ORCID Profile
0000-0001-6898-9095
Current Organisation
Nottingham Trent University
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Publisher: Informa UK Limited
Date: 23-04-2023
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.JVS.2010.07.006
Abstract: To compare articulated and nonarticulated early walking aids (EWAs) for clinical and quality-of-life outcomes in transtibial utees. Patients undergoing lower limb utation in a tertiary-care vascular surgical unit were screened over a 4-year period. Recruited patients were randomized to receive articulated utee mobility aid (AMA) or nonarticulated pneumatic post utation mobility aid (PPAMA) during early rehabilitation. Primary (10-meter walking velocity) and secondary clinical (number and duration of physiotherapy treatments during EWA rosthesis use) and quality-of-life (SF-36) outcome measures were recorded at five standardized assessment visits. Inter-group and intra-group analyses were performed. Two hundred seventy-two patients were screened and 29 transtibial utees (median age, 56 years) were recruited (14/treatment arm). No significant difference was seen in demographics and comorbidities at baseline. Inter-group analysis: Median 10-meter walking velocity was significantly (Mann-Whitney, P = .020) faster in the PPAMA group (0.245 m/s, interquartile range [IQR] 0.218-0.402 m/s) compared with the AMA group (0.165 m/s IQR, 0.118-0.265 m/s) at visit 1. However, there was no difference between the groups at any other visit. Similarly, the number of treatments using EWA was significantly (P = .045) lower in the PPAMA group (5.0 IQR, 3.5-8.0) compared with the AMA group (6.0 IQR, 6.0-10.5). No difference was observed between the groups in duration of physiotherapy or SF-36 domain and summary scores. Intra-group analysis: Both treatment groups showed significant improvement in 10-meter walking velocity (Friedman test AMA P = .001 PPAMA P = .007) however, other clinical outcomes did not show any statistically significant improvement. Only physical function domain of SF-36 demonstrated significant improvement (Friedman test AMA P = .037 PPAMA P = .029). There is no difference in clinical and QOL outcomes between articulated and nonarticulated EWAs in rehabilitation of transtibial utees.
Publisher: SAGE Publications
Date: 04-06-2022
DOI: 10.1177/19322968221101632
Abstract: Non-removable knee-high devices are the gold-standard offloading treatments to heal plantar diabetic foot ulcers (DFUs). These devices are underused in practice for a variety of reasons. Recommending these devices for all patients, regardless of their circumstances and preferences influencing their ability to tolerate the devices, does not seem a fruitful approach. The aim of this article is to explore the potential implications of a more personalized approach to offloading DFUs and suggest avenues for future research and development. Non-removable knee-high devices effectively heal plantar DFUs by reducing plantar pressure and shear at the DFU, reducing weight-bearing activity and enforcing high adherence. We propose that future offloading devices should be developed that aim to optimize these mechanisms according to each in idual’s needs. We suggest three different approaches may be developed to achieve such personalized offloading treatment. First, we suggest modular devices, where different mechanical features (rocker-bottom sole, knee-high cast walls/struts, etc.) can be added or removed from the device to accommodate different patients’ needs and the evolving needs of the patient throughout the treatment period. Second, advanced manufacturing techniques and novel materials could be used to personalize the design of their devices, thereby improving common hindrances to their use, such as devices being heavy, bulky, and hot. Third, sensors could be used to provide real-time feedback to patients and clinicians on plantar pressures, shear, weight-bearing activity, and adherence. By the use of these approaches, we could provide patients with personalized devices to optimize plantar tissue stress, thereby improving clinical outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2009
DOI: 10.1080/03093640902751762
Abstract: Physiotherapists routinely prescribe the use of two different early walking aids (EWAs) to in iduals who have recently undergone unilateral transtibial utation. No research to date has investigated the kinematic gait patterns of transtibial utees walking with an EWA during early rehabilitation. The aim of the current RCT study was to compare gait patterns when walking with two different EWAs and whether either EWA provided patients with greater gait benefits. Patients were randomly assigned into one of two EWA groups, one group using the Amputee Mobility Aid and another using the Pneumatic Post-Amputation Aid, prior to receiving their functional prosthesis. A 3D motion capture system recorded kinematic data from their first steps up to discharge from rehabilitation. Walking velocity increased significantly (p < 0.01) during rehabilitation. Control of the prosthetic knee improved during rehabilitation in both groups. A lack of conclusive differences between EWAs was noted at discharge from rehabilitation. Both groups displayed changes in gait patterns in different gait measures during rehabilitation. However, these changes were not the same for both groups. Gait adaptations occurred soon after walking with a functional prosthesis. The results from this study would suggest that neither EWA was more beneficial for gait retraining during rehabilitation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2014
Abstract: Obstacle crossing is an important activity of daily living, necessary to avoid tripping or falling, although it is not fully understood how transtibial utees adapt to performing this activity of daily living following discharge from rehabilitation. The objective of this study was to investigate the longitudinal adaptations in obstacle crossing in transtibial utees post-discharge from rehabilitation. Longitudinal repeated measures. Seven unilateral transtibial utees crossed an obstacle 0.1m high positioned along a walkway while kinematic and kinetic data were recorded at 1, 3 and 6 months post-discharge. At 6 months post-discharge, walking velocity had increased (0.17 m.s(-1)) with most participants self-selecting an intact lead limb preference. During swing phase, peak knee flexion (p = 0.03) and peak knee power absorption (K4 p = 0.01) were greater with an intact versus affected lead limb preference. Having crossed the obstacle, intact limb peak ankle power generation in pre-swing (A2 p = 0.01) and knee power absorption (K3 p = 0.05) during stance phase were greater when compared to the affected limb. Obstacle crossing improved, although a greater reliance on intact limb function was highlighted. Results suggested that further improvements to locomotor performance may be obtained by increasing affected limb knee range of motion and concentric and eccentric strength of the knee extensors and flexors. The novel objective data from this study establish an understanding of how recent transtibial utees adapt to performing obstacle crossing following discharge from rehabilitation. This allows for evidence-based clinical interventions to be developed, aimed at optimising biomechanical function, thus improving overall locomotor performance and perhaps subsequent quality of life.
Publisher: BMJ
Date: 09-2019
DOI: 10.1136/BMJOPEN-2019-032924
Abstract: The majority of older patients with a transtibial utation are prescribed a standard (more rigid, not self-aligning) prosthesis. These are mostly suitable for level walking, and cannot adjust to different sloped surfaces. This makes walking more difficult and less energy efficient, possibly leading to longer term disuse. A Cochrane Review concluded that there was insufficient evidence to recommend any in idual type of prosthetic ankle-foot mechanism. This trial will establish the feasibility of conducting a large-scale trial to assess the effectiveness and cost-effectiveness of a self-aligning prosthesis for older patients with vascular-related utations and other health issues compared with a standard prosthesis. This feasibility trial is a pragmatic, parallel group, randomised controlled trial (RCT) comparing standard treatment with a more rigid prosthesis versus a self-aligning prosthesis. The target s le size is 90 patients, who are aged 50 years and over, and have a transtibial utation, where utation aetiology is mostly vascular-related or non-traumatic. Feasibility will be measured by consent and retention rates, a plausible future s le size over a 24-month recruitment period and completeness of outcome measures. Qualitative interviews will be carried out with trial participants to explore issues around study processes and acceptability of the intervention. Focus groups with staff at prosthetics centres will explore barriers to successful delivery of the trial. Findings from the qualitative work will be integrated with the feasibility trial outcomes in order to inform the design of a full-scale RCT. Ethical approval was granted by Yorkshire and the Humber—Leeds West Research Ethics Committee on 4 May 2018. The findings will be disseminated via peer-reviewed research publications, articles in relevant newsletters, presentations at relevant conferences and the patient advisory group. ISRCTN15043643 .
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-045195
Abstract: To determine the feasibility of conducting a full-scale randomised controlled trial (RCT) of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard prosthetic ankle-foot. Multicentre parallel group feasibility RCT. Five prosthetics centres in England recruiting from July 2018 to August 2019. Adults aged ≥50 years with a vascular-related or non-traumatic transtibial utation for 1 year or longer, categorised as having ‘limited community mobility’ and using a non-self-aligning ankle-foot. Participants were randomised into one of two groups for 12 weeks: self-aligning prosthetic ankle-foot or existing non-self-aligning prosthetic ankle-foot. Feasibility measures: recruitment, consent and retention rates and completeness of questionnaire and clinical assessment datasets across multiple time points. Feasibility of collecting daily activity data with wearable technology and health resource use data with a bespoke questionnaire. Fifty-five participants were randomised (61% of the target 90 participants): n=27 self-aligning ankle-foot group, n=28 non-self-aligning ankle-foot group. Fifty-one participants were included in the final analysis (71% of the target number of participants). The consent rate and retention at final follow-up were 86% and 93%, respectively. The average recruitment rate was 1.25 participants/site/month (95% CI 0.39 to 2.1). Completeness of questionnaires ranged from 89%–94%, and clinical assessments were 92%–95%, including the activity monitor data. The average completion rates for the EQ-5D-5L and bespoke resource use questionnaire were 93% and 63%, respectively. This feasibility trial recruited and retained participants who were categorised as having ‘limited community mobility’ following a transtibial utation. The high retention rate of 93% indicated the trial was acceptable to participants and feasible to deliver as a full-scale RCT. The findings support a future, fully powered evaluation of the effectiveness and cost-effectiveness of a self-aligning prosthetic ankle-foot compared with a standard non-self-aligning version with some adjustments to the trial design and delivery. ISRCTN15043643 .
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.CLINBIOMECH.2014.05.012
Abstract: Negotiating a raised surface during continuous gait is an important activity of daily living and is a potentially hazardous task with regards to trips, falls and fall-related injury. However, it is not known how recent transtibial utees adapt to performing stepping gait tasks in the 6-month period following discharge from rehabilitation. Recent transtibial utees performed continuous gait trials, stepping onto and from a raised surface walkway representing the height of a street kerb, whilst kinematic and kinetic data were recorded at one, three and six months post-discharge from rehabilitation. Walking speed increased when stepping down (p=0.04) and was invariant across the study period when stepping up. At one month post-discharge, participants displayed an affected lead limb preference (90.8%) when stepping down and an intact lead limb preference (70.0%) when stepping up, although these lead limb preferences diminished over time. Participants spent more time in stance on the intact limb compared to the affected limb in both stepping down (trail limb) (p=0.01) and stepping up (lead and trail limbs) (p=0.05). Participants displayed significantly greater joint mobility and power bursts in the intact trail limb when stepping down and in the intact lead limb when stepping up. Transtibial utees prefer to exploit intact limb function to a greater extent, although over time, the means by which this occurs changes which affects the initial lead limb preferences. The results from the current study enable future evidence-based therapeutic and prosthetic interventions to be designed that improve transtibial utee stepping gait.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.GAITPOST.2012.07.023
Abstract: This study examined the adaptation of postural responses in transtibial utees during both perturbed and volitional dynamic balance tasks during a five-month period following discharge from inpatient rehabilitation. Seven unilateral transtibial utees performed the sensory organisation test (SOT) and the limits of stability (LOS) test protocols on the NeuroCom Equitest(®) at one, three and six months post-discharge from in-patient rehabilitation. Overall balance ability improved significantly (p=0.01) following discharge as did utilisation of somatosensory input (p=0.01), with hip strategy use decreasing. Reaction time and movement velocity did not change significantly in the majority of target directions for the LOS test. However, endpoint COG excursion and directional control were significantly increased in a number of directions (p≤0.05). Although balance ability improved following discharge from rehabilitation, participants were heavily reliant upon vision in order to maintain balance. Following discharge from rehabilitation, utees were seemingly able to increase the spatial and accuracy aspects of volitional exploration of their LOS. However, temporal aspects did not display any adaptation, suggesting a trade-off between these aspects of postural control. Further practice of performing volitional postural movements under increasing time pressure, for ex le using low-cost gaming tools, may improve balance ability and postural control.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Cleveland Barnett.