Hemakumar Devan

Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey

Lower-back pain (LBP) is a common secondary condition following lower-limb amputation. The purpose of this study was to investigate LBP prevalence and the relationship between LBP and physical activity (PA) levels in a national sample of persons with traumatic transfemoral amputation (TFA). Questionnaires were mailed to a random sample of people with traumatic TFA (n = 322) from the New Zealand Artificial Limb Board national database. Of the participants who completed the survey (55% response rate), 64.1% reported LBP and 39.1% reported restricted PA due to LBP. There was no relationship between the PA levels of persons with and without LBP (chi-square = 2.11, p > 0.05). There was an equal distribution of persons with LBP in low, medium, and high PA subgroups. However, persons who reported restricted PA due to LBP had lower PA scores than persons with LBP and no restricted PA (chi-square = 11.56, p < 0.05). Based on our results, LBP is prevalent in the traumatic TFA population. PA levels are not influenced by the presence or absence of LBP. However, future studies investigating LBP coping strategies and using objective PA outcome measures might further elucidate the relationship between PA and LBP in this population.

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

Following amputation, people with transfemoral amputation (TFA) and transtibial amputation (TTA) adapt with asymmetrical movements in the spinal and lower-limb joints. The aim of this review is to describe the trunk, lumbopelvic, and hip joint movement asymmetries of the amputated limb of people with TFA and TTA during functional tasks as compared with the intact leg and/or referent leg of nondisabled controls. Electronic databases were searched from inception to February 2014. Studies with kinematic data comparing (1) amputated and intact leg and (2) amputated and referent leg of nondisabled controls were included (26 articles). Considerable heterogeneity in the studies precluded data pooling. During stance phase of walking in participants with TFA, there is moderate evidence for increased trunk lateral flexion toward the amputated limb as compared with the intact leg and increased anterior pelvic tilt as compared with nondisabled controls. None of the studies investigated spinal kinematics during other functional tasks such as running, ramp walking, stair climbing, or obstacle crossing in participants with TFA or TTA. Overall, persons with TFA adapt with trunk and pelvic movement asymmetries at the amputated limb to facilitate weight transfer during walking. Among participants with TTA, there is limited evidence of spinal and pelvic asymmetries during walking.

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.

What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis

Background. Self‐management interventions fostering self‐efficacy improve the well‐being of people with chronic pain. Purpose. The purpose of this study was to synthesize the enablers (what works) and barriers (what does not) of incorporating self‐management strategies for people in everyday life after completion of a pain self‐management intervention. Data Sources. Major electronic databases (MEDLINE, AMED, PsycINFO, Cochrane Library, PubMed, CINAHL, Scopus, and Google Scholar) were searched from inception to July 2016. Study Selection. Study selection included qualitative and mixed‐method studies that explored the perceptions of individuals with chronic pain after completion of a self‐management intervention. Data Extraction. A thematic analysis approach was used to synthesize the review findings, and a Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence. Data Synthesis. Thirty‐three studies with 512 participants were included. Enablers to self‐management included self‐discovery—the ability to distinguish self (ie, body, thoughts, and feelings) from pain; feeling empowered by incorporating self‐management strategies into practice; and supportive ambience via collaborative relationships with clinicians and support from family and friends. Barriers to self‐management included difficulty with sustaining motivation for pain self‐management; distress experienced from ongoing pain, anxiety, and depression; and unsupportive relationships with clinicians, family, and friends. Limitations. This review only included interventions that involved at least 4 self‐management skills; thus, informative studies may have been missed. The follow‐up period varied from immediately after the intervention to 72 months following the intervention; therefore, it is uncertain which of the key enablers and barriers were most influential long term. Only articles published in the English language were included; studies conducted in low‐ and middle‐income countries could not be located. Conclusions. The sustained effort to self‐manage chronic pain could be exhausting, and motivation could wane over time following intervention. Providing intermittent support in the form of booster sessions and peer support groups may be important. Person‐centered care via shared decision making and guided problem solving is essential to facilitating ongoing self‐management.

Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy

Abstract Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. Method: We evaluated components of the therapeutic intervention, from the patients’ and the therapists’ points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation

Spinal and Pelvic Kinematics During Gait in People with Lower-Limb Amputation, with and without Low Back Pain: An Exploratory Study

Introduction Despite the high prevalence of chronic low back pain (LBP) in people with lower-limb amputation, it is not clear whether there are differences in spinal and pelvic motion in individuals with and without LBP. This exploratory study aimed to describe the spinal and pelvic kinematics during gait in people with transfemoral amputation (TFA) and transtibial amputation (TTA), with and without LBP. Methods Eighteen participants with traumatic amputation (6 TFA, 12 TTA) were grouped according to their amputation level and presence (or absence) of LBP. Three-dimensional thoracic, lumbar, and pelvic kinematics during walking were reported to identify movement patterns that may be indicative of LBP. Results The TFA-LBP group elevated the pelvis on the intact side and minimized lumbar lateral flexion to achieve the same trunk lateral flexion angle (Trendelenburg gait) as those with TFA-No LBP. Those with TFA-LBP kept the lumbar spine rotated toward the prosthetic limb throughout the gait cycle. There were no differences in the spinal and pelvic kinematics of people with TTA-LBP and TTA-No LBP. Conclusions This study provides preliminary evidence of differences in spinal and pelvic kinematics that may be associated with LBP in people with TFA.

Park-based physical activity interventions for persons with disabilities: A mixed-methods systematic review

BACKGROUND Park-based physical activity (PA) interventions improve health in the general population, but it is unknown if the evidence can be translated to persons with disabilities. OBJECTIVES To conduct a mixed-methods systematic synthesis of the evidence for park-based physical activity interventions for persons with disabilities and secondarily, to consider the health benefits across the lifespan (children and adolescents, young, middle, and older adults). METHODS All major electronic databases were searched from inception until 30th November 2016. Studies were eligible if the PA intervention was conducted in an urban park environment with people reporting a disability (e.g. physical, psychological and developmental impairments) and health outcomes were evaluated with biopsychosocial measures. Methodological quality was assessed using Crowes Critical Appraisal Tool (CCAT) and key findings extracted. RESULTS Six quantitative and four qualitative papers, comprising of 446 participants (age range seven to ninety-one years), were included for qualitative synthesis; five in children/adolescents, none in adults, and five in older adults. There was limited, low level, preliminary evidence for short-term improvements in physical, psychological, and social health outcomes in children and older adults with disabilities as well as improvements in disability-related impairments. When accessible, parks fostered societal inclusion. CONCLUSIONS Health benefits from park use in persons with disabilities were identified. Parks may provide an alternative environment for rehabilitation and management of disabilities. Further randomized controlled trials evaluating the long-term effectiveness of park-based interventions is necessary to corroborate our findings. Legislative commitment ensuring urban parks are accessible may mitigate some health disparities in persons with disabilities.

The relationship between chronic low back pain and fatigue: a systematic review

Background: Fatigue is a common non-specific symptom in the general population. The association between fatigue and pain is high and people with chronic conditions and/or pain report high prevalence of fatigue. Individuals with chronic low back pain (CLBP) often experience fatigue symptoms and those who experience fatigue are more likely to have restricted physical functioning. It is important to clarify the association between CLBP and fatigue in order to devise management strategies which alleviate and/or manage fatigue symptoms while improving physical functioning in individuals with CLBP. Objectives: The main aim of this systematic review is to determine the level of evidence supporting the association between self-reports of LBP and fatigue in individuals with CLBP. Methods: Major electronic databases were searched since inception till April 2016. Studies comparing the association between CLBP and general fatigue were included. Results: Considerable heterogeneity in the included studies precluded a meta-analysis. Five studies were included for final descriptive synthesis. There is very limited evidence to support the association between presence of CLBP and fatigue. There is moderate evidence to support the association between CLBP intensity and/or CLBP functional disability and fatigue. Conclusion: The association between fatigue and CLBP is under researched although there is moderate association between CLBP intensity and CLBP disability with fatigue. Fatigue is an important symptom that should be considered in the assessment and management of patients with CLBP.