The relationship between pelvis–trunk coordination and low back pain in individuals with transfemoral amputations

Esposito, Elizabeth Russell; Wilken, Jason M.

doi:10.1016/j.gaitpost.2014.07.019

Cited by 61 publications

(32 citation statements)

References 31 publications

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“…In addition socket fitting problems [13], decreased hip abductor strength [13–15] and changed muscle activity patterns [16] may be a possible cause for this asymmetry. Gait asymmetry, specifically in the coronal [17–19] and sagittal plane [18], are considered to be associated with secondary complaints such as back pain [20]. Both, socket-related problems and back pain can lead to limited prosthetic use [5, 21] and reduced health-related quality of life (HRQoL) [5, 7].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

Leijendekkers

Staal

Hinte

et al. 2016

BMC Musculoskelet Disord

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BackgroundPatients with lower extremity amputation frequently suffer from socket-related problems. This seriously limits prosthesis use, level of activity and health-related quality of life (HRQoL). An additional problem in patients with lower extremity amputation are asymmetries in gait kinematics possibly accounting for back pain. Bone-anchored prostheses (BAPs) are a possible solution for socket-related problems. Knowledge concerning the level of function, activity and HRQoL after surgery is limited.The aims of this ongoing study are to: a) describe changes in the level of function, activity, HRQoL and satisfaction over time compared to baseline before surgery; b) examine potential predictors for changes in kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort over time and level of stump pain at follow-up; c) examine potential mechanisms for change of back pain over time by identifying determinants, moderators and mediators.Methods/designA prospective 5-year longitudinal study with multiple follow-ups. All adults, between May 2014 and May 2018, with lower extremity amputation receiving a press-fit BAP are enrolled consecutively. Patients with socket-related problems and trauma, tumour resection or stable vascular disease as cause of primary amputation will be included. Exclusion criteria are severe cognitive or psychiatric disorders. Follow-ups are planned at six-months, one-, two- and five-years after BAP surgery. The main study outcomes follow, in part, the ICF classification: a) level of function defined as kinematics in coronal plane, hip abductor strength, prosthetic use, back pain and stump pain; b) level of activity defined as mobility level and walking ability; c) HRQoL; d) satisfaction defined as prosthesis comfort and global perceived effect. Changes over time for the continuous outcomes and the dichotomized outcome (back pain) will be analysed using generalised estimating equations (GEE). Multivariate GEE will be used to identify potential predictors for change of coronal plane kinematics, prosthetic use, walking ability, HRQoL, prosthesis comfort and for the level of post-operative stump pain. Finally, potential mechanisms for change in back pain frequency will be explored using coronal plane kinematics as a potential determinant, stump pain as moderator and hip abductor strength as mediator.DiscussionThis study may identify predictors for clinically relevant outcome measures.Trial registration NTR5776. Registered 11 March 2016, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1341-z) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

Leijendekkers

Staal

Hinte

et al. 2016

BMC Musculoskelet Disord

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“…For this particular approach, the continuous relative phase (CRP) technique is one of the most sensitive for detecting asymmetries in coordination during gait compared with other analyses of movement symmetry [ 23 – 26 ]. CRP has been effective in identifying cyclic movement deviations caused by several disabilities [ 27 , 28 ] in different locomotor tasks [ 29 , 30 ], but has seldom been utilized in the diabetic population.…”

Section: Introductionmentioning

confidence: 99%

Intralimb Coordination Patterns in Absent, Mild, and Severe Stages of Diabetic Neuropathy: Looking Beyond Kinematic Analysis of Gait Cycle

et al. 2016

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AimDiabetes Mellitus progressively leads to impairments in stability and joint motion and might affect coordination patterns, mainly due to neuropathy. This study aims to describe changes in intralimb joint coordination in healthy individuals and patients with absent, mild and, severe stages of neuropathy.MethodsForty-seven diabetic patients were classified into three groups of neuropathic severity by a fuzzy model: 18 without neuropathy (DIAB), 7 with mild neuropathy (MILD), and 22 with moderate to severe neuropathy (SVRE). Thirteen healthy subjects were included as controls (CTRL). Continuous relative phase (CRP) was calculated at each instant of the gait cycle for each pair of lower limb joints. Analysis of Variance compared each frame of the CRP time series and its standard deviation among groups (α = 5%).ResultsFor the ankle-hip CRP, the SVRE group presented increased variability at the propulsion phase and a distinct pattern at the propulsion and initial swing phases compared to the DIAB and CTRL groups. For the ankle-knee CRP, the 3 diabetic groups presented more anti-phase ratios than the CTRL group at the midstance, propulsion, and terminal swing phases, with decreased variability at the early stance phase. For the knee-hip CRP, the MILD group showed more in-phase ratio at the early stance and terminal swing phases and lower variability compared to all other groups. All diabetic groups were more in-phase at early the midstance phase (with lower variability) than the control group.ConclusionThe low variability and coordination differences of the MILD group showed that gait coordination might be altered not only when frank evidence of neuropathy is present, but also when neuropathy is still incipient. The ankle-knee CRP at the initial swing phase showed distinct patterns for groups from all degrees of neuropathic severity and CTRLs. The ankle-hip CRP pattern distinguished the SVRE patients from other diabetic groups, particularly in the transitional phase from stance to swing.

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“…While these compensations may be necessary to accomplish mobility, asymmetric movements are linked to the development of LBP [11]. This coordination of excessive trunk and pelvic motion during walking likely contributes to step-to-step asymmetric loading at the low back previously measured in patients with unilateral TTA [12], and may increase the risk of developing LBP, which was previously demonstrated in patients with transfemoral amputation [13,14]. …”

Section: Introductionmentioning

confidence: 93%

Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation

et al. 2016

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The relationship between pelvis–trunk coordination and low back pain in individuals with transfemoral amputations

Cited by 61 publications

References 31 publications

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

Long-term outcomes following lower extremity press-fit bone-anchored prosthesis surgery: a 5-year longitudinal study protocol

Intralimb Coordination Patterns in Absent, Mild, and Severe Stages of Diabetic Neuropathy: Looking Beyond Kinematic Analysis of Gait Cycle

Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation

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