Overall, BKAs had higher PLUS-M T-scores compared to AKAs and trauma etiologies had higher scores compared to DV. For AKAs, those with a MPK had higher T-scores compared to those with a nMPK. Results from this study provide average mobility for adult patients across every year of life. This can be leveraged to create a mobility adjustment factor to qualify good outcomes in lower limb prosthetic care. Normative values of mobility are needed to qualify good outcomes in prosthetic care as healthcare shifts towards value-based care. Understanding where an individual is relative to others with similar characteristics (e.g., age, etiology, gender, amputation level, and device type) can provide clinicians with better benchmarks for individual goal-setting. The ability to generate predicted mobility scores specific to each individual can create a mobility adjustment factor to better qualify good outcomes. [ABSTRACT FROM AUTHOR]

Individuals with lower limb amputation have a high incidence of falls. Above-the-knee amputation and diabetes/vascular disease are both risk factors for falls. Microprocessor knee (MPK) technology may reduce falls in this population. The objective was to determine the association between MPKs and reduced injurious falls. A retrospective analysis of injurious falls within a large, national outcomes database was conducted. Inclusion was limited to adult K3 ambulators with unilateral, transfemoral, or knee disarticulation amputation due to diabetes/vascular disease. There were 744 out of 881 individuals that did not receive an MPK. Results showed that 16.3% of non-MPK users experienced an injurious fall compared to 7.3% of MPK users (p =.007). Not having an MPK resulted in significantly increased odds (unadjusted: OR: 2.47, 95% CI: 1.26–4.83, p =.009; adjusted for confounders: OR: 2.52, 95% CI: 1.28–4.94, p =.007) of incurring an injurious fall over a 6-month period. In conclusion, the current study found use of an MPK strongly associated with reduced injurious falls in a population of patients with amputation due to diabetes/vascular disease. The findings strongly support the use of MPK technology to mitigate fall risk, and in particular injurious falls requiring medical intervention. [ABSTRACT FROM AUTHOR]

Little has been published about the process of decision-making between prosthetists and people with lower limb amputation (LLA). The purpose of this study is to identify decisions and factors influencing decision-making in prosthetic rehabilitation from the perspectives of prosthetists and prosthesis users, to identify barriers and opportunities for shared decision-making (SDM). Qualitative semi-structured individual interviews were conducted with 13 prosthetists and 14 prosthesis users from three clinics in three states of the Rocky Mountain and Southwest regions of the United States. Transcripts were analyzed using thematic analysis. Four main themes were identified: perceived decision points, importance of relationship, balancing competing priorities, and experience. Contrasts between perceptions of prosthetists and prosthesis users were related to prosthesis design decisions, and the purpose of communication (e.g., goals for a prosthesis vs. goals informing prosthesis design). Both prosthetists and prosthesis users described balancing priorities that contribute to prosthetic rehabilitation decisions, and the role of experience for informing realistic expectations and preferences necessary for participating in decision-making. Opportunities for improving SDM between prosthetists and prosthesis users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences. Many people with lower limb amputation experience poor physical function and psychosocial outcomes, which may be further compounded by under informed prosthesis-user expectations for function with a prosthesis. Shared decision-making offers an opportunity for improving realistic prosthesis-user expectations, reducing healthcare costs, and improving prosthesis-user satisfaction and adherence to care plans. Opportunities for improving shared decision-making between prosthetists and prosthesis-users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences. [ABSTRACT FROM AUTHOR]

Ankle-foot orthoses (AFOs) are used to improve physical performance measures of physical function (PF) post-stroke; however, the perception of improved PF of this population has not been described. The purpose of this study was to identify the predictors of self-reported PF of individuals seeking orthotic intervention post-stroke. A retrospective analysis of 237 patients at a nationwide orthotic services provider in the United States was conducted to characterize PF using the Patient-Reported Outcome Measures Information System®. A backward stepwise multiple regression was conducted to identify demographic characteristics predictive of self-reported PF. The mean T-score of PF of the sample was 30.8 ( ± 6.5), two standard deviations below the US general population mean, indicating significant impairment. The regression model explained approximately 15% (R = 0.411) of the variance in PF of the sample. Self-reported PF was worse for individuals requiring more supportive assistive devices ( β = 0.270, p = 0.001), those with more recent ankle problems ( β = −0.167, p = 0.035), and those with greater living assistance ( β = −0.139, p = 0.089). These results improve understanding of the factors that contribute to impaired self-reported PF of stroke survivors in need of AFO intervention. Ankle-foot orthoses (AFOs) are often used to improve physical performance measures of physical performance (PF) during stroke rehabilitation. Our data indicate that the self-reported PF of AFO users is severely impaired. Level of assistance, time since ankle and foot problems began, and living assistance status are important clinical characteristics to consider when planning AFO intervention for this population. [ABSTRACT FROM AUTHOR]

The objective of this cross-sectional observational study was to determine whether the use of a microprocessor knee for individuals with an above-the-knee amputation results in improved functional mobility compared to their peers of matched comorbid-health with a non-microprocessor knee, and to inform how this compares to the mobility observed in below-knee prosthesis users. A sample of 450 individuals with lower limb amputation were divided into three groups (n = 150 each). The groups included: nonmicroprocessor knee users (NMPK, age: 57.6 ± 17.2 years), microprocessor knee users (MPK, age: 56.5 ± 13.8 years), and below-knee prosthesis users (BKA, age: 58.4 ± 12.2 years). Primary outcome measure was functional mobility measured through Prosthetic Limb Users' Survey of Mobility (PLUS-M®). Results showed MPK mobility (48.49 ± 0.86) was greater than NMPK (43.49 ± 0.86, p < 0.001), but less than BKA (52.11 ± 0.86, p = 0.003). These results persisted when removing potential confounding effects of age, body mass index, cause of amputation, and comorbid health (MPK: 47.15 ± 0.97; NMPK: 43.47 ± 0.88; BKA: 52.61 ± 0.91). In conclusion, these results show the use of a MPK can improve functional mobility for individuals with an above-knee amputation. [ABSTRACT FROM AUTHOR]

Purpose: To develop a predictive model to inform the probability of lower limb prosthesis users' functional potential for ambulation. Materials and Methods: A retrospective analysis of a database of outcomes for 2770 lower limb prosthesis users was used to inform a classification and regression tree analysis. Gender, age, height, weight, body mass index adjusted for amputation, amputation level, cause of amputation, comorbid health status and functional mobility score [Prosthetic Limb Users Survey of Mobility (PLUS-M™)] were entered as potential predictive variables. Patient K-Level was used to assign dependent variable status as unlimited community ambulator (i.e., K3 or K4) or limited community/household ambulator (i.e., K1 or K2). The classification tree was initially trained from 20% of the sample and subsequently tested with the remaining sample. Results: A classification tree was successfully developed, able to accurately classify 87.4% of individuals within the model's training group (standard error 1.4%), and 81.6% within the model's testing group (standard error 0.82%). Age, PLUS-M™ T-score, cause of amputation and body weight were retained within the tree logic. Conclusions: The resultant classification tree has the ability to provide members of the clinical care team with predictive probabilities of a patient's functional potential to help assist care decisions. Classification and regression tree analysis is a simple analytical tool that can be used to provide simple predictive models for patients with a lower limb prosthesis. The resultant classification tree had an 81.6% (standard error 0.82%) accuracy predicting functional potential as an unlimited community ambulator (i.e., K3 or K4) or limited community/ household ambulator (i.e., K1 or K2) in an unknown group of 2770 lower limb prosthesis users. The resultant classification tree can assist with the rehabilitation team's care planning providing probabilities of functional potential for the lower limb prosthesis user. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the external work performed by individuals wearing a rocker bottom shoe compared to a standard shoe. It was hypothesized that individuals wearing a rocker bottom shoe would have changes in the amount of work over the course of contact with the ground. External work on the body's centre of mass (BCOM) was calculated for individuals in both conditions. Comparisons for external work were done for positive and negative work for the entire stance phase as well as the initial double support, single support and terminal double support periods. The results revealed that while wearing the rocker bottom shoes, individuals performed an increased amount of negative work and decreased positive work in the initial double support followed by increased positive work in single support compared to a standard sole shoe. Individuals also performed a decreased amount of positive and negative work in terminal double support when wearing the rocker bottom shoes. There were no differences, however, when the stance phase was considered undivided to subphases for either positive or negative work. The results indicate that use of rocker bottom shoes redistributes external work to earlier in the gait cycle, which may not be as energetically efficient. This shift will probably result in increased metabolic energy expenditure as it will require more energy output from proximal hip musculature, which is not as mechanically efficient as the ankle joint in late stance. This could be desirable for individuals who are wearing the shoes for increased caloric burn such as an exercise setting. Furthermore, the increased external work in single support may be causing additional work from the hip extensor musculature (i.e. gluteus maximus). This could possibly be desirable for strengthening and conditioning of the hip extensors. [ABSTRACT FROM PUBLISHER]