High-Level Performance After the Return to Run Clinical Pathway in Patients Using the Intrepid Dynamic Exoskeletal Orthosis

Abstract

Background Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge. Objective To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility. Methods Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review. The Comprehensive High-level Activity Mobility Predictor (CHAMP) and all subtests were completed prior to and after completion of the RTR as part of routine clinical care. An analysis of covariance (ANCOVA) was used to compare CHAMP scores before and after the RTR. Results Significant improvements were found in the T test (mean change, faster by 5.3 seconds; 95% confidence interval: 3.6, 7.1 seconds; P = .03) and total CHAMP score (mean change, 4.2 points; 95% confidence interval: 3.0, 5.3 points; P<.05). No significant changes were noted in the single-legged stance subtest, the Edgren sidestep test, or the Illinois agility test. Conclusion The RTR led to improvements in high-level, multidirectional mobility in IDEO users with a history of fractures. Applicability of the intervention used in this study requires further validation before widespread use. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2019;49(7):529–535. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8763

Military Service Members with Major Lower Extremity Fractures Return to Running with a Passive-dynamic Ankle-foot Orthosis: Comparison with a Normative Population

“…Thus, complex agility is likely not comparable, but single-plane agility may be more achievable. Additionally, a prior study looking at agility gains before and after the PD-AFO in patients with unilateral lower extremity fractures found that overall total CHAMP scores improved [9]. So although these patients may run with less agility compared with uninjured, full-duty runners, they still likely improve in agility compared with their own postinjury baseline.…”

A modified passive-dynamic ankle–foot orthosis: can it prevent amputation and arthrodesis in patients with ankle–foot trauma?

“…Another study assessed high-level mobility with the CHAMP in patients with lower extremity fractures utilizing the IDEO [21]. Patients participated in a rehabilitation program called the Return to Run Clinical Pathway.…”

“…No significant changes were noted in the SLS, ESST or IAT. Our population contained only HELET patients, while the study from Mazzone also contained patients with less severe injuries (e.g., stress fractures) [21]. They might have obtained higher scores on the tests without the brace, resulting in a smaller difference between pre-and post-brace scores.…”

Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians

“…Previous research has shown a beneficial effect of a sports medicine-based rehabilitation program in conjunction with CDOs, resulting in improved performance and reduced pain. 3,[9][10][11] Therefore, a similar devicespecific clinical training program was integrated into the care pathway in an effort to achieve positive outcomes in a civilian population.…”