Weight-bearing asymmetry during sit-to-stand after major lower-limb amputation: A systematic review and meta-analysis.

Weight-bearing asymmetry during sit-to-stand (STS) can cause musculoskeletal problems in people with major lower-limb amputation. Does weight-bearing asymmetry differ between individuals with major lower-limb amputation and individuals without amputation? We conducted a systematic review and meta-analysis. We searched PubMed, Cochrane Library, Web of Science, and HAL up to June 2022 using keywords and inclusion/exclusion criteria. Article quality was assessed. Data for population, intervention, weight-bearing asymmetry, and biomechanical analysis were reported. Standardized mean differences (SMDs) were calculated from the outcomes when possible. We included 11 studies (102 people with amputation). Weight-bearing asymmetry was greater in people with amputation than those without amputation (SMD = 1.72 [1.30-2.14] p < 0.00001). It was greater for individuals with transtibial amputation (TTA) and with transfemoral amputation (TFA) than for those without amputation (SMD = 1.20 [0.76-1.65] p < 0.00001 and SMD = 5.32 [4.15-6.50] p < 0.00001, respectively). STS performance time was longer for people with amputation (SMD = 0.52 [0.23-0.81] p = 0.0004) than those without amputation. Trunk motion differed in those with amputation, and lower-limb kinematics differed considerably, especially for people with TFA. Weight-bearing is more asymmetric in people with amputation than in people without amputation. The differences in weight-bearing asymmetry and kinematics during STS between people with TTA and TFA suggest that different strategies are required to improve weight-bearing symmetry: improvements in active prosthetic knees in TFA and rehabilitation focused on weight-bearing in TTA.

Le Corre T ，Bisseriex H ，Pons C ，Rémy-Néris O ... -  《-》

Effects of anterior-posterior shifts in prosthetic alignment on the sit-to-stand movement in people with a unilateral transtibial amputation.

The sit-to-stand movement can be challenging for people with a transtibial amputation (TTA). The alignment of the prosthesis may influence the movement strategies people with TTA use to transfer from sit-to-stand by affecting foot placement. The purpose of this study was to determine how shifting the prosthetic foot anterior and posterior relative to the socket affects movement strategies used to transfer from sit-to-stand. To aid in interpretation, we compared movement strategies between people with and without TTA. Nine people with TTA and nine sex-, and age-matched non-amputee controls completed five self-paced sit-to-stand trials. With the posterior alignment, participants with TTA had 1) smaller braking GRF impulse on the prosthetic side and greater impulse on the intact side compared to the anterior alignment, 2) no significant differences between sides, which suggests greater braking impulse symmetry compared to anterior and prescribed alignments, and 3) smaller axial trunk range of motion compared to the prescribed alignment. There were also differences between participants with TTA and controls in braking GRF impulse, knee extension moment, anterior/posterior center of pressure position, and lateral and axial trunk range of motion. Based on these results, shifting the prosthetic foot posterior to the socket may be a useful tool to reduce braking impulse asymmetry and trunk motion in people with TTA during sit-to-stand. Thus, prosthetic alignment can have important implications for the comfort and ability of people with TTA to transfer from sit-to-stand as well as for development of secondary health conditions like low back pain, which is associated with compensatory movements.

Nolasco LA ，Morgenroth DC ，Silverman AK ，Gates DH ... -  《-》

Whole body movement strategies during sit-to-stand and stair ascent in individuals with a lower limb amputation: A systematic review.

Individuals with a lower limb amputation use compensatory strategies during essential tasks such as sit-to-stand and stair ascent leading to secondary physical conditions. The ensuing biomechanical parameters outlining the motion strategies they put in place need to be identified and described. We searched three databases (Embase, IEEE Xplore and PubMed) for articles on the spatiotemporal, the kinematics and the kinetics that compared the amputated, the intact lower limbs, or the trunk of individuals with a unilateral transtibial or transfemoral amputation with the limbs of a control group. We found twenty articles. During sit-to-stand, individuals with a lower limb amputation increased the trunk inclination angle toward the intact lower limb, explaining higher ground reaction forces and peak knee sagittal power generation. During stair ascent, individuals with a lower limb amputation increased the stance phase duration on the intact lower limb. Moreover, individuals with a lower limb amputation increased both lower limbs hip extension moment and power, and the amputated lower limb knee extension moment. In both tasks, the individuals with a transfemoral amputation presented larger differences than those with transtibial compared to the control group. Both lower limbs intact joint moment and power were increased to compensate for the prosthesis passive joint and to ensure stability. Stair gait studies mainly focused on the lower limbs' biomechanical changes in the sagittal plane, while sit-to-stand studies focused on asymmetries without comparing the lower limbs independently. Better methodological descriptions are essential to enhance the external validity of previous results.

Miramand L ，Moisan G ，Richard V ，McFadyen BJ ，Turcot K ... -  《-》

Spinal, pelvic, and hip movement asymmetries in people with lower-limb amputation: Systematic review.

Devan H ，Carman A ，Hendrick P ，Hale L ，Ribeiro DC ... -  《-》

Exploring Factors Influencing Low Back Pain in People With Nondysvascular Lower Limb Amputation: A National Survey.

Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted. To investigate which physical, personal, and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation (TFA) and transtibial amputation (TTA). A retrospective cross-sectional survey. A national random sample of people with nondysvascular TFA and TTA. Participants (N = 526) with unilateral TFA and TTA due to nondysvascular etiology (ie, trauma, tumors, and congenital causes) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis. Personal (ie, age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (ie, level of amputation, years of prosthesis use, presence of phantom-limb pain, residual-limb problems, and nonamputated limb pain), and physical factors (ie, pain-provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs). LBP presence and intensity. A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions (prevalence odds ratio [POR] = 4.34, P = .01), residual-limb problems (POR = 3.76, P < .01), and phantom-limb pain (POR = 2.46, P = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of POR, and the results must be interpreted with caution. In those with LBP, the presence of residual-limb problems (β = 0.21, P = .01) and experiencing LBP symptoms during sit-to-stand task (β = 0.22, P = .03) were positively associated with LBP intensity, whereas being employed demonstrated a negative association (β = -0.18, P = .03) in the multivariate linear regression model. Rehabilitation professionals should be cognizant of the influence that comorbid conditions, residual-limb problems, and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP. II.

Devan H ，Hendrick P ，Hale L ，Carman A ，Dillon MP ，Ribeiro DC ... -  《-》