Abstract
Objective
To retrospectively investigate trunk-pelvis kinematic outcomes among persons with
unilateral transtibial and transfemoral limb loss with time from initial independent
ambulation with a prosthesis, while secondarily describing self-reported presence
and intensity of low back pain. Over time, increasing trunk-pelvis range of motion
and decreasing trunk-pelvis coordination with increasing presence and/or intensity
of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion
and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized.
Design
Inception cohort with up to 5 repeated evaluations, including both biomechanical and
subjective outcomes, during a 1-year period (0, 2, 4, 6, 12 months) after initial
ambulation with a prosthesis.
Setting
Biomechanics laboratory within military treatment facility.
Participants
Twenty-two men with unilateral transtibial limb loss and 10 men with unilateral transfemoral
limb loss (N=32).
Interventions
Not applicable.
Main Outcome Measures
Triplanar trunk-pelvis range of motion and intersegmental coordination (continuous
relative phase) obtained at self-selected (∼1.30m/s) and controlled (∼1.20m/s) walking
velocities. Self-reported presence and intensity of low back pain.
Results
An interaction effect between time and group existed for sagittal (P=.039) and transverse (P=.009) continuous relative phase at self-selected walking velocity and transverse
trunk range of motion (P=.013) and sagittal continuous relative phase (P=.005) at controlled walking velocity. Trunk range of motion generally decreased,
and trunk-pelvis coordination generally increased with increasing time after initial
ambulation. Sagittal trunk and pelvis range of motion were always less and frontal
trunk-pelvis coordination was always greater for persons with more distal limb loss.
Low back pain increased for persons with transtibial limb loss and decreased for persons
with transfemoral limb loss following the 4-month time point.
Conclusions
Temporal changes (or lack thereof) in features of trunk-pelvis motions within the
first year of ambulation help elucidate relationships between (biomechanical) risk
factors for low back pain after limb loss.
Keywords
List of abbreviations:
CRP (continuous relative phase), LBP (low back pain), ROM (range of motion), SSWV (self-selected walking velocity), TF (transfemoral), TT (transtibial), WV (walking velocity)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 19, 2019
Footnotes
Supported in part by the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer Reviewed Orthopaedic Research Program (award no. W81XWH-14-2-0144) as well as the Military Amputee Research Program. The views expressed in this article are those of the authors and do not necessarily reflect the official policies of the Departments of the Army, Navy, or Defense, or the United States government. The identification of specific products or instrumentation is considered an integral part of the scientific endeavor and does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
