Surgical Techniques of, and Outcomes after, Distal Muscle Stabilization in Transfemoral Amputation: A Systematic Review and Narrative Synthesis.

BACKGROUND: Distal muscle stabilization, such as myodesis (suturing muscles to bone) or myoplasty (suturing agonistic-antagonistic muscles together), can aid residual limb stabilization, provide a good soft-tissue covering, and increase rehabilitation potential. However, surgical practice varies due to scant clinical data. The aim of this review is to summarize and evaluate the literature regarding techniques and associated outcomes of distal muscle stabilization in transfemoral amputation (TFA). METHODS: A systematic review and narrative synthesis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Resources, including observational studies, nonobservational scientific papers, conference proceedings, and textbooks, detailing techniques of TFA distal muscle stabilization were identified from standard medical repositories and library search. A supplementary search of YouTube and Google was undertaken to identify additional resources. Quality assessment was undertaken using Risk Of Bias In Nonrandomized Studies-of Interventions; Authority, Accuracy, Coverage, Objectivity, Date, Significance; and modified-Discern tools. RESULTS: Forty seven resources were identified, including 17 journal articles, 17 textbooks, 5 educational websites/eBooks, 5 videos, 2 online presentations, and 1 webpage. Thirty seven described myodesis, 11 described myoplasty, and 6 described closure without distal muscle stabilization. Eight observational studies presented outcome data for 302 TFAs. No studies comparing closure with or without distal muscle stabilization were identified. All papers describing myodesis secured the adductors to the femur, and most also secured the quadriceps and/or hamstrings to this complex. Number of femoral drill holes varied from 1 to 6. Early wound complications occurred in 17% of amputations, whereas myodesis failure occurred in 9.5%. Prosthetic fitting rates were 73% and, where reported, 100% of patients maintained neutral femoral alignment. CONCLUSIONS: Distal muscle stabilization, particularly myodesis, is a commonly described technique for TFA, although operative techniques are heterogenous. There is a paucity of outcome data, and no studies comparing it to closures without distal muscle stabilization. However, these low-quality data suggest wound healing rates are equivalent to TFA without distal muscle stabilization while demonstrating improvement to patients' rehabilitation potential.

Perceptions, Experiences, Barriers and Facilitators Regarding Nutritional Intake of Patients with Chronic Limb Threatening Ischemia: A Qualitative Study.

BACKGROUND: Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake. METHODS: In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed. RESULTS: Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning, and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake. CONCLUSIONS: Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health-related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.

The association between body mass index and skin problems in persons with a lower limb amputation: an observational study.

BACKGROUND: Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. METHODS: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects' body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. RESULTS: In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). CONCLUSIONS: Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.

Motor development in children 0-2 years pre- and post-LTX, a prospective study.

To determine prospectively gross and fine motor development of children <2 years of age, who undergo LTX. In this prospective study, children aged <2 years who undergo LTX were tested using the motor scale of the Bayley Scales of infant and toddler development, 3rd edition Dutch version. Testing was done during screening pre- and post-LTX: at the time of hospital discharge (2-6 weeks), at 3 months, 6 months, and 1 year. Z-scores were calculated. Twenty-nine children participated in this study, 14 boys, median age 6 months, at screening for LTX. Gross motor skills were delayed pre-LTX (Z-score -1.3). Fine motor skills were normal (Z-score 0.3). Immediately post-LTX, both skills reduced, and at 1 year post-LTX, gross motor skills Z-score was -1.0 and fine motor skills Z-score 0.0. Both gross and fine motor skills Z-scores decline post-LTX and tend to recover after 1 year, gross motor skills to low normal and fine motor skills to normal levels. Monitoring of gross motor development and attention on stimulating gross motor development post-LTX remains important, to enable participation in physical activity and sport for health benefits later in life.

Mortality, Reamputation, and Preoperative Comorbidities in Patients Undergoing Dysvascular Lower Limb Amputation.

BACKGROUND: Historically, mortality rates after major lower limb amputations (LLAs) have been very high. However, there are inconsistencies regarding the risk factors. The reamputation rate after major LLAs is largely unknown. The aim of this study is to report the 30-day and 1-year mortality and 1-year reamputation rates after major LLA and to identify potential risk factors. METHODS: An observational cohort study in which all patients undergoing dysvascular major LLA in 2012-2013 in 12 hospitals in the northern region of the Netherlands is included. RESULTS: Of total 382 patients, who underwent major LLA, 65% were male and the mean age (standard deviation [SD]) was 71.9 ± 12.5 years. Peripheral arterial disease was observed in 88% and diabetes mellitus (DM), in 56% of patients. No revascularization or prior LLA on the amputated side was observed among 26%, whereas 56% had no minor or major LLA on either limb before the study period. The 30-day and 1-year mortality rates were 14% and 34%, respectively. Patients aged 75-84 and >85 years had 3-4 times higher odds of dying within 1 year. Transfemoral amputations (odds ratio [OR], 2.2), history of heart failure (OR, 2.3), myocardial infarction (OR, 1.7), hemodialysis (OR, 5.7), immunosuppressive medication (OR, 2.8), and guillotine amputations (OR, 5.1) were independently associated with 1-year mortality. Twenty-six percent underwent ipsilateral reamputation within 1 year, for which no risk factors were identified. CONCLUSIONS: The mortality rate in the first year after major LLA is high, particularly among those undergoing transfemoral amputations, which is likely to be indicative of more severe vascular disease. Higher mortality among the most elderly patients, those with more severe cardiac disease and who underwent hemodialysis reflects the frailty of this population. Interestingly, DM, revascularization history, and prior minor or major LLA were not associated with mortality rates.

Physical activity and aerobic fitness in children after liver transplantation.

To determine physical activity (PA), aerobic fitness, muscle strength, health-related quality of life (HRQOL), fatigue, and participation in children after liver transplantation. Children, 6-12 years, at least one year after liver transplantation, participated in this cross-sectional study. Measurements: Time spent in moderate to vigorous PA (MVPA) was measured using an accelerometer, and aerobic fitness (VO2 peak ) was measured by cardiopulmonary exercise testing. Muscle strength was measured by hand-held dynamometry. Fatigue was measured using the multidimensional fatigue scale, and HRQOL with the Pediatric Quality of life Core scales and leisure activities was measured using the Children's Assessment of Participation and Enjoyment. Outcomes (medians and interquartile range (IQR)) were compared to norm values. Twenty-six children participated in this study (14 boys, age 9.7 years, IQR 7.7;11.4). Children spent 0.8 hours/d (IQR 0.6;1.1) on MVPA. One child met the recommendation of at least 1 hour of MVPA every day of the week. Aerobic fitness was similar to norms (VO2 peak 1.4 L/min , IQR 1.1;1.7, Z-score -0.3). Z-scores of muscle strength ranged between -1.4 and -0.4 and HRQOL and fatigue between -2.3 and -0.4. Participation was similar to published norms (Z-scores between -0.6 and 0.6). Young children after liver transplantation have similar MVPA patterns and aerobic fitness compared to published norms. Despite lower HRQOL, more fatigue, and less muscle strength, these children have similar participation in daily activities. Although children do well, it remains important to stimulate PA in children after liver transplantation in the context of long-term management.

Responsiveness of the anterior cruciate ligament - Return to Sports after Injury (ACL-RSI) and Injury - Psychological Readiness to Return to Sport (I-PRRS) scales.

The ACL-Return to Sport after Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS) scales were developed to assess psychological factors associated with return to sports. Validity and reliability have been determined. The aim of this study was to investigate the responsiveness of the Dutch ACL-RSI and I-PRRS. Seventy patients with ACL reconstruction completed both scales twice 2 months apart, plus a Global Rating of Change (GRC) questionnaire. Distribution and logistic regression-based methods were used to study responsiveness. The Standardized Response Mean (SRM) for the ACL-RSI was 0.3 and for the I-PRRS 0.1, indicating low responsiveness. The minimally important change (MIC) for ACL-RSI was 2.6 and for the I-PRRS 0.9. Since the standard error of measurement (SEM) and smallest detectable change (SDC) were larger than MIC in individual patients, it does not seem possible to distinguish minimally important changes from measurement error in individual patients with either scale. At the group level responsiveness seemed sufficient; hence, both scales can be used to investigate the effectiveness of an intervention at the group level. Both scales can also be used in cross-sectional research and in clinical practice as screening instruments to identify patients at risk of not returning to sports.

Translation, cross-cultural adaptation, validity, reliability and stability of the Dutch Injury - Psychological Readiness to Return to Sport (I-PRRS-NL) scale.

The Injury Psychological Readiness to Return to Sport (I-PRRS) scale measures the psychological readiness of injured athletes to resume sports participation. The aim of this study was to translate and culturally adapt the I-PRRS scale into Dutch (I-PRRS-NL) and assess its validity, reliability, and stability in patients after anterior cruciate ligament reconstruction (ACLR). The original I-PRRS was translated and culturally adapted from English into Dutch, and tested for clinimetric quality. To assess concurrent validity, 150 patients completed the I-PRRS-NL scale and five questionnaires measuring related constructs 3-16 months after ACLR. All predefined hypotheses regarding correlations between the I-PRRS-NL scale and these questionnaires were confirmed, indicating good concurrent validity. For test-retest reliability, 107 patients completed the I-PRRS-NL scale again two weeks later. The I-PRRS-NL scale showed good internal consistency (Cronbach's alpha 0.94) and test-retest reliability (ICC 0.89). Standard error of measurement was 4.2 and smallest detectable change was 11.6. No systematic bias between test and retest was found. As the scale appears unstable at item level, only the total score should be used. Overall, the I-PRRS-NL scale showed sufficient validity and reliability to assess the psychological readiness to resume sports among Dutch-speaking patients after ACLR.

Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment: Local control and survival.

BACKGROUND: Despite multimodality limb salvage treatment (LST) for locally advanced extremity soft tissue sarcoma (ESTS), some patients still need an amputation. Indications for amputation and oncological outcome for these patients are described. METHODS: Between 1996 and 2016, all patients who underwent an amputation for ESTS were included. Patients who underwent an amputation as primary or as non-primary treatment formed Group I and II, respectively. RESULTS: Thirty-nine patients were included, 16 in Group I (41%) and 23 in Group II (59%). Tumor size or local recurrence which could not be treated with LST were the two main reasons for amputation. Local recurrence free survival (LRFS) (P = 0.396), distant metastases free survival (DMFS) (P = 0.965), disease-specific survival (DSS) (P = 0.745), and overall survival (OS) (P = 0.718) were comparable for both groups. Ten-year LRFS was 90.0% versus 83.7%; DMFS was 31.0% versus 42.2%; DSS was 52.2% versus 44.1%; and OS was 44.2% versus 41.6%, for group I and II respectively. CONCLUSIONS: Oncological outcome seems to be comparable between patients who underwent a primary or a non-primary amputation for ESTS. With the on-going possibilities concerning prosthesis and rehabilitation programs, it remains important to decide in a multidisciplinary sarcoma team meeting which treatment suits best for each individual patient.

Coping Flexibility as Predictor of Distress in Persons With Spinal Cord Injury.

OBJECTIVES: Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress 1 year after discharge. DESIGN: Longitudinal inception cohort study. SETTING: Rehabilitation center. PARTICIPANTS: Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. n=150 (80%) agreed to participate; the data of participants (N=113) with a complete dataset were used in the statistical analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Coping flexibility was operationalized by (1) flexible goal adjustment (FGA) to given situational forces and constraints and (2) tenacious goal pursuit (TGP) as a way of actively adjusting circumstances to personal preference. The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale was used to assess distress. RESULTS: Scores on FGA and TGP measured at admission were negatively associated with the scales depression (r= -.33 and -.41, respectively) and anxiety (r= -.23 and -.30, respectively) 1 year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of depression and anxiety. FGA, TGP, and the interaction term together explained a significant additional 16% of the variance of depression and 10% of anxiety. CONCLUSIONS: The tendency to pursue goals early postonset of the injury seems to have a protecting effect against distress 1 year after discharge. People with low TGP may experience protection against distress from high FGA.

Bicycling participation in people with a lower limb amputation: a scoping review.

BACKGROUND: To review literature on bicycling participation, as well as facilitators and barriers for bicycling in people with a lower limb amputation (LLA). METHODS: Peer-reviewed, primary, full text, studies about bicycling in people with a LLA from midfoot level to hemipelvectomy were searched in Pubmed, Embase, Cinahl, Cochrane library, and Sportdiscus. No language or publication date restrictions were applied. Included full-text studies were assessed for methodological quality using the Effective Public Health Practice Project tool. Data were extracted, synthesized and reported following Preferred Reporting Items for Systematic Review. RESULTS: In total, 3144 papers were identified and 14 studies were included. The methodological quality of 13 studies was weak and 1 was moderate. Bicycling participation ranged from 4 to 48%. A shorter time span after LLA and a distal amputation were associated with a higher bicycling participation rate particularly for transportation. In people with a transtibial amputation, a correct prosthetic foot or crank length can reduce pedalling asymmetry during high-intensity bicycling. People with limitations in knee range of motion or skin abrasion can use a hinged crank arm or a low profile prosthetic socket respectively. CONCLUSION: People with a LLA bicycled for transportation, recreation, sport and physical activity. Adaptation of prosthetic socket, pylon and foot as well as bicycle crank can affect pedalling work and force, range of motion, and aerodynamic drag. Because the suggestions from this review were drawn from evidences mostly associated to competition, prosthetists should carefully adapt the existing knowledge to clients who are recreational bicyclists.

Dosage of pain rehabilitation programs: a qualitative study from patient and professionals' perspectives.

BACKGROUND: There is a large and unexplained practice variation in prescribed dosages of pain rehabilitation programs (PRP), and evidence regarding the optimum dosage is unknown. METHODS: To explore perspectives of patients and rehabilitation professionals regarding dosages of PRP an explorative qualitative research design was performed with thematic analysis. Patients and rehabilitation professionals were recruited from three rehabilitaton centers in the Netherlands. A purposive sample of patients who completed a PRP, with a range of personal and clinical characteristics was included. Rehabilitation professionals from all different disciplines, working within multidisciplinary PRP for a minimum of two years, for at least 0.5 fte were included. Individual semi-structured interviews were conducted with 12 patients undergoing PRP, and three focus groups were formed with a total of 17 rehabilitation professionals involved in PRP. RESULTS: All patients were satisfied with received dosage. Factors important in relation to dosage of PRP were categorized into patient related characteristics (case complexity from a biopsychosocial perspective) to treatment related characteristics (logistics and format of the program, interaction between patients and professionals), and external factors (support from others, costs, traveling distance and injury compensation). Professionals concluded that dosage was currently based on historical grounds and clinical expertise. CONCLUSION: Patients and professionals from different centers considered the same factors related to dosage of PRP, but these considerations (from patients and professionals) led to different dose choices between centers. PRP dosage appeared to be mainly based on historical grounds and clinical expertise. The insights of this study could assist in future research regarding optimum dosage of PRP and rehabilitation programs in general.

Changes in the Content of Pediatric Physical Therapy for Infants: A Quantitative, Observational Study.

AIMS: The aim of our observational longitudinal study is to evaluate changes over time in standard pediatric physical therapy (PPT) for infants at risk of neurodevelopmental disorders. METHODS: Treatment sessions in two time periods (2003-2005 [n = 22] and 2008-2014 [n = 16]) were video recorded and analyzed quantitatively in five categories: neuromotor actions, educational actions, communication, position, and situation of treatment session. Differences in percentages of time spent on therapeutic actions between periods were tested with Mann-Whitney U and Hodges Lehmann's tests. RESULTS: No significant changes appeared in the main categories of neuromotor actions. Time spent on not-specified educational actions toward caregivers (median from 99% to 81%, p = .042) and not-specified communication (median from 72% to 52%, p = .002) decreased. Consequently, time spent on specific educational actions (caregiver training and coaching; median from 1% to 19%, p = .042) and specific communication (information exchange, instruct, provide feedback; median from 21% to 38%, p = .007) increased. Infant position changed only minimally: time spent on transitions-that is, change of position-decreased slightly over time (median from 7% to 6%, p = .042). Situation of treatment session did not change significantly over time. CONCLUSIONS: Neuromotor actions in PPT remained largely stable over time. Specific educational actions and communication increased, indicating larger family involvement during treatment sessions.

Quality of life in rehabilitation outpatients: normal values and a comparison with the general Dutch population and psychiatric patients.

PURPOSE: To provide Dutch normal values for rehabilitation outpatients with chronic pain or musculoskeletal diseases utilizing the World Health Organization Quality of Life questionnaire abbreviated version (WHOQOL-BREF) and analyse influence of diagnosis and patient characteristics on normal values and increase understanding in those values. METHODS: Five hundred and forty-two outpatients were referred to a rehabilitation psychologist. Referral diagnoses were "musculoskeletal", "chronic pain", "neurological" and "miscellaneous". Comparisons between groups were made for each of the four domains of the WHOQOL-BREF (scoring range 4-20). RESULTS: Domain scores of rehabilitation outpatients were physical domain 11.0 (±2.7), psychological domain 13.6 (±2.4), social domain 14.8 (±3.4) and environmental domain 14.2 (±2.2). Outpatients with chronic pain reported the lowest scores on the WHOQOL-BREF when compared to the "musculoskeletal", "neurological" and "miscellaneous" groups. Increased age, lower education, living alone and unemployment had a negative impact on WHOQOL-BREF scores. Compared to the general Dutch population, rehabilitation outpatients scored, unadjusted for age, significantly lower difference for the physical domain 4.5 [95% confidence interval (CI) 4.2; 4.8], the environment domain 1.7 (95% CI 1.5; 2.0), the psychological domain 1.1 (95% CI 0.4; 1.2) and the social domain 0.4 (95% CI 0.0; 0.8). CONCLUSIONS: WHOQOL-BREF scores of rehabilitation outpatients are lower and differed significantly from normal values of a Dutch population in all four domains. Therefore, the WHOQOL-BREF can be used to measure the subjective impact of their disease or injury. The subjective impact of chronic pain was found to be particularly high.

Sports participation of individuals with major upper limb deficiency.

BACKGROUND: The aim of this study was to analyse sports participation of individuals with upper limb deficiency (ULD) and associated factors. METHODS: Individuals with ULD originating from the Netherlands were invited, via their attending physiatrist or prosthetist, to answer a digital or paper questionnaire. The questionnaire consisted of 34 items related to personal characteristics, type of deficiency and participation in sports. RESULTS: Of the 175 respondents, 57% participated in sports for at least 60 min/week (athletes). Results of logistic regression analyses indicated that the presence of an additional health problem hindering sports participation (ß=-1.31, p<0.001) and a more proximal onset of the limb deficiency (ß=0.76, p=0.022) had a negative influence on sports participation. For individuals with an acquired ULD, a medium education level (ß=0 0.77, p=0.108) and participation in sports before their amputation (ß=1.11, p=0.007) had a positive influence on sports participation. The desire to stay healthy and the pleasure derived from sports participation represented the main reasons for participation in sports according to athletes. The presence of an additional medical problem and a lack of motivation were reasons for non-athletes to not participate in sports. CONCLUSIONS: The majority of individuals with ULD participate in sports regularly. The presence of an additional medical problem, as well as the level of ULD, educational level and participation in sports before amputation, was related to participation in sports.

Does language ambiguity in clinical practice justify the introduction of standard terminology? An integrative review.

AIMS AND OBJECTIVES: To research the use of ambiguous language in written information concerning patients' functioning and to identify problems resulting from the use of ambiguous language in clinical practice. BACKGROUND: Many projects that aimed to introduce standard terminology concerning patients' functioning in clinical practice are unsuccessful because standard terminology is rarely used in clinical practice. These projects mainly aim to improve communication by reducing ambiguous language. Considering their lack of success, the validity of the argument that language ambiguity is used in clinical practice is questioned. DESIGN: An integrative literature review. METHODS: A systematic search of the MEDLINE (1950-2012) and CINAHL (1982-2012) databases was undertaken, including empirical and theoretical literature. The selected studies were critically appraised using a data assessment and extraction form. RESULTS: Seventeen of 767 papers were included in the review and synthesis. The use of ambiguous language in written information concerning patients' functioning was demonstrated. Problems resulting from the use of ambiguous language in clinical practice were not identified. However, several potential problems were suggested, including hindered clinical decision-making and limited research opportunities. CONCLUSION: The results of this review demonstrated the use of ambiguous language concerning patients' functioning, but health professionals in clinical practice did not experience this issue as a problem. This finding might explain why many projects aimed at introducing standard terminology concerning functioning in clinical practice to solve problems caused by ambiguous language are often unsuccessful. Language ambiguity alone is not a valid argument to justify the introduction of standard terminology. RELEVANCE TO CLINICAL PRACTICE: The introduction of standard terminology concerning patients' functioning will only be successful when clinical practice requires the aggregation and reuse of data from electronic patient records for different purposes, including multidisciplinary decision-making and research.

Do analgesics improve functioning in patients with chronic low back pain? An explorative triple-blinded RCT.

PURPOSE: TREATMENT of patients with chronic low back pain (CLBP) aims to reduce disability, improve functional capacity, and participation. Time contingent prescription of analgesics is a treatment modality in CLBP. The impact of analgesics on functional capacity is unknown. Aim of the study was to explore the effect of analgesics on functioning measured by functional capacity evaluation, and self-reported disability in patients with CLBP. METHODS: Explorative Randomized Placebo-Controlled Clinical Trial was performed in an outpatient pain rehabilitation setting on patients waiting for rehabilitation. Included patients had low back pain lasting >3 months, visual analogue scale worst pain ≥4.0 cm, and age >18 years. Outcome measures before (T0) and after treatment (T1): functional capacity, pain intensity, Roland Morris Disability Questionnaire. T1: global perceived pain relief. Patient characteristics and psychological questionnaires were assessed. Fifty patients were included in this study and were randomly assigned to 2 weeks treatment or placebo. TREATMENT: acetaminophen/tramadol 325 mg/37.5 mg per capsule. Dose: maximum acetaminophen 1,950 mg and tramadol 225 mg per day; treatment and placebo titrated identically. Compliance and side-effects were monitored. TREATMENT effects between groups over time were compared. RESULTS: One patient (treatment group) was lost to follow-up. Forty-nine patients remained in the study. TREATMENT effects in primary outcomes did not differ significantly between groups. A subgroup of 10 (42%) patients (treatment group) reported global pain relief (responders) who reduced self-reported disability (p < 0.05). Responders had significantly lower catastrophizing scores. CONCLUSION: Overall treatment effects were small and non-significant. A subgroup, however, reported improved functioning as a result of treatment. Responders had lower catastrophizing scores.

Barriers to and facilitators of sports participation in people with visual impairments.

We examined barriers to and facilitators of sports participation in people with visual impairments. Participants registered at Royal Visio, Bartiméus, and the Eye Association were invited to complete a questionnaire (telephone or online). Six hundred forty-eight of the invited participants (13%) completed the questionnaire, and 63% of the respondents reported sports participation. Walking (43%), fitness (34%), and cycling (34%) were frequently mentioned sports. Costs, lack of peers/buddies, and visual impairment were negatively associated with sports participation, whereas higher education and computer (software) use were positively associated. The most important personal barrier was visual impairment; transport was the most important environmental barrier. Active participants also mentioned dependence on others as a personal barrier. The most important personal facilitators were health, fun, and social contacts; support from family was the most important environmental facilitator. To improve sports participation in people with visual impairments, the emphasis in a sports program should be on the positive aspects of sports, such as fun, health, and social contacts.

Cardiorespiratory fitness in persons with lower limb amputation.

The aim of this study is to gain insight in the cardiorespiratory fitness of persons with lower limb amputation (LLA) during rehabilitation, and in potential factors influencing their cardiorespiratory fitness. We performed a retrospective cohort study using data from cardiopulmonary exercise tests. Included participants were adults with LLA. Main outcome was cardiorespiratory fitness expressed as O 2 peak (ml/min/kg) and was directly determined using breath-by-breath gas analysis. O 2 peak was compared to reference values for able-bodied controls. Multivariate regression analysis was performed to investigate potential factors related to O 2 peak in persons with LLA. Potential factors were age, BMI adjusted, gender, level of amputation, aetiology of amputation, unilateral/bilateral, type of ergometry and use of beta blockers. Data of 74 participants with LLA are presented; 84% male (n = 62), mean age 58.9 (SD 11.6), mean BMI 26.7 (SD 5.6), 44 participants have a LLA above the knee, 30 below the knee. Overall O 2 peak was lower in persons with LLA compared to reference values for able-bodied controls, with mean O 2 peak for the total LLA group of 14.6 ±â€…4.1 ml/kg/min. In the multivariate regression analysis, only age was a significant predictor for lower O 2 peak (regression coefficient: -0.15, 95% CI [0.23-0.069], r 2  = 0.166). These results indicate that the cardiorespiratory fitness in persons with LLA is low, while they actually need more energy to walk and perform other daily activities. Cardiorespiratory fitness is not closely associated with the analysed demographic or clinical factors and will have to be determined on an individual basis for use in daily practice.

A scoping review on nutritional intake and nutritional status in people with a major dysvascular lower limb amputation.

PURPOSE: To systematically review literature on nutritional intake, nutritional status and nutritional interventions, and to study their association with short- and long-term clinical outcomes in people with a major dysvascular lower limb amputation. METHODS: PubMed, Ovid, CINAHL, and The Cochrane Library were searched. Studies were included if nutritional intake, nutritional status, or nutritional interventions in people with a major dysvascular lower limb amputation were analyzed. RESULTS: Of the 3038 unique papers identified, 30 studies were included. Methodological quality was moderate (1 study) or weak (29 studies). Limited information was available on nutritional intake (2 studies) and nutritional interventions (1 study). Nutritional intake and nutritional status were assessed by diverse methods. The percentage of people with a poor nutritional status ranged from 1% to 100%. In some studies, measures of poor nutritional status were associated with adverse short- and long-term clinical outcomes. CONCLUSIONS: The percentage of people with a poor nutritional status is inconclusive in the major dysvascular lower limb amputation population, because of the heterogeneity of the assessment methods used. Some included studies reported a negative association between poor nutritional status and clinical outcomes. However, these results should be interpreted with caution, because of the limited quality of the studies available. Studies high in methodological quality and high in hierarchy of evidence are needed.IMPLICATIONS FOR REHABILITATIONThe proportion of people with a poor nutritional status in the major dysvascular lower limb amputation population is inconclusive.Poor nutritional status seems to affect clinical outcomes negatively.More uniformity in assessment of malnutrition in the major dysvascular lower limb amputation population is needed.