A Review of the Long-Term Health Outcomes Associated With War-Related Amputation

Robbins, Christopher; Vreeman, Daniel J.; Sothmann, Mark S.; Wilson, Stephen; Oldridge, Neil

doi:10.7205/milmed-d-00-0608

Cited by 82 publications

(52 citation statements)

References 18 publications

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“…TFLL, when compared with LLL at more distal levels, has also been reported to be associated with a decreased frequency of prosthetic fitting [7,[14][15] and an increased frequency of back, knee, and hip pain [16][17][18][19]; obesity [20]; and osteoarthritis [17,21].…”

Section: Introductionmentioning

confidence: 99%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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Abstract-Microprocessor-controlled prosthetic knees (MPKs) have been developed as an alternative to non-microprocessorcontrolled knees (NMPKs) to address challenges facing individuals with lower-limb loss. A body of scientific literature comparing MPKs and NMPKs exists but has yet to be critically appraised. Therefore, we conducted a systematic review to examine outcomes associated with the use of these interventions among individuals with transfemoral limb loss. A search of biomedical databases identified 241 publications, of which 27 met the inclusion and exclusion criteria and were reviewed for methodological quality and content. We developed 28 empirical evidence statements (EESs) in 9 outcome categories (metabolic energy expenditure, activity, cognitive demand, gait mechanics, environmental obstacle negotiation, safety, preference and satisfaction, economics, and health and quality of life) based on findings in the literature. The level of evidence supporting these EESs varied due to quantity, quality, and consistency of the results. EESs supported by a moderate level of evidence that noted significant differences between MPKs and NMPKs were derived in five of the nine outcome categories. The results from this review suggest that evidence exists to inform clinical practice and that additional research is needed to confirm existing evidence and better understand outcomes associated with the use of NMPKs and MPKs.Key words: amputation, artificial limb, function, gait, knee, microprocessor, outcome, preference, rehabilitation, safety. Abbreviations: AAOP = American Academy of Orthotists andProsthetists, ABC = Activities-specific Balance Confidence, CWS = controlled walking speed, DLW = doubly labeled water, EBP = evidence-based practice, EES = empirical evidence statement, EV = external validity, GRF = ground reaction force, HAI = Hill Assessment Index, HRQL = health-related quality of life, IV = internal validity, LLL = lower-limb loss, MFCL = Medicare Functional Classification Level, MP = microprocessor, MPC = microprocessor control, MPK = microprocessor-controlled prosthetic knee, MRPP = Montreal Rehabilitation Performance Profile, NMPK = non-microprocessor-controlled prosthetic knee, O 2 = oxygen, O&P = orthotic and prosthetic, PAEE = physical activity-related energy expenditure, PCBS = Prosthetic Cognitive Burden Scale, PCI = physiological cost index, PEQ = Prosthesis Evaluation Questionnaire, PEQ-A = PEQ Addendum, PRO = patient-reported outcome, QALY = quality adjusted life year, QOL = quality of life, RPE = rating of perceived exertion, SAI = Stair Assessment Index, SF-36 = 36-Item Short-Form Health Survey, SOT = sensory organization test, SSWS = selfselected walking speed, SSC = State of the Science Conference, TDEE = total daily energy expenditure, TFLL = transfemoral limb loss.

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Section: Introductionmentioning

confidence: 99%

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Sawers¹,

Hafner²

2013

JRRD

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“…However, the prevalence of this degenerative disease is approximately five to 10 times higher and occurs sooner in the intact limb among persons with unilateral lower limb loss compared with individuals without limb loss [9,11,13,16,23,26,30]. To date, nearly 1500 US servicemembers have sustained traumatic injuries resulting in major limb loss during recent and current conflicts [7].…”

Section: Introductionmentioning

confidence: 99%

Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

Pruziner

Werner

Copple

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The initiation and progression of knee and hip arthritis have been related to limb loading during ambulation. Although altered gait mechanics with unilateral lower limb loss often result in larger and more prolonged forces through the intact limb, how these forces differ with traumatic limb loss and duration of ambulation have not been well described.Questions/purposes The purpose of this study was to determine whether biomechanical variables of joint and limb loading (external adduction moments, vertical ground reaction force loading rates, and impulses) are larger in the intact limb of servicemembers with versus without unilateral lower limb loss and whether intact limb loading differs between shorter (B 6 months) versus longer (C 2 years) durations of ambulation with a prosthesis. 4.45-16.79; 10.18-12.81] 4.64-14.47; 8.26-9.74 82-19.51; 12.98-15.05]; ES = 0.43; p = 0.001), respectively. Intact limb mean and peak vertical ground reaction force loading rates were also larger in subjects with transfemoral limb loss with B 6 months and C 2 years of experience ambulating with a prosthesis versus control subjects .68] versus 9.03 BW/s [4.64-14.47; 8.26-9.74]; ES C 0.53; p \ 0.001;.05]; ES C 0.68; p \ 0.001, respectively). Similarly, intact limb vertical ground reaction force impulses ; ES C 0.53, p \ 0.001) were also larger among both groups of transfemoral subjects versus control subjects, respectively. Limb loading variables were not statistically different between times ambulating with a prosthesis within groups with transtibial or transfemoral limb loss. Conclusions Larger intact limb loading in individuals with traumatic transtibial loss were only noted early in the rehabilitation process, but these variables were present early and late in the rehabilitation process for those with transfemoral limb loss. Such evidence suggests an increased risk for early onset and progression of arthritis in the intact limb, especially in those with transfemoral limb loss. Clinical Relevance Interventions should focus on correcting modifiable gait mechanics associated with arthritis, particularly among individuals with transfemoral limb loss, to potentially mitigate the development and progression in this population.versus 9.03 BW/s [

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“…Amputasyon sayısındaki artış, tedavi ve rehabilitasyon hizmetlerine gereksinimi de artırmıştır. Uzuv kaybının nedeni çatışmaya bağlı travmatik nedenlerden ise, ampütasyona eşlik eden çoklu organ yaralanmaları, tedavi sürecinin genellikle multidisipliner yürütülmesini de zorunlu kılmaktadır (4) . Çünkü ampütasyon yaşamı kurtaran ancak sosyal ve iş yaşa-mını değiştiren bir cerrahidir.…”

Section: Etiyolojiunclassified

Amputation as a result of war injuries and terrorist attacks

Erdem¹,

Yıldız²,

Kürklü³

2017

Okmeydani Medical Journal

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A Review of the Long-Term Health Outcomes Associated With War-Related Amputation

Cited by 82 publications

References 18 publications

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Outcomes associated with the use of microprocessor-controlled prosthetic knees among individuals with unilateral transfemoral limb loss: A systematic review

Does Intact Limb Loading Differ in Servicemembers With Traumatic Lower Limb Loss?

Amputation as a result of war injuries and terrorist attacks

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