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AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo explore behavioral risk factors contributing to fall and near-fall scenarios for Veterans with dysvascular lower-limb amputation.Participants were a convenience sample of Veterans with unilateral dysvascular lower-limb amputation, receiving care at a single Veterans Administration Regional Amputation Center, who participated in an interview (12/2021–04/2023). We used phenomenological research and directed content analysis to explore participant perspectives on fall scenarios. Two frameworks informed a priori codes (The Health Action Process Approach, and the Falls-Type Classification Framework); however, analysis was also inductive, with additional codes emerging. Following an independent and iterative coding process, codes were categorized, and patterns identified to create final themes.Twenty-one veterans completed interviews. Five themes were identified that were salient across a behavioral fall risk factor spectrum from low to high: self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation, and one theme pertaining to context surrounding the index fall.Different levels of behavioral fall risk factors exist for Veterans with dysvascular lower-limb amputation. Understanding individuals’ perceptions of these behavioral risk factors is important as a first step in developing comprehensive fall-risk management rehabilitation interventions for Veterans with amputation.Behavioral fall risk factors are important to consider for individuals with lower limb amputation who experience high fall risk.With lower limb amputation behaviors on the high and low end can both contribute to fall risk (e.g., high self-efficacy vs. low self-efficacy, or high trust in the prosthesis vs. low trust in the prosthesis) and both should be addressed.Rehabilitation targets for fall risk management in individuals with lower limb amputation should consider different types of self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation.Further, the variability in levels of risk associated with each of these factors can operate independently, underscoring the need to tailor interventions for individuals with lower limb amputation.Behavioral fall risk factors are important to consider for individuals with lower limb amputation who experience high fall risk.With lower limb amputation behaviors on the high and low end can both contribute to fall risk (e.g., high self-efficacy vs. low self-efficacy, or high trust in the prosthesis vs. low trust in the prosthesis) and both should be addressed.Rehabilitation targets for fall risk management in individuals with lower limb amputation should consider different types of self-efficacy, trust in the prosthesis, dual-task awareness, participation, and emotional regulation.Further, the variability in levels of risk associated with each of these factors can operate independently, underscoring the need to tailor interventions for individuals with lower limb amputation. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionThe Upper Quarter Y Balance Test (YBT-UQ) assesses upper limb dynamic balance in able-bodied individuals but lacks a reliable version for those with disabilities.This study aimed to introduce a modified YBT-UQ (mYBT-UQ) for physically impaired individuals (PI) and establish its validity and reliability.The study involved 33 male athletes aged 18–55, divided into three equal groups: able-bodied, spinal cord injury with trunk control (SCI), and below-the-knee amputation (BKA). To ensure test validity, able-bodied athletes completed both tests. Test-retest reliability was evaluated by repeating the mYBT-UQ seven days after the first test by PI groups. The validity was assessed using the Pearson correlation and Bland-Altman plot. The intraclass correlation coefficient (ICC) (2,1), standard error of measurement (SEM), and the minimal detectable change with 95% confidence (MDC95%) were calculated to assess relative and absolute reliability.There were significant differences and excellent relationships between YBT-UQ and the mYBT-UQ. Also, the Bland-Altman plot showed minimal bias and an acceptable range of agreement. In athletes with BKA, the ICC (2,1) was above 0.90 for both limbs. The SEM ranged from 2.4%-2.7%, and MDC95% ranged from 6.7%-7.5%. In athletes with SCI, the ICC (2,1) ranged from 0.72–0.80. The SEM ranged from 3.1%-3.2% and MDC95% ranged from 8.6%-8.9%.The results indicate that the mYBT-UQ is a reliable test to assess upper quarter dynamic balance in athletes with SCI and BKA. However, regarding the small sample size of the study, there is a need to conduct other research to establish the validity of the test. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this review is to synthesise the experiences and needs of people who had undergone dysvascular lower extremity amputations. Given the increasing global prevalence of vascular diseases like diabetes mellitus and peripheral arterial disease, the risk of requiring an amputation remains high. Materials and methods: This systematic review follows the PRISMA and ENTREQ reporting guidelines. Seven databases were searched for qualitative studies from January 2011 to October 2023. In total 6435 studies were obtained, where 1146 were duplicates and 5271 studies failed to meet the eligibility criteria. The remaining 18 studies were synthesised using Sandelowski and Barroso's approach and appraised using the CASP checklist. Results: Four themes emerged from the meta-synthesis: (1) making the decision to amputate, (2) difficulties in the physical adaptation to limb loss, (3) psychosocial consequences of living with an amputation, and (4) regaining control and building hope. Conclusions: Having dysvascular lower extremity amputations is a complicated experience as not only was the pre-amputation pain relieved, but a new set of physical, emotional and social challenges would surface after the amputation. These synthesised findings serve as a platform to explore the factors behind the various experiences faced by these people and how healthcare professionals can help them in their adjustment. IMPLICATIONS FOR REHABILITATION: Dysvascular lower extremity amputations can affect the physical and mental well-being of people who have experienced them. Healthcare professionals (HCPs) are encouraged to individualise care that meets the physical and emotional needs of patients. Sufficient time and information should be provided before the operation for these people to be better prepared for the changes following the amputation. Physical support by HCPs should include physical rehabilitation, checking on the wound healing and managing any existing co-morbidities. Emotional support can be given through additional referral to medical social workers or psychologists and the involvement of support groups. [ABSTRACT FROM AUTHOR]

AbstractAfter lower limb amputation, the primary challenge is to facilitate the patient’s adoption of a prosthetic limb seamlessly, without encountering complications or discomfort. Elevated stress levels within the residual limb, experienced when wearing the socket and while standing or walking, contribute to patient discomfort. As an initial step in this study, we developed a finite element model of above-knee amputation. Additionally, we designed a prototype orthopedic implant composed of several parts, with the lower section featuring a honeycomb structure aimed at absorbing and diminishing stresses at the interface of the residual limb and prosthetic. In this study, finite element models with and without orthopedic implants were analyzed to assess the feasibility and impact of incorporating a honeycomb structure within the implants on stress distribution, particularly at the stump-prosthetic interface. Models with honeycomb-structured implants, at varying densities, showed a reduction in interface stress to approximately 2.15e-2 MPa and 2.01e-2 MPa, compared to 4.5e-2 MPa in model without honeycomb structure in the implant and 7.97e-2 MPa in models without any implants. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets. Materials and methods: This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes. Results: Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets. Conclusion: We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed. Implications for Rehabilitation: 3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation. Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve). To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads. [ABSTRACT FROM AUTHOR]

To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population. It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty. An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs. Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants. A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs. [ABSTRACT FROM AUTHOR]

To perform a detailed psychometric Rasch analysis of the Prosthesis Embodiment Scale (PEmbS) administered in adults with lower limb amputation (LLA). A convenience sample of German-speaking adults with LLA (n = 150), recruited from German state agencies' databases, was asked to complete the PEmbS, a 10-item patient-reported scale assessing prosthesis embodiment. The local dependency between two items was resolved by keeping for the global score only the lower score of these two items (#9 and #10). Collapsing the seven response categories to four (two expressing disagreement and two agreement) eliminated disordered thresholds. After that, the PEmbS demonstrated unidimensionality, acceptable item fit, and good reliability indices. A keyform plot was created to transform raw scores into linear measures of prosthesis embodiment, making it possible to compare the individual's item responses with those expected by the Rasch model, and to manage missing responses. The PEmbS is useful for assessing prosthesis embodiment in people with LLA, both for research and clinical purposes. We propose a revised version of the PEmbS for lower limb amputees; its appropriateness in other LLA contexts requires further investigation. Prosthesis embodiment has been empirically related to positive clinical outcomes in limb amputees. The Prosthesis Embodiment Scale (PEmbS) is a patient-reported scale that has been recently recommended for use in research on prosthesis embodiment. Rasch analysis showed that the revised version of the German PEmbS is a psychometrically sound instrument for the assessment of prosthesis embodiment in lower limb amputees. The PEmbS thus also allows reliable and valid diagnosis of prosthesis embodiment in clinical and rehabilitation contexts. [ABSTRACT FROM AUTHOR]

Objectives. To examine whether possibilities to improve care among patients with diabetes are reflected in the numbers of cardiovascular complications at national and regional level in Finland. Methods. The study population included all patients with diabetes in Finland since 1964. The incidences of first acute coronary syndrome, ischemic stroke and lower limb amputation were examined for the period from 2010 to 2017. The age- and sex-standardised incidence rates were calculated for the first events. Adjusted Poisson regression mixed models were used to calculate average annual trends and assess regional variation of incidences during the periods 2010 to 2013 and 2014 to 2017 in the university hospital districts (UHDs) and hospital districts (HDs). Results. The nationwide incidence of first acute coronary syndrome decreased among patients with diabetes by 2.7% (95% confidence interval 2.3%; 3.0%), ischemic stroke by 2.0% (1.5%; 2.4%) and major lower limb amputation by 4.6% (3.1%; 5.9%) annually. The sexes differed only in the decrease in acute coronary events. The annual decrease among males was 2.1% (1.6%; 2.6%) and among females was 3.4% (2.8%; 4.0%) (p =.001). Marked variation was observed among UHDs and HDs in the incidences of cardiovascular events and lower limb amputations in patients with diabetes. The variation in annual trends of diabetic complications was most pronounced in acute coronary syndrome among UHDs with an estimated variance of 0.0006 (p =.034). Conclusions. The decrease in the incidence of first cardiovascular events among patients with diabetes continued from 2010 to 2017 in Finland. However, the declining national incidence rates hide regional differences which should be a target for improvement. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the barriers and facilitators to physical activity from multiple stakeholder perspectives including individuals with LLA and health professionals. A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semi-structured interviews were held with individuals with LLA recruited from rehabilitation hospitals in a metropolitan city in Canada. Health professionals with experience in amputation care were recruited from across Canada. Data were analysed using codebook thematic analysis. Thirty-three individuals with LLA and eighteen health professionals participated. Six themes were generated which represent the perceived barriers and facilitators to physical activity. Themes including Informal and Formal Supports, Availability of and Access to Community Resources, and Fit and Function of the Prosthesis were perceived by many individuals as facilitators, while acting as a barrier for others depending on an individual's circumstances. These findings provide us with a basis of understanding from which we can begin addressing barriers to physical activity for individuals with LLA, in support of developing patient-centred interventions and physical activity programs for this population. Irrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity. Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation. A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient's motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change. The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals. [ABSTRACT FROM AUTHOR]

Although leg amputation is common among patients with diabetic foot ulcers, only few studies have examined the thoughts regarding leg amputation from the perspective of patients. This study aims to explore the thoughts of patients with diabetic foot ulcers regarding leg amputation. A qualitative design using semi-structured interviews were used and analysed using Interpretative Phenomenological Analysis (IPA). In all five patients participated and the interview questions were focused on thoughts in relation to a possible leg amputation. Four significant themes were revealed: 1) "Considered—not spoken"—reflections on being alone with one's thoughts, 2) "What people think about me"—concerns about consequences on social relations, 3) "The tough ones and the ones who whine"—considerations about expected self-efficacy and 4) "Limitations and opportunities"—thoughts about physical consequences. Even if an amputation is not yet planned, having a diabetic foot ulcer can result in divergent thoughts regarding leg amputation. The findings indicate that amputation is considered a taboo which makes it difficult for the patient to talk about it within either the health care context or with relatives. Health care professionals should therefore be aware of how they communicate regarding leg amputation. [ABSTRACT FROM AUTHOR]

The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018. A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11). Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services. A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery. Comprehensive and accessible amputee rehabilitation services can enable people with amputations to regain their independence and aid their participation in their community and workplace. There are numerous barriers to both accessing and providing amputee rehabilitation services in the Western Area, Sierra Leone, chiefly financial. We recommend a revised effort by the Sierra Leonean government to implement the progressive policies on disability they have already adopted into law, which will aid the improvement of amputee rehabilitation services. New education and training programmes for all levels of prosthetic and orthotic professions are needed to secure the future of prosthetics and orthotics in Sierra Leone. [ABSTRACT FROM AUTHOR]

There is conflicting literature on the effect of post-amputation pain on quality of life (QOL) and no available literature on the relationship of pain medications to QOL of amputees in pain. The aims of the study were to compare QOL in lower limb amputees with significant pain to those with minimal pain and compare QOL in amputees on multiple pain medications (≥3 and/or ≥ 40 mg morphine equivalent/day) to those on minimal. Cross-sectional study of amputees (n = 101) utilizing standardized (brief pain inventory, pain self-efficacy, Euro QOL scale), institutional amputee specific questionnaires. Post-amputation pain was common (69%), but only 13% of the participants were using more pain medications. High-pain interference and poor self-efficacy were associated with poorer QOL after adjusting for age, gender and cause of amputation. High medication use was associated with high-pain interference and poor self-efficacy, but there was minimal correlation between pain scores and medication usage (p > 0.05). Quality of life was not influenced by high medication usage (p > 0.05 for pain interference; p > 0.05 for self-efficacy). Post-amputation pain continues to be a major determinant of QOL in lower limb amputees, but the role of pain medications on an amputee's QOL remains unclear. An amputee's QOL is affected by the severity of their post-amputation pain even beyond six months post their amputation. An amputee with more pain may not necessarily take more pain medications to manage their pain. The amount of pain medications taken may not influence their self-reported QOL. Pain and QOL assessment should be integrated into routine clinical evaluation of adult amputees. Standardized screening tools and/or formative assessment can be utilized for assessing QOL. [ABSTRACT FROM AUTHOR]

The prosthetic socket is the connecting part between the stump and the prosthesis, which is the important basis for the function of the prosthesis. The current prosthetic socket is difficult in meeting the needs of amputees current, which is the main reason for amputees abandoning their prostheses. This paper reviews the design and use of prosthetic sockets for lower limb. The contribution of this publication is to review the skin problem, interface stress and volume fluctuations for prosthetic sockets, which are proposed as the key factors affecting the use of prosthetic sockets. Moreover, the lower limb prosthetic sockets are classified into the full-contact and the frame-type sockets according to the different contact type between stump and prosthetic socket, and their advantages and disadvantages are analyzed from different perspectives. Aim to design the prosthetic socket with function transfer, suspension stability and comfort of socket, a design concept for prosthetic socket with self-adapt in real-time is proposed. It can be achieved by the smart materials with special mechanical properties. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the causes, types, and consequences of lower limb amputation and the demographics of subjects with such amputation who attended a tertiary rehabilitation center in Bangladesh, Centre for the Rehabilitation of the Paralysed. Methods: Cross-sectional data were collected from subjects with lower limb amputation who attended a specialized rehabilitation center between January 2014 and August 2016. Telephone interviews were conducted using a structured questionnaire. Descriptive analysis, paired t-test, and Fisher's exact test were conducted as well as a regression analysis was performed. Results: A total of 332 respondents, aged 5 to 76 years (mean 37.5± SD 13.8), with lower limb amputation participated in the study. Of the respondents, the majority were male (87.7%) and lived in rural areas (64.8%). Road traffic accidents were the leading cause (58.7%) of amputation followed by peripheral vascular diseases (7.5%) and hit by sharp objects (7.2%). Age (odds ratio: 0.9) and driving as occupation (odds ratio: 7.3) were found to be statistically significant covariates for amputation from road traffic accidents. The mean duration between having an amputation and receiving the first prosthetic fitting was 6.4 years (±8.9). Among the study participants, 30.7% lost their jobs after amputation and their mean monthly income reduced significantly (p < 0.01) from US$119.9 (±421.5) to US$45.8 (±63.1). Conclusion: Majority of the lower limb amputations resulted from traumatic road traffic accidents. Younger males and drivers were found to be more prone to amputation from road traffic accidents. Lower limb amputation creates great health and economic disparity in the amputee's lives. Majority of the lower limb amputation cases in Bangladesh were attributable to road traffic accidents—a largely preventable cause. The mean time between amputation and prosthetic fitting was more than 6 years which implies lack of awareness and inaccessibility of prosthetic management. Policymakers, regulators, law enforcement, and traffic safety advocates should take urgent actions to prevent road traffic accidents and raise awareness about and improve availability of prosthetic rehabilitation in Bangladesh. [ABSTRACT FROM AUTHOR]

Aim: This study investigates the effect of time and age on health-related quality of life, general self-efficacy, and functional level 12 months following dysvascular major lower limb amputation (LLA). Methods: A prospective cohort study design with assessments at baseline and follow-up 3, 6, and 12 months post-amputation. Data were collected via in-person interviews using Short Form 36, the General Self-efficacy scale and Barthel Index 100. Out of a consecutive sample of 103 patients having dysvascular major LLA (tibia, knee, or femoral), 38 patients completed the study. Outcome at follow-up was compared with baseline and analyzed in age groups. Results: All SF36 subscale scores were below population norms at baseline. At 12 months, two out of eight scores—physical function and role-physical—had not improved. Different patterns of change over the 12 months were detected among the subscales, and psychosocial problems persisted and fluctuated throughout the 12 months in all age groups. Large differences were identified between age groups in physical function with the loss of physical function almost solely evident among the oldest (aged 75+ years) patients. Conclusions: Special attention should be given to the oldest patients need for rehabilitation so that they gain higher quality of life. Psychosocial problems persist and fluctuate throughout the first 12 months after major LLAs in all age groups and rehabilitation services should include psychosocial support throughout the first year to all patients independent of age. Waiting for an unnecessarily long period of time for a prosthesis can negatively impact both physical and psychosocial aspects of health-related QOL, and interventions to reduce waiting time are warranted. Differences between age groups in functional level after 12 months exist, with the loss of function almost solely evident among the oldest patients (aged 75+ years). A special focus should be given to the oldest patients' need of everyday rehabilitation to regain basic physical functions. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to estimate fall incidence and describe associated risk factors among people with a lower limb amputation (LLA) during various stages of recovery: the surgical ward, in-patient rehabilitation and return to community life. Materials and methods: A systematic search of relevant English language articles was performed using PubMed and EMBASE. Out of 310 initial "hits," six retrospective cohort studies, one prospective cohort study and eleven cross-sectional studies from which fall incidence and risk factors could be extracted, were selected for critical review. Fall incidence and associated risk factors were extracted and analyzed in the context of various clinical stages of recovery after amputation. The studies were evaluated for quality using the "Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies." Results: Results showed that during all stages of recovery, people with a LLA are at increased risk of falling compared with able-bodied individuals, as well as other clinical populations. Each stage of recovery is associated with different fall risk factors. The current review is limited mainly by the paucity of studies on the topic. Conclusions: Specialised care focusing on the most relevant risk factors for each stage of recovery may enhance fall prevention during post-fall recovery. • People with a lower limb amputation are at a high risk of falling in all stages of their clinical course. • Health professionals should be aware that people with a lower limb amputation in the first 4 years ofamputation or with four or more health-related problems are at an increased risk. • Health professionals should also be aware that increased gait variability, excess confidence in balance andwalking abilities and less cautious stair walking, impose an elevated risk of falling and should focus theirefforts in reducing these factors. [ABSTRACT FROM AUTHOR]

Background:End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis. Objective:The study aims to document trends in the prevalence and identify risk factors of non-traumatic LLA in Australian patients on dialysis. Methods:A retrospective review of all patients (218) who attended the regional dialysis center between 1st January 2009 and 31st December 2013 was conducted. Demographic, clinical and biochemical data were analyzed. Results:We identified a high prevalence of 13.3% of LLAs amongst Australian patients with ESRF on dialysis at our center. The associated risk factors were the presence of diabetes (OR 1.67 [1.49–1.88]p < 0.001), history of foot ulceration (OR 81 [18.20–360.48]p < 0.001), peripheral arterial disease (OR 31.29 [9.02–108.56]p < 0.001), peripheral neuropathy (OR 31.29 [9.02–108.56]p < 0.001), foot deformity (OR 23.62 [5.82–95.93]p < 0.001), retinopathy (OR 6.08 [2.64–14.02]p < 0.001), dyslipidemia (OR 4.6 [1.05–20.05]p= 0.049) and indigenous background (OR 3.39 [1.38–8.33]p= 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05). Conclusion:There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels. [ABSTRACT FROM PUBLISHER]

Regardless of the type of prosthetic lower limb, successful ambulation requires proper prosthetic attachment. To help alleviate many of the problems associated with prosthetic attachment, direct skeletal attachment (DSA) has been proposed as an alternative to conventional sockets. The purpose of the current study was to evaluate the feasibility of lower limb DSA in a micropig model and to develop a systematic approach to the development and analysis of DSA systems. The DSA device consisted of two stages. The load-carrying stage embedded in the bone canal was designed using bone remodeling theory in conjunction with finite element analysis to approximate implant-induced remodeling and stabilization out to 36 months postimplantation. The skin-interfacing stage was designed to maintain an immutable infection barrier where the prosthesis exited the body. Following successful design, fabrication, and benchtop evaluation, the device was surgically implanted in a Yucatan micropig. The animal trial was successful out to 10 weeks and revealed potential flaws in the surgical protocol related to thermal necrosis. However, no signs of infection were present at the time of implant retrieval. While results of this pilot study support the feasibility of a DSA approach to prosthetic limb attachment, additional animal trials are necessary to prove long-term viability. [ABSTRACT FROM AUTHOR]