Alain Lacraz

Capacité de marche en milieu extra-hospitalier des amputés appareillés

Resume L’objectif de cette etude etait d’analyser la marche appareillee en milieu extra-hospitalier d’une population de patients amputes, et de determiner les variables qui influencent la performance de marche. Ont ete inclus les patients presentant une amputation de Syme ou d’un niveau plus proximal, beneficiant d’une prothese de marche, capables de se lever seuls de leur siege au test Up and go et vivant a domicile. Chaque patient a ete equipe d’un enregistreur de la marche (StepWatch3™ (SW3)) directement implante sur la prothese pendant 15 jours consecutifs. Les parametres enregistres ont ete le nombre de pas, la duree de deambulation et la vitesse de marche. Nous avons egalement analyse des variables susceptibles d’influencer la marche appareillee : sexe, indice de masse corporelle, utilisation d’un moyen auxiliaire de marche, niveau, etiologie et âge lors de l’amputation et de l’enregistrement. Quarante-trois patients ont porte sans defaut le SW3 dans leur vie quotidienne ; âge au moment de l’amputation : 42 (1378) ; au moment de l’etude : 52 (25-85). L’analyse des parametres de marche montre que tous les patients utilisent leur prothese quotidiennement et que les meilleures performances de marche s’observent de facon significative chez les patients amputes au-dessous du genou, marchant sans moyen auxiliaire et operes pour une cause non vasculaire. L’analyse multivariee montre une perte de deambulation de 93 minutes (21 %) par jour si le niveau d’amputation ne preserve pas le genou, et une perte de 58 minutes (13 %) si le patient marche avec un moyen auxiliaire. Chaque patient perd 2,5 minutes de marche par jour par annee d’âge. Par ailleurs, l’indice de masse corporelle n’a pas d’influence sur la duree totale de marche quotidienne, mais affecte significativement la vitesse de marche.

Comparison of the International Committee of the Red Cross Foot With the Solid Ankle Cushion Heel Foot During Gait: A Randomized Double-Blind Study

OBJECTIVE To compare the well-recognized solid ankle cushion heel (SACH) foot with the prosthetic foot developed by the International Committee of the Red Cross (CR Equipements SACH) during gait. DESIGN Double-blind study was conducted to compare the influence on the biomechanics of gait of the CR Equipements SACH foot and the SACH foot. SETTING University hospital research center. PARTICIPANTS Participants with unilateral transtibial amputation (N=15) were included. INTERVENTIONS Three-dimensional motion analysis system and 2 forceplates were used to capture body motion and ground reaction forces during gait at a self-selected speed and at 1.2m/s. MAIN OUTCOME MEASURES Nonparametric Wilcoxon matched-pairs tests were used to compare the 2 prosthetic feet with respect to their spatiotemporal (gait velocity, stride length, and percentage of stance phase), kinematic (range and peak angles of the pelvis, hip, knee, and ankle), and kinetic (peak moment and power of the hip, knee, and ankle) parameters. RESULTS Compared with the SACH foot, the CR Equipements SACH foot demonstrated a significantly greater stance phase symmetry ratio (SACH: 94% vs CR Equipements SACH: 97%), a more extensive ankle range of motion in the sagittal plane (SACH: 7° vs CR Equipements SACH: 12°), a greater maximal dorsiflexion angle during the terminal stance phase (SACH: 10° vs CR Equipements SACH: 13°), and a higher ankle power (SACH: .31W/kg vs CR Equipements SACH: .40W/kg). No significant difference was found for the examined knee, hip, and pelvis parameters. CONCLUSIONS The CR Equipements SACH foot provides more symmetry and improves ankle kinematics and kinetics in the sagittal plane compared with the SACH foot. This study suggests that individuals using the CR Equipements SACH foot improve their gait biomechanics compared when using the SACH foot.

Cross-cultural adaptation and validation of the ABIS questionnaire for French speaking amputees: French validation of the ABIS questionnaire

Abstract Background: The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F). Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach’s α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach’s α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was −3.90 with limits of agreement from −18.71 to 10.92. For ABIS-R-F, the mean difference was −2.12 with limits of agreement from −8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F). Conclusions: The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible. Implications for rehabilitation The quality of life of amputees is impacted by their satisfaction with body image The Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputees The Standard Errors of Measurement proposed could be useful for clinical and research purposes Both ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliability The shortened version has a better response structure and is more readily feasible.

Comparison of the Otto Bock solid ankle cushion heel foot with wooden keel to the low-cost CR-Equipements™ solid ankle cushion heel foot with polypropylene keel: A randomized prospective double-blind crossover study assessing patient satisfaction and energy expenditure:

Background: The International Committee of the Red Cross supports a worldwide program of prosthetic fitting and rehabilitation. In this context, a prosthetic foot was developed and widely distributed in least developed countries. Study design: Prospective, randomized, double-blind, controlled study. Objective: To compare patient satisfaction and energy expenditure during ambulation between a low-cost prosthetic foot designed with a polypropylene keel (CR-Equipements™ solid ankle cushion heel, International Committee of the Red Cross) to a well-recognized solid ankle cushion heel foot with a wooden keel (solid ankle cushion heel foot, Otto Bock). Methods: A total of 15 participants with unilateral transtibial amputation were evaluated using the two prosthetic feet in a randomized prospective double-blind crossover study. Main outcomes were patient satisfaction questionnaires (Satisfaction with Prosthesis Questionnaire and prosthetic foot satisfaction) and energy expenditure (oxygen consumption—mL/kg/min, oxygen cost—mL/kg/m, and heart rate—bpm). Results: There were no significant differences between the two prosthetic feet for satisfaction and energy expenditure. Conclusion: The low-cost solid ankle cushion heel foot with polypropylene keel provides comparable satisfaction and similar energy expenditure as the solid ankle cushion heel foot with wooden keel. Clinical relevance The results of this study support the application and widespread use of the CR-Equipements™ solid ankle cushion heel foot. From a cost-effectiveness standpoint, patients are well satisfied and exhibit similar outcomes at a substantially lower cost.

Step activity monitoring to assess ambulation before and after total ankle arthroplasty.

BACKGROUND The study objective was to compare walking activity before and after total ankle arthroplasty (TAA). METHODS Nineteen patients who underwent TAA were prospectively reviewed with a dedicated ambulatory activity-monitoring device. Patients were tested 1 month prior to surgery, and at least 18 months post-operative. Ambulatory parameters included number of steps at different cadences and time spent walking at different paces. The American Orthopaedic Foot and Ankle (AOFAS) hindfoot scale was assessed at similar intervals. RESULTS Following TAA, there was significant improvement in the number of steps walked at normal cadence, while importantly the number of steps walked at low and medium cadence decreased. There was no significant difference between the time actually spent walking at any cadence after arthroplasty. The mean AOFAS hindfoot scale significantly improved. CONCLUSIONS Following TAA, patients show an improved walking pace and AOFAS hindfoot scale, but no difference in the amount of time spent walking.