Physical Disability After Severe Lower-Extremity Injury (original) (raw)
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Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage
The Journal of Bone and Joint Surgery (American), 2008
Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making regarding whether to amputate or perform limb salvage after high-energy trauma to the lower extremity. These scoring systems have been shown to not be good predictors of limb amputation or salvage. This study was performed to evaluate the clinical utility of the five commonly used lower-extremity injury severity scoring systems as predictors of final functional outcome.
A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores
The Journal of Bone and Joint Surgery American Volume, 2001
Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: High-energy trauma to the lower extremity presents challenges with regard to reconstruction and rehabilitation. Failed efforts at limb salvage are associated with increased patient mortality and high hospital costs. Lower-extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The purpose of the present study was to prospectively evaluate the clinical utility of five lower-extremity injury-severity scoring systems. Methods: Five hundred and fifty-six high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity scoring systems for lower-extremity trauma designed to assist in the decision-making process for the care of patients with such injuries. Four hundred and seven limbs remained in the salvage pathway six months after the injury. The sensitivity, specificity, and area under the receiver operating characteristic curve were calculated for the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97) for ischemic and nonischemic limbs. The scores were analyzed in two ways: including and excluding limbs that required immediate amputation. Results: The analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores. The high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential. The converse, however, was not true. The low sensitivity of the indices failed to support the validity of the scores as predictors of amputation. Conclusions: Lower-extremity injury-severity scores at or above the amputation threshold should be cautiously used by a surgeon who must decide the fate of a lower extremity with a high-energy injury.
Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma
Physical Therapy, 2006
Background and Purpose. Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lowerextremity reconstruction. Subjects. Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. Methods. The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. Results. The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. Discussion and Conclusion. The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions. [Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ; LEAP Study Group. Gait symmetry and walking speed analysis following lower-extremity trauma.
Functional Outcomes Following Trauma-Related Lower-Extremity Amputation
The Journal of Bone and Joint Surgery-American Volume, 2004
Background: The principal aims of this study were to examine functional outcomes following trauma-related lowerextremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-theknee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. Methods: A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; selfselected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates. Results: There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-theknee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-theknee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome. Conclusions: Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.
International Journal of Environmental Research and Public Health, 2022
Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient’s condition.
Rehabilitation after lower limb injury: development of a predictive score (RALLI score)
Canadian journal of surgery. Journal canadien de chirurgie, 2015
BACKGROUND The purpose of our study was to identify the risk factors associated with the need for inpatient rehabilitation after lower limb injury to develop a predictive scoring tool for early identification of such patients. METHODS We followed a prospective cohort of patients admitted to a level 1 trauma centre. Data were collected through chart review and a self-administered questionnaire on sociodemographics, patient living environment, pretrauma status, injury and treatment received. We compared patients who were discharged home with those going to rehabilitation after acute care. Analysis consisted of bivariate comparisons and logistic regression. RESULTS Our study included 160 patients with a mean age of 56 years. A total of 40% were discharged to an inpatient rehabilitation centre. Factors associated with inpatient rehabilitation were low preinjury physical health status, concomitant injury of the upper limbs, bilateral lower limb injury, the use of a walking aid before inj...
Efficiency of gait measurement after complex foot trauma
Foot and Ankle Surgery, 1996
Four different gait analysis techniques (three-dimensional kinematic analysis, two force plates, dynamic electromyography (EMG), dynamic analysis of plantar pressure distribution) were employed in a study on 10 normal subjects and 12 patients after treatment of displaced calcaneal fractures. The aim was to evaluate each method for accuracy of measurement of the severity of functional impairment. Analysis of ankle joint kinematics revealed that the loss of motion after trauma at the subtalar joint (range of motion after injury 2.9 _+ 2.0 °, normal subjects 7.5 + 2.6 °) was compensated by an increased inward rotation of the foot. If the foot adduction mechanism did not suffice to prevent lateralization of the resultant force, additional inverting or adducting mechanisms (at the ankle, knee, hip and the pelvic level) could be demonstrated. Generally, three-dimensional joint moments and the shank muscle activity pattern were changed at an insignificant level. Force plate data and the analysis of plantar pressure distribution allowed us to assess gait with an accuracy of 83%. For evaluation of dynamic joint motion at the ankle level or above, classical kinetic-kinematic studies are indispensable but, as the kinetics and kinematics at the examined joint levels are highly complex, they can hardly be used to formulate a simple and reliable measure of gait. As the ground reaction force and the plantar impulse distribution as assessed by dynamic pedography represent the net sum of the effects of both the primary gait disturbance and the existing compensation mechanisms, these methods can easily be used for verification and quantification of gait disturbance with an acceptable cost/effectiveness ratio.
Evaluation of Walking Disorders After Lower Extremity Fractures
SVOA Orthopaedics, 2023
Objective: This study was conducted to evaluate gait disturbances after lower extremity fractures. Method: Socio-demographic and physical characteristics of all individuals participating in the study were recorded. Fracture histories of the cases were examined and recorded. Balance and walking of individuals were evaluated with tinetti balance and gait analysis, gait analysis with "Biodex Gait Trainer" system, and fear of movement with Tampa kinesiophobia scale. Results: The mean age of 21 participants (8 women and 13 men) included in the study was 44.53±8.12 years, and body mass index was calculated as 27.40±3.89 kg/m2. The results of the measurements were analyzed by comparing the three fracture groups. According to the findings, the kinesiophobia of the femur fracture group, the stance phase score and the tinetti balance walking test score of the tarsal fracture group were significantly worse than the other groups. (p<0.05) Conclusion: According to the results of the study, functional scores may vary as a result of fractures in different regions and different bones of the lower extremity.