5 March 2005

Ossur Scientific E-letter #3

The first issue of the Empower Scientific E-letter of 2005 includes four different scientific papers within O&P. All the selected papers have been published in 2004 and 2003 cover everything from Insoles to How to score Prosthetic Fit.

The paper by Bussmann et al. deals with an instrument to assess over the long-term the duration and spatio–temporal characteristics of walking of amputees, during normal daily life. The instrument, Patient Activity Monitor (PAM) has been evaluated according to validity.

Tsung et al. present results of the effectiveness of different design insoles for redistributing pressure during walking for diabetic patients and for normal control subjects. They found that insoles could significantly reduce local peak pressure and pressure-time integral and increase the contact area.

Van der Linde and co-workers made a review of how prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user.

A possibility to score prosthetic socket fit has been described and validated by Hanspal and co-workers. They conclude that the score has clinical utility and they also recommend wider use of the score. Hope you enjoy the reading!

Best regards, Magnus Lilja

Prosthesis (Lower Limb)

Validity of the Prosthetic Activity Monitor to Assess the Duration and Spatio–Temporal Characteristics of Prosthetic Walking

Johannes B. J. Bussmann, Karen M. Culhane, Herwin L. D. Horemans, Gerard M. Lyons, and Henk J. Stam

IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 12, NO. 4, DECEMBER 2004

The prosthetic activity monitor (PAM) is an instrument to assess over the long-term the duration and spatio–temporal characteristics of walking of amputees, during normal daily life. In this study, the validity of PAM-derived measurements was investigated. Twelve transtibial amputees performed an activity protocol, consisting of stationary and walking activities, and activities associated with nonlocomotor movements. The protocol also included potential sources of error and activities assumed to be prone to misdetection. Measurements consisted of the PAMand video recordings. Agreement between video analysis and PAM output was the main outcome measure. The PAM generally correctly classified stationary activities (100% inactive, 0% active, 0% locomotion), nonlocomotor activities (45% inactive, 55% active, 0% locomotion) and walking activities (0% inactive, 1.8% active, 98.2% locomotion). When walking, the number of strides taken was slightly underestimated ( 1.0%). The underestimation of distance travelled ( 6.2%) and walking speed ( 5.8%) was greater. The agreement with video output decreased when the PAM was misaligned, when persons walked at a speed below the defined minimum speed, and when persons walked with crutches. The PAM provides valid data on activity classes and number of strides. Although the majority of the distance data was satisfactory, in some cases considerable differences were found between the PAM and the video data. The impact of alignment, walking speed, and use of assistive devices on the PAM’s operation should be considered.

A systematic literature review of the effect of different prosthetic components on human functioning with a lower-limb prosthesis

Harmen van der Linde, MD, PhD; Cheriel J. Hofstad, MsC; Alexander C. H. Geurts, MD, PhD; Klaas Postema, MD, PhD; Jan H. B. Geertzen, MD, PhD; Jacques van Limbeek, MD, PhD

Journal of Rehabilitation Research & Development Volume 41 Number 4, July/August 2004 Pages 555—570.

A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic components. No clear clinical consensus seems to be given on the precise prescription criteria. To obtain information about different prosthetic components and daily functioning of amputees with a prosthesis, we performed a systematic literature search. The quality of the studies was assessed with the use of predetermined methodological criteria. Out of 356 potentially relevant studies, 40 studies eventually qualified for final methodological analysis and review. Four satisfied all the criteria and were classified as A-level studies, 26 as B-level, and 10 studies as C-level studies. Despite a huge amount of literature, our formal clinical knowledge had considerable gaps concerning the effects of different prosthetic components and their mechanical characteristics on human functioning with a lower-limb prosthesis. Therefore, with regard to prosthetic guideline development, we must still largely rely on clinical consensus among experts. The integration of knowledge from research with the expert opinion of clinical professionals and the opinions and wishes of consumers can form a solid base for a procedure on guideline development for prosthetic prescription.

Prosthetic socket fit comfort score

Hanspal RS, Fisher K, Nieveen R.

Disabil Rehabil. 2003 Nov 18;25(22):1278-80.

PURPOSE: To validate a simple numerical scale to record the socket comfort of an artificial limb. METHOD: This study has adapted the numerical rating scale for pain (Downie et al.(1)) to form a 11 point scale to record the socket comfort score (SCS). Patients were asked to rate the comfort of their socket on a 0 - 10 scale where 0 and 10 represented the most uncomfortable and the most comfortable socket imaginable. Ratings of clinical evidence of poor fit were recorded independently by the physician and the prosthetist. Patients gave new numerical ratings of comfort after any necessary intervention to the socket. Repeatability, criterion related validity, sensitivity to change and use in clinical practice was studied on 44 consecutive patients in the prosthetic rehabilitation clinic. RESULTS: The study showed the reported SCS was consistent and reliable, high correlations being found between three scores obtained from patients by independent recorders. A strong relationship existed between the reported SCS and clinical evidence of poor fit judged by the physician and by the prosthetists' ratings. Significant positive changes in SCS were found after intervention to improve the fit. CONCLUSION: SCS has shown repeatability, criterion related validity and sensitivity to change. It has clinical utility and wider use is recommended.

Quality Management

Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative

Swinehart, Kerry ; Green, Ronald F

Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.

Journal: International Journal of Health Care Quality Assurance Issn: 09526862 Year: 1995 Volume: 8 Issue: 1 Pages: 23-27 Publisher: Emerald (MCB) Provider: Catchword Key words: Continuous Improvement ; Health Care ; Strategic Planning ; Tqm ; Usa

Total quality management as a health care corporate strategy

Johnson, James A ; Omachonu, Vincent K

Total quality management (TQM) must become a part of corporate strategy if it is to become a way of life in health care. TQM should be understood in the context of a cultural transformation. The greatest challenge for top management is to create an organization in which every employee, department and function is linked inextricably to the organization's mission and vision. One of the key benefits of TQM is the use of teams to work on and achieve organizational objectives. Health care managers must understand motivation in order to carry the workforce with them to attain those objectives.

Journal: International Journal of Health Care Quality Assurance Issn: 09526862 Year: 1995 Volume: 8 Issue: 6 Pages: 23-28 Publisher: Emerald (MCB) Provider: Catchword Key words: Health Care ; Organizational Culture ; Organizational Strategy ; Tqm

Insoles

Effectiveness of insoles on plantar pressure redistribution

Bonnie Yuk San Tsung, MPhil; Ming Zhang, PhD; Arthur Fuk Tat Mak, PhD; Margaret Wan Nar Wong, FRCS

Journal of Rehabilitation Research & Development Volume 41, Number 6A, Pages 767–774 November/December 2004 For this study, we compared the effectiveness of different design insoles for redistributing pressure during walking for diabetic patients and for normal control subjects. Comparisons of dynamic plantar foot pressure patterns were made with different support, including shoe-only, flat insole, and three contoured insoles. We custom-molded the three contoured insoles by casting the plantar surface of the foot under the conditions of non-weight-bearing, semi-weight-bearing, and fullweight-bearing. With the F-Scan in-shoe system, the interfacial pressure distribution during walking with different plantar supports was measured at 50 Hz for 10 s. The use of insoles could significantly reduce local peak pressure and pressure-time integral and increase the contact area. Contoured insoles were significantly better than flat insoles with regard to the insole functions in reducing local peak pressures. The insole with the semi-weight-bearing foot shape can offer the greatest peak pressure reduction compared to other insole designs, especially for patients with peak pressure located at the second to third metatarsal heads.