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Does a Torsion Adapter Improve Functional Mobility, Pain, and Fatigue in Patients with Transtibial Amputation?

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

Abstract

Background

Turning gait is an integral part of daily ambulation and likely poses a greater challenge for patients with transtibial amputation compared with walking a straight pathway. A torsion adapter is a prosthetic component that can increase transverse plane compliance of the prosthesis and decrease the torque applied to the residual limb, but whether this will improve patients’ mobility, pain, and fatigue remains unknown.

Questions/purposes

Does prescription of a torsion adapter translate to improvements in (1) functional mobility and (2) self-perceived pain and fatigue in moderately active patients with lower limb amputation?

Methods

Ten unilateral transtibial amputees wore a torsion or rigid adapter in random order. Functional mobility was assessed through a field measurement using an activity monitor and through a laboratory measurement using a 6-minute walk test that included turns. The residual limb pain grade assessed self-perceived pain and the Multidimensional Fatigue Inventory assessed fatigue.

Results

We found relatively small functional differences for amputees wearing a torsion adapter versus a rigid adapter. Amputees wearing a torsion adapter tended to take more low- and medium-intensity steps per day (331 ± 365 and 437 ± 511 difference in steps; effect size = 0.44 and 0.17; confidence interval [CI], 70–592 and 71–802; p = 0.019 and 0.024, respectively). They also experienced less pain interference with activities (1.9 ± 1.7 change in score; effect size = 0.83; CI, 0.3–3.4; p = 0.026) when wearing a torsion adapter. However, these patients took a similar number of total steps per day, walked a comparable distance in 6 minutes, and reported similar residual limb pain and fatigue.

Conclusions

For a moderately active group of amputees, the torsion adapter did not translate to substantial improvements in functional mobility and self-perceived pain and fatigue. The small increases in low- and medium-intensity activities with less pain interference when wearing a torsion adapter provides evidence to support prescribing this device for amputees with difficulty navigating the household and community environments.

Level of Evidence

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

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Acknowledgments

We thank Jane B. Shofer MS, for performing the statistical analysis and Wayne Biggs CPO, for the prosthetic adjustments.

Author information

Authors and Affiliations

  1. Department of Veterans Affairs, Rehabilitation Research and Development Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Seattle, WA, USA

    Ava D. Segal MS, Rose Kracht BS & Glenn K. Klute PhD

  2. Department of Mechanical Engineering, University of Washington, Seattle, WA, 98108, USA

    Glenn K. Klute PhD

Authors
  1. Ava D. Segal MS
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  2. Rose Kracht BS
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  3. Glenn K. Klute PhD
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Corresponding author

Correspondence to Glenn K. Klute PhD.

Additional information

The institution of the authors has received funding from the Department of Veterans Affairs, Rehabilitation Research and Development Service, grants A3611I and A9243C.

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 before 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 the Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

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Segal, A.D., Kracht, R. & Klute, G.K. Does a Torsion Adapter Improve Functional Mobility, Pain, and Fatigue in Patients with Transtibial Amputation?. Clin Orthop Relat Res 472, 3085–3092 (2014). https://doi.org/10.1007/s11999-014-3607-9

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  • DOI: https://doi.org/10.1007/s11999-014-3607-9

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