Canadian Prosthetics Orthotics Journal最新文献

{"title":"Exploring the correlation between gait speed and balance in limb prosthesis users: A pilot study.","authors":"A Alhuzaymi, G Fiedler","doi":"10.33137/cpoj.v8i1.45517","DOIUrl":"10.33137/cpoj.v8i1.45517","url":null,"abstract":"<p><strong>Background: </strong>Increasing balance and stability, along with efficient locomotion, is a high-priority goal of physical rehabilitation after limb loss in order to facilitate effective participation in society. Research in the general population suggests that the ability to walk fast is correlated to good performance in balance tests. However, it is unclear if and how prosthesis use influences this correlation.</p><p><strong>Objective: </strong>Our small-sample pilot study aimed to explore whether the general relationship between walking speed and balance holds true for people with limb loss whose physical capabilities are inevitably influenced by their prosthetic devices.</p><p><strong>Methodology: </strong>Participants with any level of limb loss were recruited and asked to perform the Ten-Meter Walk Test and Narrowing Beam Walking Test. Scores in both tests were analyzed using Spearman's rank correlation coefficient.</p><p><strong>Findings: </strong>The initial sample of eleven participants was reduced to eight (5 males, 3 females, mean age 52 years, mean height 171 cm, mean weight 68 kg, mean BMI 23, limb loss levels ranging from partial hand to trans-femoral amputation) after removing outliers. The mean Ten-Meter Walking velocity was 1.16 m/s, and the mean Narrowing Beam Test score was 11.38. The results indicate a medium to strong correlation between fast walking speed and high balance scores (ρ = 0.681, p = 0.063) when outliers are excluded.</p><p><strong>Conclusion: </strong>These findings are consistent with prior research conducted in other populations. However, outliers in our data suggest that this relationship is not universal across all individuals with limb loss. Possible confounding variables include the activity level and the respectively prescribed prosthetic technology. Our finding, that gait speed and balance scores should be evaluated separately to tailor rehabilitation strategies effectively, is preliminary and needs to be confirmed in a larger study.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"45517"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prosthetic treatment of women with lower limb absence during pregnancy & the postpartum period: A chart review.","authors":"B M Pousett, D Cumming, C Phillips, F Azhari, C MacKay","doi":"10.33137/cpoj.v8i1.45142","DOIUrl":"10.33137/cpoj.v8i1.45142","url":null,"abstract":"<p><strong>Background: </strong>Little information is available for women with lower limb absence (LLA) and their prosthetists regarding expectations for prosthetic treatment during and after pregnancy. A main concern is prosthesis use and what adjustments may be required to sustain mobility.</p><p><strong>Objectives: </strong>This study examines the prosthetic treatment of women with LLA to understand what specific prosthetic interventions occurred during the perinatal period and to gather information from the prosthetists regarding key learnings to be shared with others.</p><p><strong>Methodology: </strong>This study was a retrospective review of clinical records for women with LLA who received prosthetic care across Canada. Between January - May 2023, all 19 women who participated in a previous study on LLA and pregnancy consented to have their prosthetist contacted. Prosthetists were asked to complete a structured survey documenting appointment details, socket and alignment adjustments made during the perinatal period and key learnings in providing care to this population.</p><p><strong>Findings: </strong>15 prosthetists were contacted to complete surveys for the 19 participants. Reviews of clinical records were completed between April - August 2023 by 7 prosthetists covering 18 pregnancies from 11 women with LLA (two bilateral transtibial, two unilateral transtibial, four unilateral transfemoral, and three unilateral rotationplasty). Socket adjustments were required in 11/18 pregnancies with common methods including circumferential stretching and localized adjustments. Alignment adjustments to existing sockets were only required in two pregnancies. Additional sockets were required in six pregnancies when the existing socket could no longer be adjusted to achieve comfort, most often during the first six months of pregnancy (the first or second trimester). Everyone who had a socket adjustment during pregnancy required additional socket adjustments or new sockets in the postpartum period. Prosthetists observed wide variations in physiological changes and prosthetic fit during the perinatal period and shared prosthetic management techniques to address residual limb volume changes. A data collection framework was also proposed to support the ongoing collection of this data to include a wider diversity of women and experiences.</p><p><strong>Conclusion: </strong>A wide range of prosthetic treatment interventions may occur during pregnancy and the postpartum period. While prosthetists and women with LLA can anticipate that socket and alignment changes may be necessary, sometimes none are required. By preparing for potential fluctuations in prosthetic fit and addressing each individual's needs, prosthetists can help minimize disruptions to mobility throughout pregnancy.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"45142"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glass ceiling among female prosthetists & orthotists: Perceptions, opportunities and strategies for moving forward.","authors":"A Eshraghi, Z Safaeepour","doi":"10.33137/cpoj.v8i1.44720","DOIUrl":"10.33137/cpoj.v8i1.44720","url":null,"abstract":"<p><strong>Background: </strong>The glass ceiling, a metaphorical barrier hindering women's career advancement, is prevalent across various sectors, including healthcare. Women have proved their competence as successful senior-level leaders. Despite this, there is still a striking under-representation of female prosthetists and orthotists in leadership positions as managers and business owners. This study investigated the \"glass ceiling𠇜 phenomenon in the prosthetics and orthotics (P&O) field, where women, despite growing representation in the profession, are underrepresented in leadership roles.</p><p><strong>Objective: </strong>This study aimed to examine the beliefs and expectations of female prosthetists and orthotists regarding career advancement and leadership opportunities.</p><p><strong>Methodology: </strong>This survey study had two sections; the first section was general demographic questions, and any gender could participate but the second section was the Career Pathways Survey (CPS), which assessed beliefs about the glass ceiling and only female practitioners could participate. The survey evaluated four factors: Denial, Resilience, Acceptance, and Resignation, to understand how women perceive their ability to break through the glass ceiling. All individuals with a professional qualification in prosthetics and/or orthotics were eligible to participate. The survey was distributed worldwide through the ISPO and other professional associations. The survey was opened in April 2021 and remained active for six months.</p><p><strong>Findings: </strong>110 female participants completed the survey. The participants were mainly from North America, Europe and Australia. Findings revealed that factors like age, marital status, and salary were significant predictors of different belief scores, particularly with respect to career acceptance and denial. Results highlighted that women's beliefs about their career advancement were influenced by their personal life situations, such as having children, and the number of years of professional experience.</p><p><strong>Conclusion: </strong>The study calls for organizational reforms to address gender inequalities by implementing policies that support work-life balance, mentoring, and career development. It also emphasizes the importance of further research, particularly examining the intersectionality of gender, race, and other diversity factors, to provide a comprehensive understanding of barriers to leadership in P&O and other healthcare fields.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"44720"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"South African users' function and experience with a magnetorheological microprocessor knee: A mixed methods study.","authors":"S Visagie, B Theron","doi":"10.33137/cpoj.v8i1.45286","DOIUrl":"10.33137/cpoj.v8i1.45286","url":null,"abstract":"<p><strong>Background: </strong>Microprocessor knees (MPKs) support safe and confident prosthetic walking. Their cost often prohibits prescription in low- and middle-income settings like South Africa. Funding of high-end prosthetic products in South Africa is dependent on justifications that explain why the component is prescribed, and how it can improve the user`s function. There is little local evidence to support these justifications.</p><p><strong>Objective: </strong>To explore and describe South African users' function and experience with the Rheo XC microprocessor knee (MPK).</p><p><strong>Methodology: </strong>An explanatory sequential mixed methods design was used. A pre-test, post-test study was followed by a descriptive qualitative study to explore and explain the observed outcomes. In the pre-test phase, baseline data were collected while participants used their regular non-microprocessor knees (e.g., mechanical or hydraulic joints). Post-test data were collected after a two-week trial with the Rheo XC knee joint. Data were collected from 16 consecutively sampled participants, using a self-developed functional level scale and the L-Test. Nine (56.3%) participants had a transfemoral amputation, six (37.5%) had a knee disarticulation and one (6.3%) had bilateral amputations (transtibial and transfemoral). Baseline and follow-up data were paired for each participant and analyzed with the Wilcoxon Signed-Rank test. The descriptive qualitative study explored six purposively sampled participants' experiences of the trial knee through semi-structured interviews. Inductive thematic analysis was done.</p><p><strong>Findings: </strong>The time to complete the L-Test decreased on average 7.5 s between baseline (35.4 s) and post-test (27.9 s) data. L-Test Wilcoxon Singed-rank findings showed a significant increase in walking speed (p < 0.001). Mean functional level scores increased by an average of 12.7 points (p < 0.001) with improvements observed across all activities except running, for which scores remained unchanged. Two themes emerged from the qualitative data. Theme 1: <i>Acceptance of the MPK</i> showed enthusiasm for the MPK. However, Theme 2: <i>Real-world limitations of the MPK</i> cautioned that the MPK is not suitable for everybody.</p><p><strong>Conclusion: </strong>This study provides context specific scientific evidence that may support funding decisions for MPKs in South Africa. However, it is not suitable for everyone, and a trial period to assess appropriateness is advised before prescription. The test period in this study was short, and further research over longer durations is recommended.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"45286"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using a novel psychosocial group intervention to improve adaption, coping and mental health outcomes following dysvascular limb amputations: A feasibility study.","authors":"R J Steinberg, L R Robinson, O Kachmarchuk, S Jankey, S Posa, A L Mayo, M Simon, A Kiss, C MacKay, R Simpson, M B Wasilewski, S Dilkas, S L Hitzig","doi":"10.33137/cpoj.v8i1.45122","DOIUrl":"10.33137/cpoj.v8i1.45122","url":null,"abstract":"<p><strong>Background: </strong>Individuals with lower extremity amputations (LEA) often face high rates of depression and anxiety that hinder their rehabilitation and post-discharge coping. Group therapy is a clinically and cost-effective way to address these mental health challenges, but evidence for its use with LEA inpatients is limited.</p><p><strong>Objective: </strong>To determine the feasibility of a psychosocial group therapy intervention for individuals with dysvascular LEA undergoing inpatient rehabilitation.</p><p><strong>Methodology: </strong>This randomized controlled trial randomly assigned dysvascular LEA rehabilitation inpatients into a supportive-expressive group therapy (SEGT) or a treatment as usual (TAU) group. The SEGT intervention, a form of group therapy adapted from outpatient medical settings, consisted of six one-hour sessions held twice weekly over a three-week period. Participants completed baseline, exit and three-month surveys assessing the study's secondary outcomes of SEGT effectiveness on depression, anxiety, coping, body image, health, and community participation. The main outcomes assessed recruitment, survey completion, treatment adherence, and participant retention rates. Interviews and a focus group were completed to obtain feedback on the intervention.</p><p><strong>Findings: </strong>Twenty-five participants were recruited, with 12 randomly assigned to the SEGT group, and 13 to the TAU group. The average number of sessions attended by SEGT participants was 3.9 (SD = 2.1). The survey completion rates for all participants were 84% (21/25) for the baseline assessment, 64% (18/25) for discharge, and 44% (11/25) for the three-month follow-up. The SEGT group showed a significant improvement in anxiety and depression scores (p = 0.02). SEGT was well-received by participants and staff.</p><p><strong>Conclusion: </strong>The findings suggest a larger pragmatic SEGT trial is feasible, despite a small sample size and implementation challenges during the COVID-19 pandemic, given this study achieved moderate rates of recruitment, retention, and survey completion. Several critical insights were gained on how to optimize an inpatient group therapy intervention for dysvascular LEA populations in rehabilitative settings.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"45122"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of human thermoregulation in thermal discomfort in lower-limb prosthetics: A scoping review.","authors":"R Edwards, L Murray, A Buis","doi":"10.33137/cpoj.v8i1.43073","DOIUrl":"10.33137/cpoj.v8i1.43073","url":null,"abstract":"<p><strong>Background: </strong>Thermal discomfort is one of the most prevalent issues experienced by lower-limb prosthetic users where, on average, 54% of users report thermal-related issues. This arises from wearing a prosthetic socket, which may disrupt the thermoregulatory system due to the low thermal conductivity of materials used in prosthetic sockets and liners. Despite the reported prevalence, there is little understanding of the impact of wearing a prosthesis on the body's thermoregulatory system and how users perceive thermal discomfort.</p><p><strong>Objectives: </strong>This review aimed to evaluate the current understanding of how human thermoregulation correlates with subjective measures of thermal discomfort among lower-limb prosthetic users. It sought to gain a deeper understanding of how thermoregulatory parameters compare and relate to the subjective experience of thermal discomfort in this population.</p><p><strong>Methodology: </strong>The study design followed a scoping review structure to identify gaps in knowledge on the topic. A literature search was conducted across five online databases: Medline (ProQuest), EMBASE, Cochrane, CINAHL and PsycINFO. The searches covered literature from the earliest available date in each database up until February 2024. A search strategy was created to identify the relevant literature. An inclusion/exclusion criterion was then applied to identify studies that only measured either physiological or psychological aspects of thermoregulation and compared these aspects to thermal discomfort/comfort feedback. The QualSyst critical appraisal tool was used to gain quality score for each included article.</p><p><strong>Findings: </strong>8 articles were identified for inclusion in this review, confirming a dearth in research into how wearing a prosthesis affects thermoregulation at the body/device interface (BDI) and the perception of thermal discomfort. Furthermore, it raised question to the relevance of using residual limb skin temperature measurements to assess thermal discomfort in lower-limb prosthetics. Perspiration at the BDI emerged as a potentially significant contributor to thermal discomfort, a consensus reflected in the literature.</p><p><strong>Conclusion: </strong>Despite significant technological advancements, thermal discomfort remains a persistent issue. Therefore, further research is warranted to further understand how wearing a prosthesis affects the thermoregulatory system, enabling the development of innovative components which can mitigate thermal discomfort and in turn improve the quality of life of lower-limb prosthetic users.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"43073"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of amputation level and vaulting on loading parameters during level ground walking.","authors":"E Pröbsting, T Schmalz, M Bellmann","doi":"10.33137/cpoj.v8i1.44416","DOIUrl":"10.33137/cpoj.v8i1.44416","url":null,"abstract":"<p><strong>Background: </strong>Previous studies show that during level walking, the load on the contralateral side increases with more proximal amputation levels. Furthermore, a typical compensation mechanism, vaulting on the contralateral side, may also influence the load. However, no study has compared the load applied to the contralateral side across more than two different amputation levels.</p><p><strong>Objective: </strong>The objectives of this study were to analyze the biomechanical impact of different lower limb amputation levels and vaulting on the load applied to the locomotor system.</p><p><strong>Methodology: </strong>Gait data from 82 individuals with different amputation levels (44 transtibial (TT), 30 transfemoral (TF), and 8 hip disarticulation (HD)) were retrospectively analyzed in this study. Peak knee adduction, flexion and extension moments, vertical ground reaction force peaks, and force rates were statistically analyzed between different amputation levels and between two groups \"TF with vaulting\" and \"TF without vaulting\".</p><p><strong>Findings: </strong>As the level of amputation increases, walking speed decreases and asymmetry of stance duration increases. TF individuals with vaulting tend to walk faster than those without vaulting. The first peak of vertical ground reaction forces, the peak knee adduction and extension moments increase, and the peak knee flexion moments decrease with higher amputation level. The higher the amputation level, the curve of the vertical ground reaction force becomes significantly steeper during the first 5% of the gait cycle (GC). The first peak of ground reaction forces, the knee flexion, extension and adduction moments tend to be higher in TF individuals with vaulting.</p><p><strong>Conclusion: </strong>In summary, a higher lower limb amputation level can increase loading on the contralateral limb and contribute to a higher incidence of vaulting during gait. The effect of vaulting as a compensation pattern leads to an additional increase in contralateral limb loading.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"44416"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wound management, healing, and early prosthetic rehabilitation: Part 3 - A scoping review of chemical biomarkers.","authors":"H Williams-Reid, A Johannesson, A Buis","doi":"10.33137/cpoj.v8i1.43717","DOIUrl":"10.33137/cpoj.v8i1.43717","url":null,"abstract":"<p><strong>Background: </strong>Poor post-amputation healing delays prosthetic fitting, adversely affecting mortality, quality of life, and cardiovascular health. Current residual limb assessments are subjective and lack standardized guidelines, emphasizing the need for objective biomarkers to improve healing and prosthesis readiness assessments.</p><p><strong>Objectives: </strong>This review aimed to identify predictive, diagnostic, and indicative chemical biomarkers of healing of the tissues and structures found in the residual limbs of adults with amputation.</p><p><strong>Methodology: </strong>This scoping review followed Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines. Searches using the terms \"biomarkers,\" \"wound healing,\" and \"amputation\" were performed across Web of Science, Ovid Medline, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Inclusion criteria were: 1) References to chemical biomarkers and healing; 2) Residuum tissue healing; 3) Repeatable methodology with ethical approval. Included articles were evaluated for quality of evidence (QualSyst tool) and level of evidence (JBI classification). Sources were categorized by study (e.g., randomized controlled trial or bench research), wound (diabetic, amputation, other), and model (human, murine, other) type. Chemical biomarkers repeated across study categories, and quantification methods were reported on.</p><p><strong>Findings: </strong>From 3,306 titles and abstracts screened, 646 underwent full-text review, and 203 met the criteria for data extraction, with 76% classified as strong quality. 38 chemical biomarkers were identified across 4 to 50 sources, with interleukins (predictive, indicative, and diagnostic) and HbA1c (predictive) most prevalent, appearing in 50 and 48 sources, respectively. Other biomarkers included predictive blood markers (e.g., cholesterol, white blood cell counts), indicative growth factors, bacteria presence (predictive), proteins (predictive, indicative, and diagnostic, e.g., matrix metalloproteinases), and cellular markers (indicative and diagnostic, e.g., Ki-67, alpha-smooth muscle actin [α-SMA]).</p><p><strong>Conclusion: </strong>Predictive biomarkers identify comorbidities that may hinder healing, aiding in pre-amputation risk assessment for poor recovery. Indicative biomarkers monitor key biological healing processes, such as angiogenesis (the formation of new blood vessels), wound contraction, and inflammation. Diagnostic biomarkers provide direct insights into tissue composition and cellular-level healing. Integrating these biomarkers into post-amputation assessments enables continuous monitoring of the healing process while accounting for comorbidities, enhancing the objectivity of post-surgical healing management and ensuring more effective, personalized rehabilitation strategies.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"8 1","pages":"43717"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the need for lower limb prosthetic guidelines in South Africa's private healthcare sector.","authors":"B Theron, S Visagie","doi":"10.33137/cpoj.v7i2.44450","DOIUrl":"10.33137/cpoj.v7i2.44450","url":null,"abstract":"<p><strong>Background: </strong>Evidence based guidelines can assist with prosthetic component selection and clinical intervention. There is limited evidence on lower limb prosthetic prescription guidelines in the South African private health care sector.</p><p><strong>Objective: </strong>To explore the need for lower limb prosthetic prescription guidelines in the South African private healthcare sector.</p><p><strong>Methodology: </strong>Three main funders of lower limb prosthetics in the South African private healthcare sector (Road Accident Fund (RAF), Workmen's Compensation Fund (WCA), and Council of Medical Schemes (CMS)) were explored using a case study design. Data were collected from six regulatory documents, sixteen purposively sampled prosthetic users, who received services from these funders, and seven key informants. Documents were assessed with the Appraisal of Guidelines for Research & Evaluation II (AGREE II), across six domains. Data from users and key informants were collected with telephonic, semi-structured interviews guided by interview schedules. Interview schedules were self-developed and tailored for each participant group. AGREE II data were analyzed descriptively. Inductive thematic analysis was used for interview data.</p><p><strong>Findings: </strong>Across cases, the \"Scope and Purpose\" domain scored the highest: 50% (WCA), 47% (CMS), and 22% (RAF). \"Editorial Independence\" scored 0% for all three cases. Other challenging domains were \"Applicability\" (WCA: 17%, CMS: 6%, RAF: 6%) and \"Rigour of Development\" (WCA: 8%, CMS: 25%, RAF: 0%). The following three cross-case themes emerged from the interviews: \"Guideline Availability and Necessity\" showed that guidelines were seldom used and that guidelines could be beneficial; \"Purpose of a Lower Limb Prosthetic Guideline\" indicated that guidelines can support accessible, equitable, ethical, and transparent services; and \"Guideline Development Requirements\" explained that an evidence based collaborative process, facilitated by an independent body should underscore guideline development.</p><p><strong>Conclusion: </strong>Evidence based, standardized, transparent guidelines will be beneficial to direct prosthetic service delivery in the South African private healthcare sector. The guidelines must be applicable, rigorously developed, and show editorial independence.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"7 2","pages":"44450"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and evaluation of an anteriorly mounted microprocessor-controlled powered hip joint prosthesis.","authors":"K Brannen, N Baddour, L Cho, D Langlois, P Dumond, E D Lemaire","doi":"10.33137/cpoj.v7i2.44494","DOIUrl":"10.33137/cpoj.v7i2.44494","url":null,"abstract":"<p><strong>Background: </strong>Prosthetic solutions for individuals with hip disarticulation and hemipelvectomy amputations currently rely exclusively on passive hip joint mechanisms. Although powered knee and ankle joint prostheses have improved gait in people with amputation, no powered hip joint options are commercially available.</p><p><strong>Objective: </strong>To develop and validate the mechanism, structural integrity, and design of an anteriorly mounted powered hip joint prosthesis.</p><p><strong>Methodology: </strong>A microprocessor-controlled powered hip joint prosthesis (PHP) was developed, incorporating a cable-and-pulley transmission system. Stress calculations and Finite Element Analysis (FEA) were performed to ensure that the device can withstand the forces from daily activities. The prototype underwent mechanical strength testing in accordance with International Organization for Standardization (ISO) 15032:2000 standards, ensuring suitability for user loads of up to 100 kg. For functional testing, three able-bodied individuals were video recorded while walking with the power hip in a prosthesis simulator. For each participant, hip angles and stride parameters during level walking were assessed by analyzing five gait cycles.</p><p><strong>Findings: </strong>The novel PHP met most of the design criteria; however, it protruded 56 mm anteriorly from the lamination plate, exceeding the specified criterion of 20 mm. The joint's range of motion included 22° of extension and 145° of flexion. The joint prototype's height was 347 mm, and it weighed 3.9 kg. Furthermore, it passed ISO 15032:2000 strength tests, withstanding a 3360 Newton (N) load without failure. The device successfully enabled able-bodied individuals to walk using a hip disarticulation simulator and supported a 98 kg user during level walking.</p><p><strong>Conclusion: </strong>The microprocessor-controlled PHP exhibited successful performance in both mechanical strength and functional testing. Future work is needed to optimize and assess the design, which could reduce the device's weight and size. A complex control system to adjust gait based on pelvic motion is currently under development.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"7 2","pages":"44494"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}