Skin problems of the stump in lower-limb amputees: 2. Influence on functioning in daily life.

The aim of this study was to analyse the influence of stump skin problems on functioning in daily life in lower-limb amputees. A cross-sectional study was performed by means of a questionnaire containing 9 questions assessing functioning in daily life. Question scores were added to give a total score (range 0 (no influence) to 27 (maximum negative influence)). Two thousand and thirty-nine people were invited to participate, with 805 participants completing a questionnaire. Of these, 507 reported one or more skin problems. Skin problems had a negative influence on ability to perform household tasks, prosthesis use, social functioning, and participation in sports. The mean total score was 5.5 ± 4.1. This correlated significantly with the number of skin complaints (r = 0.483; p = 0.01). In linear regression analyses, gender (ß = -0.15) and number of skin problems (ß = 0.25) accounted for 23% of the total score. This study confirms the influence of skin problems on functioning in daily life.

Skin problems of the stump in lower limb amputees: 1. A clinical study.

Use of a prosthesis in lower limb amputees can lead to skin problems of the amputation stump. However, little is known about the epidemiology and type of problems experienced. We conducted a cross-sectional survey consisting of a questionnaire and a clinical assessment of the amputation stump. The aims of the study were to estimate the prevalence of skin problems of the amputation stump, to evaluate the impact of these skin problems and to evaluate differences between clinically observed skin problems and skin problems reported by the amputee. Participants (n = 124) were recruited from among lower limb amputees who visited an orthopaedic workshop. The prevalence of skin problems was 36%. Problems identified were: reduction in prosthesis use, and reduction in walking distance without a break. Significantly more skin problems were reported than observed (p = 0.011). Cold skin and excessive perspiration in particular were significantly more reported than observed.

Kidney Function in Patients With Neuromuscular Disease: Creatinine Versus Cystatin C.

Background: Accurate measurement of kidney function in patients with neuromuscular disorders is challenging. Cystatin C, a marker not influenced by skeletal muscle degradation, might be of clinical value in these patients. Methods: We consecutively enrolled 39 patients with neuromuscular disorders. We investigated the association of the eGFR, based on plasma creatinine and Cystatin C, with clinical and biochemical variables associated with kidney function, namely age and galectin-3. Results: Creatinine-based eGFR was 242 (±80) and Cystatin C-based eGFR was 110 (±23) mL/min/1.73 m2. Cystatin C-based eGFR was associated with age (ß -0.63 p < 0.0001) and galectin-3 levels (ß -0.43 p < 0.01), while creatinine-based eGFR was not (ß -0.22 p = 0.20; ß -0.28 p = 0.10). Sensitivity analyses in Duchenne and Becker patients revealed the same results: Cystatin C-based eGFR was associated with age (ß -0.61 p < 0.01) and galectin-3 levels (ß -0.43 p = 0.05), while creatinine-based eGFR was not (ß -0.32 p = 0.13; ß -0.34 p = 0.14). Conclusions: These data indicate that estimation of renal function in patients with neuromuscular disorders cannot reliably be achieved with creatinine, while Cystatin C appears a reasonable alternative. Since a large proportion of patients with neuromuscular disorders develops heart failure, and requires heart failure medication, adequate monitoring of renal function is warranted.

Predictors of physical independence at discharge after stroke rehabilitation in a Dutch population.

The aim of this study was to identify predictors, available at admission, of physical independence at discharge from inpatient rehabilitation. Secondary aims were to identify predictors of functional gain and length of stay (LOS). We included 1310 adult stroke patients who were admitted for inpatient rehabilitation in five Dutch rehabilitation centres. Data on the Utrecht Scale for Evaluation of Clinical Rehabilitation at admission and discharge (physical and cognitive independence, mood, pain and fatigue), age, sex and in a subsample stroke characteristics as well were collected. A prediction model was created using random coefficient analysis. None of the stroke characteristics were independently associated with physical independence or functional gain at discharge, or LOS. Higher physical and cognitive independence scores and severe pain at admission were predictors of higher physical independence scores at discharge. Furthermore, lower physical independence scores, higher cognitive independence scores, less pain at admission and younger age predicted more functional gain. Finally, lower physical and cognitive independence scores at admission and younger age predicted longer LOS. Physical independence at admission was the most robust predictor for rehabilitation outcome in a Dutch rehabilitation setting. To a lesser extent, age, cognitive independence and pain predicted rehabilitation outcome after stroke. Treatment of cognition and pain should be taken into account during rehabilitation. Further work needs to be carried out to establish whether focusing on these factors improves outcome after rehabilitation.

Skin problems in lower limb amputees: a systematic review.

PURPOSE: Skin problems of the stump in lower limb amputees are relative common in daily rehabilitation practice, possibly impeding prosthetic use. This impediment may have great impact in daily life. Our objective was to review literature systematically concerning incidence and prevalence of skin disorders of the stump in lower limb amputees. METHOD: A literature search was performed in several medical databases (MEDLINE, CINAHL, EMBASE, RECAL) using database specific search strategies. Reference lists in the identified publications were used as threads for retrieving more publications missed in the searches. Only clinical studies and patient surveys were eligible for further assessment. RESULTS: 545 publications were initially found. After selection, 28 publications were assessed for research methodology. Only one publication fulfilled the selection criteria. The prevalence of skin problems in a series of 45 lower leg amputees of 65 years and older was 16%. CONCLUSIONS: Prevalence and incidence of skin problems of the stump in lower limb amputees are mainly unknown.

Sports participation of Dutch lower limb amputees.

OBJECTIVE: To analyze sports participation of Dutch lower limb amputees and factors influencing sports participation. STUDY DESIGN: A cross-sectional survey was performed. Dutch lower limb amputees (N = 2039) were invited to participate in a postal survey addressing personal and amputation characteristics, physical limitations, sports participation, skin problems, and prosthesis use. Only data concerning personal and amputation characteristics together with the data concerning sports participation were used for this study. RESULTS: Of the 816 questionnaires received, 780 were suitable for statistical analysis. The mean age of the participants was 59.6 years (SD 14.8), 62% were men and 27% of the amputations was due to vascular diseases or diabetes. Only 15% of all respondents participate in sports at least 5 hours a month. Smoking (odds ratio: 0.55), an age older than 60 (odds ratio: 0.97 per year), and a vascular cause of amputation (odds ratio: 0.42) were negatively associated with sports participation. CONCLUSION: Less than 15% of the Dutch lower limb amputees participate in sports at least 5 hours per month. Older age, smoking and a vascular cause of amputation have a negative influence on the sports participation of these individuals.