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Can an Integrated Orthotic and Rehabilitation Program Decrease Pain and Improve Function After Lower Extremity Trauma?

  • Symposium: Recent Advances in Amputation Surgery and Rehabilitation
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation over time is unknown.

Questions/purposes

(1) Does an 8-week integrated orthotic and rehabilitation initiative improve physical performance, pain, and outcomes in patients with lower extremity functional deficits or pain? (2) Is the magnitude of recovery different if enrolled more than 2 years after their injury versus earlier? (3) Does participation decrease the number considering late amputation?

Methods

We prospectively evaluated 84 service members (53 less than and 31 > 2 years after injury) who enrolled in the initiative. Fifty-eight sustained fractures, 53 sustained nerve injuries with weakness, and six had arthritis (there was some overlap in the patients with fractures and nerve injuries, which resulted in a total of > 84). They completed 4 weeks of physical therapy without the orthosis followed by 4 weeks with it. Testing was conducted at Weeks 0, 4, and 8. Validated physical performance tests and patient-reported outcome surveys were used as well as questions pertaining to whether patients were considering an amputation.

Results

By 8 weeks, patients improved in all physical performance measures and all relevant patient-reported outcomes. Patients less than and greater than 2 years after injury improved similarly. Forty-one of 50 patients initially considering amputation favored limb salvage at the end of 8 weeks.

Conclusions

We found this integrated orthotic and rehabilitation initiative improved physical performance, pain, and patient-reported outcomes in patients with severe, traumatic lower extremity deficits and that these improvements were sustained for > 2 years after injury. Efforts are underway to determine whether the Return to Run clinical pathway with the Intrepid Dynamic Exoskeletal Orthosis (IDEO) can be successfully implemented at additional military centers in patients > 2 years from injury while sustaining similar improvements in patient outcomes. The ability to translate this integrated orthotic and rehabilitation program into the civilian setting is unknown and warrants further investigation.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Andrea Garza for her assistance as the research nurse overseeing this study. We also thank Socorro Garcia, Kerri Anguiano, Dennis Mann, Donna Lopez, and Mary Fan for assistance with carrying out the testing and Eduardo Anguiano for assistance with data management and John Jones for assistance with the statistics.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA

    Katherine M. Bedigrew MD, Jeanne C. Patzkowski MD & Daniel J. Stinner MD

  2. Center for the Intrepid, Fort Sam Houston, TX, USA

    Jason M. Wilken PhD, MPT & Johnny G. Owens MPT

  3. Hanger Clinic, Tacoma, WA, USA

    Ryan V. Blanck LCPO

  4. University Orthopaedic Associates of New Jersey, Somerset, NJ, USA

    Kevin L. Kirk DO

  5. Carolinas Medical Center, Charlotte, NC, USA

    Joseph R. Hsu MD

Authors
  1. Katherine M. Bedigrew MD
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  2. Jeanne C. Patzkowski MD
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  3. Jason M. Wilken PhD, MPT
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  4. Johnny G. Owens MPT
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  5. Ryan V. Blanck LCPO
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  6. Daniel J. Stinner MD
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  7. Kevin L. Kirk DO
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  8. Joseph R. Hsu MD
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Consortia

Skeletal Trauma Research Consortium (STReC)

Corresponding author

Correspondence to Katherine M. Bedigrew MD.

Additional information

One of the authors (RVB) is the developer of the Intrepid Dynamic Exoskeletal Orthosis but does not have any financial interests, patent, or licensing agreements. One of the authors (JRH) is on the speakers’ bureau for Smith & Nephew (Memphis, TN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at San Antonio Military Medical Center, Fort Sam Houston, TX, USA. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, Department of Defense, or the US Government.

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Bedigrew, K.M., Patzkowski, J.C., Wilken, J.M. et al. Can an Integrated Orthotic and Rehabilitation Program Decrease Pain and Improve Function After Lower Extremity Trauma?. Clin Orthop Relat Res 472, 3017–3025 (2014). https://doi.org/10.1007/s11999-014-3609-7

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  • DOI: https://doi.org/10.1007/s11999-014-3609-7

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