The Effect of Advanced Age on Prosthetic Rehabilitation Functional Outcomes in People With Lower Limb Amputations: A Retrospective Chart Audit of Inpatient Admissions.

OBJECTIVE: To evaluate the effect of age on functional outcomes at discharge from prosthetic rehabilitation. DESIGN: Retrospective chart audit. SETTING: Rehabilitation hospital. PARTICIPANTS: Individuals ≥50 years with a transtibial level lower limb amputation (LLA) and above admitted to the inpatient prosthetic rehabilitation program from 2012 to 2019 (n=504). A secondary analysis included a subset of matched participants (n=156). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The L-Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence scale. RESULTS: A total of 504 participants (66.7±10.1 years) met the inclusion criteria, 63 participants (84.9±3.7 years) were part of the oldest old group. The sample was stratified into 4 age groups (50-59, 60-69, 70-79, and 80+) for data analysis. The analysis of variances were statistically significant for all outcome measures (P<.001). Post-hoc testing for the L-Test, 2MWT, and 6MWT demonstrated that the oldest old had significantly reduced performance compared with people 50-59 years old (P<.05), but there were no significant differences between the oldest old and the 60-69 [(L-Test, P=.802), (2MWT, P=.570), (6MWT, P=.772)] and 70-79 [(L-Test, P=.148), (2MWT, P=.338), (6MWT, P=.300)] age groups. The oldest old reported significantly lower balance confidence compared with all 3 age groups (P<.05). CONCLUSION: The oldest old achieved similar functional mobility outcomes as people 60-79 years, the most common age group of people with an LLA. Advanced age alone should not disqualify individuals from prosthetic rehabilitation.

A survey of nurses, physiotherapists and occupational therapists in mobility care and gait aid use for hospital patients with dementia.

This study described mobility care practice of nurses, physiotherapists and occupational therapists and gait aid use for hospital patients with dementia. Two surveys, tailored to staff mobility care roles were distributed in Australian hospitals. Physiotherapists and occupational therapists were asked additional questions regarding assessments and factors for prescribing gait aids to patients with dementia. Descriptive statistics for closed-ended and summative content analyses for open-ended questions were undertaken. Nurses (n=56), physiotherapists (n=11) and occupational therapists (n=23) used various practices to ensure ambulation safety for patients with dementia. Nurses and occupational therapists commonly referred patients with dementia to physiotherapists for mobility and gait aid assessments. Therapists predominantly considered the severity of dementia, the person's learning ability and mobility history in deciding about gait aid use. Exploring ways to strengthen nursing and health professional education, and inter-professional practice for safe mobility in patients with dementia, with and without gait aids, could be helpful.

Perioperative gait analysis after total hip arthroplasty: Does outpatient surgery compromise patient outcomes?

Background: There has been a continuing trend toward decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). We aimed to investigate the impact of timing of discharge on gait and patient-reported outcomes early after THA. Methods: In this prospective observational cohort study conducted from May 2014 to November 2015, we measured gait velocity, stride length, single-limb support and single-limb support symmetry in adults aged 18-75 years before direct anterior THA, at discharge from the hospital, and 2, 6 and 12 weeks postoperatively. All procedures were performed by a single surgeon. Patients were discharged on the same day as surgery (outpatient group) or stayed at least 1 night in hospital (inpatient group). Participants also completed the Timed Up and Go test (all postoperative time points) and a series of questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [6 and 12 wk], 12-Item Short Form Health Survey [2, 6 and 12 wk], Harris Hip Score [12 wk] and a pain visual analogue scale [all postoperative time points]). Results: Thirty-six participants were enrolled in the study, of whom 16 were outpatients and 20 were inpatients. The mean pain rating at the time of discharge was lower in the outpatient group than in the inpatient group (adjusted mean difference -1.5, 95% confidence interval -3.0 to 0.0). We found no other significant differences between the groups for any gait, patient-reported or surgical outcome. Conclusion: There were no statistically significant differences in gait or patient-reported outcomes after direct anterior THA between patients who stayed overnight and those who were discharged as outpatients. Patients discharged as outpatients were younger than those who stayed overnight. Our results suggest that discharging patients as an outpatient after direct anterior THA may have a similar impact on patient function and outcomes as a standard overnight stay in hospital.

Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype.

BACKGROUND: concurrent declines in gait speed and cognition have been associated with future dementia. However, the clinical profile of 'dual decliners', those with concomitant decline in both gait speed and cognition, has not been yet described. We aimed to describe the phenotype and the risk for incident dementia of those who present with dual decline in comparison with non-dual decliners. METHODS: prospective cohort of community-dwelling older adults free of dementia at baseline. We evaluated participants' gait speed, cognition, medical status, functionality, incidence of adverse events and dementia, biannually over 7 years. Gait speed was assessed with a 6-m electronic walkway and global cognition using the MoCA test. We compared characteristics between dual decliners and non-dual decliners using t-test, chi-square and hierarchical regression models. We estimated incident dementia using Cox models. RESULTS: among 144 participants (mean age 74.23 ± 6.72 years, 54% women), 17% progressed to dementia. Dual decliners had a 3-fold risk (HR: 3.12, 95%CI: 1.23-7.93, P = 0.017) of progression to dementia compared with non-dual decliners. Dual decliners were significantly older with a higher prevalence of hypertension and dyslipidemia (P = 0.002). Hierarchical regression models show that age and sex alone explained 3% of the variation in the dual decliners group. Adding hypertension and dyslipidemia increased the explained variation by 8 and 10%, respectively. The risk of becoming a dual decliner was 4-fold higher if hypertension was present. CONCLUSION: older adults with a concurrent decline in gait speed and cognition represent a group at the highest risk of progression to dementia. Older adults with dual decline have a distinct phenotype with a higher prevalence of hypertension, a treatable condition.

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia.

BACKGROUND: Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. METHODS: Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations. RESULTS: Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs = 0.84), but not EQ (rs = 0.39). CONCLUSIONS: The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.

Cognition Predicts Mobility Change in Lower Extremity Amputees Between Discharge From Rehabilitation and 4-Month Follow-up: A Prospective Cohort Study.

OBJECTIVES: To assess (1) the effect of task (single and dual task), time (discharge and 4mo), and their interaction for mobility; (2) task prioritization during dual-task testing; and (3) the association between cognition on change in mobility between discharge from rehabilitation and 4 months' follow-up. DESIGN: Prospective cohort study. SETTING: Rehabilitation hospital. PARTICIPANTS: People with lower extremity amputations (N=22) were consecutively recruited at discharge from an inpatient prosthetic rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait velocity and the L Test of Functional Mobility, single and dual task (serial subtractions by 3), were the primary outcomes. Montreal Cognitive Assessment and Trail Making Test quantified cognition as secondary outcomes. Repeated measures analysis of variance evaluated the effects of task (single task and dual task) and time (at discharge and 4 months' follow-up) and their interaction on each outcome. A performance-resource operating characteristic graph evaluated gait and cognitive task prioritization. Multivariable linear regression evaluated the association between cognition and change in mobility over time. RESULTS: No significant interactions between task and time were found (all P>.121) for L Test and gait velocity. The L Test single task (P=.001) and dual task (P=.004) improved over time. Gait velocity improved over time for both single task and dual task (P<.001). Dual-task performance was slower than single-task performances at each time point. The Trail Making Test B was independently associated with the change in dual-task L Test (P=.012), and single-task (P=.003) and dual-task (P=.006) gait velocity at follow-up. CONCLUSIONS: Gait velocity and L Test single and dual task improved over time. No significant interactions indicated that cognitive task did not differentially affect performance over time. Lower executive function scores at discharge were independently associated with lower gains in all gait velocity and dual-task L Test outcomes at follow-up.

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review.

BACKGROUND: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. OBJECTIVE: To review gait parameters and characteristics associated with falls in people with dementia. METHODS: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. RESULTS: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. CONCLUSION: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees.

OBJECTIVE: To investigate the association between cognitive functioning, as measured by the Montreal Cognitive Assessment (MoCA), and functional outcomes upon discharge from prosthetic rehabilitation. DESIGN: Retrospective chart audit. SETTING: Rehabilitation hospital. PARTICIPANTS: Consecutive admissions (N=130; mean age, 66.21±11.19y) with lower extremity amputation of dysvascular etiology. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cognitive status was assessed using the MoCA. The L Test of Functional Mobility (L Test) and the 2-minute walk test were used to estimate functional mobility and walking endurance. RESULTS: In multivariable linear regression analysis, those who scored 2 on the visuospatial/executive functioning (out of 5) and language (out of 3) domains had statistically shorter distances walked on the 2-minute walk test than did those who scored the highest on these MoCA domains. These values were not clinically relevant. Time to complete the L Test for those who scored the lowest on the MoCA domains of visuospatial/executive functioning and delayed recall and 3 on the attention domain (out of 6) was significantly longer than that for those who scored the highest. CONCLUSIONS: Individuals with lower extremity amputation have an increased risk of cognitive impairment related to amputation etiology. Lower levels of functioning on MoCA domains of visuospatial/executive functioning, delayed recall, and attention were shown to negatively relate to the rehabilitation outcome of functional mobility, as measured by the L Test.

Determining Reliability of a Dual-Task Functional Mobility Protocol for Individuals With Lower Extremity Amputation.

OBJECTIVE: To determine the relative and absolute reliability of a dual-task functional mobility assessment. DESIGN: Cross-sectional study. SETTING: Academic rehabilitation hospital. PARTICIPANTS: Individuals (N=60) with lower extremity amputation attending an outpatient amputee clinic (mean age, 58.21±12.59y; 18, 80% male) who were stratified into 3 groups: (1) transtibial amputation of vascular etiology (n=20); (2) transtibial amputation of nonvascular etiology (n=20); and (3) transfemoral or bilateral amputation of any etiology (n=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time to complete the L Test measured functional mobility under single- and dual-task conditions. The addition of a cognitive task (serial subtractions by 3's) created dual-task conditions. Single-task performance on the cognitive task was also reported. Intraclass correlation coefficients (ICCs) measured relative reliability; SEM and minimal detectable change with a 95% confidence interval (MDC95) measured absolute reliability. Bland-Altman plots measured agreement between assessments. RESULTS: Relative reliability results were excellent for all 3 groups. Values for the dual-task L Test for those with transtibial amputation of vascular etiology (n=20; mean age, 60.36±7.84y; 19, 90% men) were ICC=.98 (95% confidence interval [CI], .94-.99), SEM=1.36 seconds, and MDC95=3.76 seconds; for those with transtibial amputation of nonvascular etiology (n=20; mean age, 55.85±14.08y; 17, 85% men), values were ICC=.93 (95% CI, .80-.98), SEM=1.34 seconds, and MDC95=3.71 seconds; and for those with transfemoral or bilateral amputation (n=20; mean age, 58.21±14.88y; 13, 65% men), values were ICC=.998 (95% CI, .996-.999), SEM=1.03 seconds, and MDC95=2.85 seconds. Bland-Altman plots indicated that assessments did not vary systematically for each group. CONCLUSIONS: This dual-task assessment protocol achieved approved levels of relative reliability values for the 3 groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the population with lower extremity amputation.

A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment.

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI). METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test. RESULTS: Gait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%). CONCLUSIONS: Not all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk.

Association Between Montreal Cognitive Assessment Scores and Measures of Functional Mobility in Lower Extremity Amputees After Inpatient Rehabilitation.

OBJECTIVE: To determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation. DESIGN: Retrospective cohort study. SETTING: Rehabilitation hospital. PARTICIPANTS: Consecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance. RESULTS: The mean ± SD MoCA score was 24.05±4.09 (range, 6-30), and 56.3% of patients had scores <26. MoCA scores had a small positive correlation with the 2MWT (r=.29, P<.01), and a small negative correlation to the L Test (r=-.24, P<.01). In multivariable linear regression, compared with people with the highest MoCA score quartile, there was no difference on the 2MWT, but people in the lowest 2 quartiles took longer to complete the L Test. CONCLUSIONS: Cognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone.

Screening for frailty in primary care: Accuracy of gait speed and hand-grip strength.

OBJECTIVE: To examine the accuracy of individual Fried frailty phenotype measures in identifying the Fried frailty phenotype in primary care. DESIGN: Retrospective chart review. SETTING: A community-based primary care practice in Kitchener, Ont. PARTICIPANTS: A total of 516 patients 75 years of age and older who underwent frailty screening. MAIN OUTCOME MEASURES: Using modified Fried frailty phenotype measures, frailty criteria included gait speed, hand-grip strength as measured by a dynamometer, and self-reported exhaustion, low physical activity, and unintended weight loss. Sensitivity, specificity, accuracy, and precision were calculated for single-trait and dual-trait markers. RESULTS: Complete frailty screening data were available for 383 patients. The overall prevalence of frailty based on the presence of 3 or more frailty criteria was 6.5%. The overall prevalence of individual Fried frailty phenotype markers ranged from 2.1% to 19.6%. The individual criteria all showed sensitivity and specificity of more than 80%, with the exception of weight loss (8.3% and 97.4%, respectively). The positive predictive value of the single-item criteria in predicting the Fried frailty phenotype ranged from 12.5% to 52.5%. When gait speed and hand-grip strength were combined as a dual measure, the positive predictive value increased to 87.5%. CONCLUSION: There is a need for frailty measures that are psychometrically sound and feasible to administer in primary care. While use of gait speed or grip strength alone was found to be sensitive and specific as a proxy for the Fried frailty phenotype, use of both measures together was found to be accurate, precise, specific, and more sensitive than other possible combinations. Assessing both measures is feasible within primary care.

Attitudes and Beliefs of Physical Therapists and Physical Therapist Students Towards Working with Older Adults: A Systematic Review.

OBJECTIVE: The aim of this study was to systematically review physical therapists' and physical therapist students' attitudes towards working with older adults. METHODS: CINAHL, EMBASE, ERIC, MEDLINE, Scopus, PsycINFO, and SocIndex databases were searched in duplicate (from inception to March 2023). Studies that assessed knowledge on aging, intention to work with older adults or attitudes towards older adults for physical therapist students and/or clinicians, and that were written in English, Finnish, Spanish, or Swedish were included. Grey literature, qualitative studies, or articles of people with a specific diagnosis (eg, dementia) were excluded. All articles were reviewed by 2 authors independently and consensus was required for inclusion. Data extraction was completed using a standardized data extraction sheet. RESULTS: Of 2755 articles screened, 34 met the inclusion criteria. Twenty-five studies recruited only physical therapist students, 6 recruited only physical therapist clinicians, and 3 involved mixed samples of both. Ten intervention studies were included, all of which recruited physical therapist students. Overall, physical therapist students were observed to have predominantly positive attitudes towards older adults, while clinicians had neutral to weak positive attitudes towards older adults. Both physical therapist students and clinicians were observed to have low knowledge on aging and low intentions to work with older adults. Results from intervention studies suggest that education combined with clinical experience with older adults improves attitudes towards older adults. CONCLUSIONS: A discrepancy is observed in physical therapists in that although attitudes towards older adults are positive, a lack of knowledge on aging and a disinterest in working with older adults exists. Intervention studies suggest that clinical experience may improve attitudes towards older adults in physical therapist students. IMPACT: Predominantly positive attitudes towards older adults are reported by physical therapist students, while for clinicians mixed results are observed. Education coupled with clinical experiences appear to be effective interventions to improve attitudes towards older adults, but such research has only been explored in student samples.

The effect of exercise interventions on gait outcomes in subacute and chronic rehabilitation from lower-limb amputation: A systematic review and meta-analysis.

Successful walking is a substantial contributor to quality of life in people with lower-limb amputation (PLLA), yet gait difficulties are common. Evidence-based exercise guidelines are necessary for PLLA with different clinical characteristics and at different phases of recovery. To systematically review the literature evaluating effects of exercise interventions on gait outcomes in PLLA at subacute and chronic stages of recovery. Databases MEDLINE, EMBASE, CINAHL, SPORTDiscus, Scopus, and the Cochrane Library were searched (inception to May 10, 2022). Inclusion criteria: randomized controlled trials assessing gait outcomes following exercise intervention; subjects were PLLA ≥18 years of age and used a prosthesis for walking. Meta-analysis using random effects with inverse variance to generate standardized mean differences (SMDs) was completed for primary gait outcomes. Subgroup analysis was conducted for the recovery phase (i.e., subacute and chronic) and level of amputation (e.g., transfemoral and transtibial). Of 16 included articles, 4 studies examined the subacute phase of recovery, whereas 12 examined the chronic phase. Subacute interventions were 30 minutes, 1-7 times/week, for 2-12 weeks. Chronic interventions were 15-60-minutes, 2-3 times/week, for 4-16 weeks. Low-moderate level evidence was shown for a small improvement in the subacute phase (SMD = 0.42, 95% confidence interval [0.06-0.79], I 2 = 46.0%) and a moderate improvement in the chronic phase (SMD = 0.67, 95% confidence interval [0.40-0.94], I 2 = 0.0%) in favor of exercise intervention groups. Multicomponent exercise programs consisting of gait, balance, and strength training are effective at improving gait outcomes in PLLA at subacute and chronic phases of recovery. The optimal duration and frequency of exercise is unclear because of variation between interventions, highlighting an area for future work.

Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To quantify the effectiveness of prehabilitation prior to total knee and hip arthroplasty (TKA/THA) for osteoarthritis on postoperative outcomes assessed by self-report and performance-based measures. METHODS: Embase, MEDLINE, CENTRAL, CINAHL and Scopus (inception-August 2022) were searched for randomized controlled trials. Self-report outcomes were function, health-related quality of life (HRQoL), and pain. Performance-based outcomes were strength, range of motion (ROM), balance, and functional mobility. The RoB 2.0 assessed risk of bias. Random-effects meta-analysis was performed up to 52 weeks after TKA/THA. RESULTS: High risk of bias was found in 24 of 28 trials. Prehabilitation improved function (SMD = 0.50 [95%CI: 0.23, 0.77]), pain (SMD = 0.44 [95%CI: 0.17, 0.71]), HRQoL (SMD = 0.28 [95%CI: 0.12, 0.43]), strength (SMD = 0.72 [95%CI: 0.47, 0.98]), ROM (SMD = 0.31 [95%CI: 0.02, 0.59]), and functional mobility (SMD = 0.39 [95%CI: 0.05, 0.73]) post-TKA. No significant effect of prehabilitation on balance (SMD = 0.28 [95%CI: -0.11, 0.66]) post-TKA. All outcomes assessed had significant heterogeneity (p < 0.01). There were limited and contradictory trials (n = 2) for THA. CONCLUSION: High risk of bias and significant heterogeneity observed in our meta-analysis prevent conclusions regarding prehabilitation effectiveness on outcomes up to one year after TKA/THA.

Prehabilitation has been promoted to improve postoperative outcomes and shorten recovery periods after total knee/hip arthroplasty (TKA/THA) for osteoarthritisPrehabilitation improved relevant self-report and performance-based outcomes after TKA surgeryA high risk of bias and significant heterogeneity across trials prevent drawing any conclusionsMore high-quality research is required before recommending the implementation of prehabilitation programs in clinical practice for people awaiting TKA/THA.

How has body image been evaluated among people with lower limb loss? A scoping review.

PURPOSE: Lower limb loss can result in an altered body image, leading to changes in self-esteem, mental health and quality of life. This scoping review explored how body image has been evaluated among people with lower limb loss. MATERIALS AND METHODS: Five databases (Embase, Medline, PsychINFO, CINHAL, and Nursing and Allied Health Database) were searched from inception until March 19, 2023. Inclusion criteria: 1) people with lower limb loss; 2) evaluated a body image outcome or theme; and 3) a qualitative, quantitative or mixed methods design. RESULTS: Twenty-four quantitative (n = 19 cross-sectional, n = 3 intervention cohort and n = 2 prospective cohort), 2 qualitative and 1 mixed methods design studies were included. The definition of body image varied across studies, with 59% of studies not reporting a conceptual or theoretical definition. People with lower limb loss perceived a more negative body image compared to control groups. In prospective cohort studies, changes in body image over time were inconclusive. CONCLUSION: People with lower limb loss report a negative body image when compared to other populations. Definitions and understanding of body image changed overtime and varied among studies which may impact introducing interventions to promote positive body image during rehabilitation and beyond in this population.

People with lower limb loss experience altered body image following limb amputation, at the initiation, during and after prosthetic rehabilitation, and re-integrating into the community.Clinicians are encouraged to use this study's proposed lower limb loss-specific definition of body image.The proposed definition incorporates common terminology used in past research in the field and amputee-specific situations when referring to altered body image among this patient population.To better support the psychological adjustment of people with lower limb loss in rehabilitation programs and beyond, clinicians and researchers should evaluate body image at multiple time points (e.g., admission and discharge to rehabilitation, follow-up) using an outcome measure that asks about both with and without a prosthesis on the residual limb.

The reliability of four standardized concern for falling scales among adults with a major lower extremity amputation.

INTRODUCTION: More than 52.4% of people with a lower extremity amputation (PLEA) will fall at least once each year. Previously established standardized scales that evaluate a concern for falling (CFF) were developed primarily among community-dwelling older adults. The reliability of commonly used scales to evaluate a CFF among PLEA is needed. OBJECTIVE: To evaluate test-retest relative and absolute reliability, and agreement of the Modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), Falls Efficacy Scale - International (FES-I), Consequences of Falling (COF) Scale, Perceived Control Over Falling (PCOF) Scale, and Perceived Ability to Manage Falls (PAMF) Scale among PLEA. DESIGN: Web-based cross-sectional repeated-measures study. SETTING: Rehabilitation hospital. PARTICIPANTS: Adults with a transtibial or transfemoral level amputation, who had completed a prosthetic rehabilitation program, and at minimum of 1 year using a prosthesis for ambulation were recruited after regularly scheduled appointments (N = 22, mean age ± SD, 63.5 ± 12.9 years). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Initial and re-test scores on the mSAFFE, FES-I, COF, PCOF, and PAMF. RESULTS: Intraclass correlation coefficients (ICCs) demonstrated excellent relative reliability of the mSAFFE (ICC = 0.92, 95% confidence interval [CI]: 0.82-0.97), good relative reliability of the FES-I (ICC = 0.87, 95% CI: 0.70-0.94), and fair relative reliability of the COF (ICC = 0.78, 95% CI: 0.53-0.90) and PAMF (ICC = 0.73, 95% CI: 0.46-0.88) scales. The ICC value of the PCOF scale could not be validly calculated and was not further analyzed. Calculated standard error of measurement values for the mSAFFE, FES-I, COF, and PAMF scales were small in magnitude, and Bland-Altman graphs demonstrated good agreement of initial and re-test scores for all scales. CONCLUSION: This study provides initial evidence on the suitability and reliable use of the mSAFFE, FES-I, COF, and PAMF scales within this population. Further evaluation of the validity of these scales is needed.

An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation: a Canadian perspective.

PURPOSE: To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. METHODS: A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. RESULTS: A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [ß = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [ß = -0.08, (95% CI: -0.13, -0.02), p = 0.011] were independently associated with admission time. CONCLUSION: People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population.

It is expected that the rate of inpatient prosthetic rehabilitation admissions due to lower limb amputations will increase amongst those over eighty.An analysis of participant characteristics of people admitted to inpatient prosthetic rehabilitation over time will inform modification and developments to future programs.Future prosthetic rehabilitation programs should consider an increased number of comorbidities when developing prognostic expectations for participants.A shortened interval between amputation surgery and admission should be considered when developing prosthetic rehabilitation programs.

A Survey of Canadian Physiotherapists' and Physiotherapy Students' Knowledge and Use of Executive Functioning Assessments in Clinical Practice.

Purpose: This study examined what physiotherapists and physiotherapy students understand and know about executive functioning (EF), what EF outcome measures they use clinically, and whether their primary area of practice influences their assessment practices. Method: An open online survey was distributed to registered members of the Canadian Physiotherapy Association, its various divisions, and colleges of physiotherapy within Canada that took approximately 15 minutes to complete and was available for 13 months. Pearson correlation was used to assess the relationship between subjective and objective understanding and knowledge of EF (UKEF) and a one-way multivariate analysis of variance was used to analyze differences in survey responses based on respondents' primary area of practice. Results: A total of 335 respondents consented to participate (completion rate = 78.4%). There was a significant moderate positive correlation between subjective and objective UKEF (r = 0.43; 95% CI: 0.32, 0.54; n = 260; p < 0.001). Significant differences in survey responses were related to physiotherapists' primary areas of practice (i.e., musculoskeletal, neurological, cardiorespiratory, or multi-systems; F12,555.89 = 2.29, p = 0.008; Wilks Λ = 0.880; partial η2 = 0.042). Conclusions: Respondents reported that they had good subjective UKEF, but this was only moderately correlated with objective UKEF.

Objectif : examiner ce que les physiothérapeutes et les étudiants en physiothérapie comprennent et savent sur le fonctionnement exécutif (FE), les mesures de résultats du FE qu'ils utilisent en clinique et si leur secteur primaire de pratique influe sur leurs pratiques d'évaluation. Méthodologie : les membres de l'Association canadienne de physiothérapie, ses diverses divisions et les ordres de physiothérapie du Canada ont reçu un sondage en ligne ouvert qui exigeait une quinzaine de minutes de leur temps et qui était disponible sur une période de 13 mois. Les chercheurs ont utilisé la corrélation de Pearson pour évaluer la relation entre la compréhension et les connaissances subjectives et objectives du FE (CCEF) et une analyse de variance multivariée unidirectionnelle pour analyser les différences entre les réponses au sondage d'après les secteurs primaires de pratique des répondants. Résultats : Au total, 335 répondants ont consenti à participer (taux d'achèvement = 78,4 %). Ils ont constaté une corrélation positive modérée significative entre les CCEF subjectives et objectives (r = 0,43; IC à 95 % : 0,32, 0,54; n = 260; p < 0,001). Des différences significatives dans les réponses au sondage étaient liées aux secteurs primaires de pratique des physiothérapeutes (musculosquelettique, neurologique, cardiorespiratoire ou multisystémique; F12,555,89 = 2,29; p = 0,008; Λ de Wilks = 0,880; η2 partiel = 0,042). Conclusions : les répondants ont déclaré qu'ils avaient de bonnes CCEF, mais leur réponse était seulement corrélée modérément avec les CCEF objectives.