Background: Cosmesis has been found to have an impact on prosthesis users' body image. Therefore the satisfaction of the cosmesis plays an essential role in a prosthesis user perception of themselves. Most cosmeses on the market are natural-looking, although more futuristic options are coming to the market. Most of the previous evidence has been conducted using quantitative methods. There is a lack of research investigating the experiences of cosmesis in transtibial prosthesis users through qualitative methods. This is expected to elucidate potentially undiscovered areas and factors surrounding patient satisfaction. 

Purpose: The aim of this thesis is to explore transtibial prosthesis user's satisfaction with the appearance of their cosmesis and gain a deeper understanding of their experiences regarding cosmeses. 

Methods: The method in this thesis is a qualitative phenomenology approach with an interpretivist view. The experiences of 5 male transtibial users regarding their cosmesis and satisfaction towards it were explored. This was done by having in-depth semi-structured interviews that were analyzed with thematic analysis. 

Results: The results five main themes arrived: Satisfaction, Natural-looking cosmesis, Function, Difficulties with the material, and Awareness. The results of these themes showed that the participants have different experiences regarding cosmesis. 

Conclusion: This thesis found a variation regarding satisfaction of the appearance among unilateral transtibial prosthesis users. Similarities in satisfaction and experience were found in the respective age groups of the participants. However, due to saturation not being fully reached, there should be further investigations. 

En studie har genomförts med syftet att undersöka diabetespatienters tolkning av informationen som ges av deras respektive ortopedingenjör under ett patientmöte samt undersöka vad ortopedingenjören anser sig ha förmedlat för information till patienten under patientmötet. Metoden i studien är kvalitativ där intervjuer med semistrukturerade öppna frågor har använts. I studien ingick två ortopedingenjörer samt två diabetespatienter. Efter avslutade intervjuer har materialet från intervjuerna analyserats och bildat kategorier. Dessa kategorier har sedan använts för att finna skillnader samt likheter mellan ortopedingenjörens och patientens tolkningar. Patientmötens har spelats in för att få möjligheten att se vart missförstånd uppstått. Genomgående i resultatet var att ortopedingenjören anser sig ha förmedlat mer information än vad patienten beskriver under intervjuerna. Några missförstånd upptäcktes men kommunikationen mellan parterna var god.  

The aim of this scoping review is to identify and map literature available on how different seating solutions in wheelchairs impact pelvic stability in adult patients with spinal cord injury. The secondary aim is to describe how pelvic stability is assessed in a wheelchair in the studies. 70 million people worldwide need a wheelchair, and 250–500 thousand people suffer a spinal cord injury each year worldwide. Spinal cord injury patients spend on average nine to eleven hours a day sitting in a wheelchair, which makes the seating interface very important. The stability is affected in the majority of individuals with SCI since the stabilizing muscles abilities are impaired or completely lost. To increase the stability a solid base of support is needed, and that begins with the pelvis. (n=12) articles and (n=3) sources of grey literature were found about the subject. All information relating to how the pelvis was affected was extracted and analyzed. (n=32) seating solutions were investigated for their impacts on the pelvis. (n=12) assessment methods were analyzed. The results showed a clear lack of evidence in all aspects related to seating solutions impact on pelvic stability in adult spinal cord injury patients.

Background: Prosthetic users often have problems with optimal fit and experience changes in volume. A RevoFit2 lamination kit allows the prosthetist to apply targeted compression gates that allows the user to change or reduce pressure without removing clothes.

Aim: The purpose of this study was to investigate whether a volume-adjustable prosthetic with RevoFit2 can give the user a better comfort throughout the day based on pressure distribution and volume change compared to a traditional laminated prosthesis.

Method: The pressure between the lower leg and the prosthetic and the volume of the lower leg were measured on a healthy person diagnosed with longitudinal dysmelia. The static and dynamic tests and volume of the residual limb were examined over four days. All tests spread over morning, noon and afternoon.

Results: Significant pressure reduction occurred using the RevoFit2-prosthetic compared to the traditional laminated prosthetic on most of the pressure points. The change of pressure throughout the day was also significantly decreasing on the RevoFit2-prosthetic compared to the laminated prosthetic, which were significantly increasing. No significance was found when measuring volume changes throughout the day.

Conclusion: RevoFit2 is a useful and easily manageable method to gain increased comfort for the user. By using RevoFit2 it is possible to reduce the pressure on the bony landmarks.

Background: Scanners are becoming widespread in Prosthetics and Orthotics, replacing plaster casting in the manufacture of some types of devices. P&O shape capture must be accurate and reliable, so the device is comfortable and reproducible between clinicians/sessions.

Objectives: To map knowledge on measuring accuracy and reliability of spatial data produced from 3D scanners.

Methods: The study design was a scoping review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Studies published in or after 2010 in English with a full-text available that analyse either the accuracy/validity or reliability of human 3D scanning data within a P&O context. Sources were obtained from Pubmed, CINAHL, Scopus, Cochrane Library, Web of Science, and AMed databases on 25th March.

Results: The search identified 115 studies of which 9 were included (7 experimental [4 prosthetic, 3 orthotic], 1 systematic review, 1 literature review). 7 analysed both reliability and accuracy/validity and 2 analysed reliability. High heterogeneity amongst studies’ methods, techniques, and equipment.

Conclusion: Methods, techniques, and equipment used to measure accuracy/validity and reliability varied greatly though more so in the measurement of accuracy/validity. Within the studies, researchers called for more research on standardisation of measurement methods and techniques.

Introduction:Malawi is located in south-east Africa, 53% of the population live below the poverty line. Few studies have specifically investigated the situation for people with physical disabilities in Malawi. The aim of this study was to explore the opinions and feelings of how it is to live with a physical disability in Malawi from a prosthetic and orthotic patient perspective.

Methods:A qualitative study using individual semi-structure interviews for data collection was performed with 16 patients, men and women with physical disabilities receiving services from the prosthetic and orthotic centre in Lilongwe, Malawi. Data were analysed using content analysis.

Results:Six categories emerged from the data. People with physical disabilities felt independent and wanted to take care of themselves. They experienced mainly positive attitudes and encouragement from others. They had a positive view of life, but the disability affected their life situation. Contact with other people with physical disabilities was requested for support and experience-sharing. The major concern was work and the financial situation. Ability to work was important to meet basic needs and for the feeling of independence. Negative attitudes were a result of poor knowledge.

DiscussionThe study showed a clear need of creating work opportunities specifically for people with physical disabilities, since having a job was found important for many reasons. Support programs profiled to help and strengthen people with physical disabilities in Malawi would be beneficial for them to access the labour market. Spreading knowledge and information about physical disabilities and orthopedic devices is a key issue to create a better understanding and to change people ́s attitudes.

Conclusions:Work was important for the feeling of freedom, independence and for the self-image. Negative attitudes were uncommon, but when seen they were a result of poor knowledge about causes of disability and the situation for these people.

Aim: According to Swedish and Danish law interventions must be based on evidence, and evidence related to rest orthoses in contracture management is limited and inconclusive, making justification of using rest orthoses difficult. The aim is to understand the clinicians’ perceptions of the benefit of rest orthoses when managing wrist and hand contractures, to shape a basis for clinical evidence.Method: A qualitative interview study was made and a total of 13 participants with 2 to 40 years of experience was included. Interviews were transcribed and translated into English. A thematic analysis was undertaken by two researchers. Three themes and seven subthemes were identified and discussed. Results: There was congruence among the participants that rest orthoses can maintain RoM when used but they need to be used at least 6 to 8 hours every day. Combination of botox and rest orthoses has a good effect in many patients with spasticity for maintaining RoM and some function. Many patients gain a benefit in maintaining hygiene, a reduction in pain and easier for patients getting dressed. Conclusion: The interviewed clinicians perceived that rest orthoses can impact pain and prevent contracture formation however evidence was inconclusive, but it merits further research.

Background: Sweating of the stump is a well-known problem which affects lower limb prosthetic users. The problem has not been investigated in Denmark. Therefore the aim of this study is to investigate the prevalence of sweat related problems, plus whether reasons like level of amputation, age, time since amputation etc., may affect hyperhidrosis in the socket in people with lower-limp amputations. The investigation is carried out by people who live in Denmark.

Method: A questionnaire was used to investigate hyperhidrosis and the factors which may affect this. The questionnaire contained descriptive questions and the Hyperhidrosis Disease Severity Scale (HDSS).

Results: In the present study 27 participants were included. 66,7 % of participants were affected by hyperhidrosis in their daily activities. The participants sweat significantly more in the summer season compared to the others seasons. 33,3 % had problems with the prosthetic fit because of sweating. Level of amputation, age, time since amputation, BMI and level of activity had no influence on hyperhidrosis.

Conclusion: Sweating of the stump is a big problem for people with amputation in Denmark. Especially in the months of summer where sweating was reported as significantly worse when compared to other seasons. The reasons why people with amputation are affected by hyperhidrosis in the socket is still not clear. More research is therefore needed in this area.

Aim: The aim of this in vitro study was to develop and test an experimental set-up consisting of a video camera and computer-based optoelectronic motion analysis system, synchronized with a loading device, for studying load-dependent deflections in three dimensions of single implant-supported cantilever beams.

Material and methods: One Brånemark System implant was tightly screwed into a steel plate so that the entire implant became submerged. An abutment was attached to the implant and a cast 22-mm-long cantilever gold alloy beam incorporating a prefabricated gold cylinder was attached to the abutment with a prosthetic gold screw. A force transducer was glued on the upper surface of the beam end with its centre 19.4 mm from the centre of the implant abutment gold cylinder unit to register the applied load. A specially designed loading device was used to apply increasing vertical loads of the beam end via the transducer. The motion analysis system was synchronized with the transducer to enable measurements of three-dimensional positional changes of the beam end related to known loads.

Results: Vertical loads from 15.7 to 40.4 N were applied resulting in vertical positional changes of the beam end ranging from 40.8 to 225.2 μm (z-axis). The corresponding horizontal changes perpendicular to the long axis of the beam (y-axis) due to counterclockwise horizontal rotation of the beam around the abutment- and prosthetic cylinder threads varied from 7.4 to 77.4 μm. This rotation changed the position of the beam end from 11.9 to 49.3 μm along the x-axis of the coordinate system toward the supporting implant.

Conclusion: It was possible to arrange an experimental set-up for optoelectronic 3-D measurements within such a limited measurement volume that would permit satisfactory registrations of small load-dependent deflections of the prosthetic beam and implant components.

Aim: The aim of this study was to evaluate the accuracy, i.e. trueness (validity) and precision (repeatability) for load-dependent deflections in three dimensions of an implant-supported cantilever beam obtained with an optoelectronic motion analysis system compared with a well-known reference method.

Materials and methods: A cantilever beam with a length of 22 mm (roughly corresponding to the width of two premolars) was screw-connected to an implant–abutment unit stiffly anchored in a steel plate. The positional changes of beam-end were measured when the beam-end step by step was subjected to four loads, 15.5–40.1 N. This measurement procedure was repeated to comprise six consecutive measurements. The trueness of the method was estimated by comparing the data obtained for vertical deflections with those from a reference method where a hydraulic test system was used to measure the load-deflection ratios of the same beam when subjected to the four mentioned vertical loads.

Results: All applied transducer-mediated loads had accuracies (truenesses and repeatabilities below 0.05%). Also, the trueness and precision of the reference method, regarding both movements (deflections) of tested objects and magnitude of applied loads, were tested and found to be high, not exceeding 0.5%.

The optoelectronic method however underestimated the smallest vertical deflections for the cantilever beam when compared with the data obtained from the reference method. The underestimation was 26.4%, 15.5% and 8.6% for loads 15.5, 26.6 and 32.6 N, respectively, while there was a slight overestimation of 1.2% for 40.1 N. The precision for the optoelectronic method was found to be for z-axis 1.8 μm, y-axis 3.8 μm and x-axis 1.9 μm.

Conclusion: It can be concluded that the trueness (validity) for the optoelectronic method is very high for deflections above 143 μm. The precision (repeatability) of the optoelectronic method was found to be very high.

Aim: The purpose of this in vitro study was to investigate the influence of degree of stiffness of implant-abutment connection of a Brånemark implant system on load- deflection ratios in three dimensions of the beam-end of a screw-retained stiff cantilever beam when subjected to vertically directed loads.

Material and methods: Two different implant-abutment connections were tested; welded and screw-retained. One of the abutments (EsthetiCone 2.0; Nobel Biocare AB) was screwed with a torque force of 20 N cm and then laser welded around its entire periphery to one of two Brånemark implants (welded unit). This unit and the other implant were tightly screwed into each of two pre-threaded holes in a steel plate so that the implants became submerged in the plate. The remaining abutment was thereafter screwed to its implant with a torque force of 20 N cm (screw-retained unit). A cantilevered gold beam of 6 mm height and width comprising a gold cylinder (Nobel Biocare AB) was attached to each abutment with a slotted, flat headed, prosthetic gold screw (torque force 10 N cm). A force transducer, synchronized with a 3-D motion analysis system, was glued on the upper surface of each beam-end 19.4 mm from the implant, to register the loads transferred from a specially built loading device. The beam-ends were stepwise subjected to vertically directed loads from 14.9 to 40.3 N and the vertical and horizontal deflections of the beam-ends were registered with the 3-D motion analysis system.

Results: For load 14.9–40.3 N the vertical (z-axis) deflections of the beam-end were for the welded implant-abutment connection reduced with 18–46% compared with the screw-retained unit. After maximal loading (40.3 N) the horizontal counter-clockwise rotation of the beam around the screw joints (y-axis rotations) was reduced with 61% for the welded connection. The horizontal movements of the beam-end along the x-axis (x-axis deflections) were reduced with 49% at maximal loading.

Conclusion: It was concluded that increased implant-abutment stiffness will substantially reduce both vertical and horizontal deflections of a screw-retained stiff cantilever beam subjected to vertically directed loads.

SummaryBackground

Prosthetic users face significant challenges both physically and psychologically. Falling poses a significant risk for the individual, and a consequence of this is gaining a fear of falling and self-imposed restrictions. These consequences can have a major impact on the individuals’ health and quality of life. However, the research in this area is limited.

Objectives 

This study aims to investigate prosthetic users’ fear of falling and the circumstances surrounding falls among individuals with a lower-limb amputation in England and Sweden.

Method 

In April 2022 a cross-sectional survey was conducted in England and Sweden. 11 participants were recruited. The survey was aimed at the population of lower-limb amputated individuals at the age of 18 or above in the two countries. The survey consists of 111 items with mostly closed-ended questions. Descriptive and inferential statistical methods were used for the analysis of the data.    

Results 

The study showed that 8 (72.7%) out of 11 participants had not experienced a fall within the last 30 days and the most common frequency of falls was every six months (54,5%). 2 (18.2%) participants had a fall once every three months which was the highest frequency of falls reported in the survey. This is seen as low frequency, however, 7 (63,3%) out of 11 participants had a fear of falling. A correlation between Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC) and Gait-Specific Attentional Profile instruments (G-SAP) was performed using a Pearson’s product-moment correlation which showed there was a strong relationship between the three instruments. The correlation between the FES-I and G-SAP is 0,800, FES-I and ABC are -,853 and the correlation between ABC and G-SAP is -, 821.

Conclusion 

A strong relationship was found between the Falls Efficacy Scale-International, Activities-specific Balance Confidence Scale and the Gait-Specific Attentional Profile. Regardless of having fallen within the past 30 days, a high concern of fear of falling was found, and the most common reason for falls was uneven surfaces such as gardens.

Aim: This review aims to describe the existing evidence base for using elevated vacuum suspension and pin-lock suspension systems in regards to fluctuations of limb volume, balance, effect on gait (spatial and temporal, kinematic, and kinetic data), and in-socket movement (pistoning and transverse forces).

Background: There is a growing population with a TT amputation thus there is an increased demand for TT prosthetic solutions. There are a multitude of different suspension methods with different drawbacks and benefits. This review investigates elevated vacuum suspension (EVS) and pin-lock suspension systems.

Method: A systematic search was conducted in Medline, PubMed, and Scopus, and included or excluded articles per the eligibility criteria. The chosen studies will be carefully read and critically appraised for their quality of evidence.

Results: 13 articles were found that matched the eligibility criteria and aim, 5 articles included pin-lock suspension systems and 9 included EVS systems. 3 looked at limb volume fluctuation, 1 at balance, 4 at in-socket movement (transverse forces and pistoning), and 8 at the quality of gait (temporal and spatial, kinematic, and kinetic).

Conclusion: Several of the articles included in this review indicate that EVS results in better performance on balance tests, higher velocity, and a more stable residual limb volume than other suspension systems. Furthermore, it was shown that prosthetic users with an EVS had more normal values in their ROM during gait and less in-socket movement.

Background: Osteoarthritis of the knee is a condition that can emerge without any known reason, though most commonly it is caused by previous damage to the anatomical structures inside the joint. The most common symptom is pain during rest and activity. Individuals diagnosed with osteoarthritis often experience difficulties with performing certain types of movements and activities due to pain. Aim: Based upon a qualitative inductive content analysis, the aim is to investigate on a subjective level how individuals diagnosed with medial osteoarthritis experience pain and function, in relation to brace usage. Method: This study is based on recorded semi structured open-ended interviews with three individuals diagnosed with medial osteoarthritis whom uses a knee brace or knee orthosis. Results: The study generated six sub-categories which created two main categories describing the experience of medial osteoarthritis by the individuals. The results showed experience of affected physical ability and adaptation to pain. Conclusion: Individuals diagnosed with medial osteoarthritis experience limitation in activity and ADL mostly due to pain, though decreased function of the knee joint seems to be a contributing factor to limitation as well. Using a knee brace eases pain to some degree and enable individuals to perform some activities in comparison to when not using a knee brace. These conclusions should be considered with caution since the number of individuals interviewed in this study is small and may not provide the same information as of a larger number of individuals with medial osteoarthritis. 

Aim: The project aimed to assess the frequency of offloading provision for diabetes-related plantar neuropathic forefoot ulcers and the factors influencing the choice.

Methods: Operational managers from 51 prosthetic and orthotic clinics in Sweden were contacted to select the participants. An online survey including seven closed-ended questions was conducted through SurveyMonkey.

Results: The response rate was 68.6%. The majority of the participants provided the least efficient offloading intervention being off-the-shelf footwear combined with the insole to treat diabetes-related plantar neuropathic forefoot ulcers.  It also resulted that the two gold-standard devices to treat this ulcer type being total contact cast (TCC) and non-removable knee-high walker, were vastly underutilized. Most of the practitioner, patient, intervention, and wound-related factors were considered a median of “often” or “always” being considered when providing offloading interventions for this type of ulcer. The majority of the participants did not consider TCC or non-removable knee-high walkers being the gold standard. 

Conclusions: A variety of offloading interventions resulted in being provided to patients having diabetes-related plantar neuropathic forefoot ulcers. Participants mainly provided the inadequate pressure distribution offloading intervention, being off-the-shelf footwear with modifications combined with an insole. The gold standards TCC and non-removable knee-high walkers were underutilized. That is, the pattern of providing offloading devices was almost exactly opposite to what evidence-based guidelines recommend. The clinicians’ unawareness regarding gold standard devices may have contributed to the underutilization of TCC and non-removable knee-high walker. Different factors were considered when providing offloading interventions to patients with diabetes-related plantar neuropathic forefoot ulcers. It is concluded that clinicians in Swedish P&O clinics need to have greater awareness regarding the most appropriate offloading device for plantar neuropathic forefoot DFUs. This is of great importance due to the choice of the offloading device greatly impacts ulcer healing.

Background:Within the prosthetics profession, there is a lack of evidence to support many clinical practices. It is therefore important that clinicians systematically document and evaluate their daily practices.Objectives:To record preoperative characteristics and functional outcomes for patients with a lower limb amputation and to investigate variations between prosthetic users and non-prosthetic users.Study Design:Prospective cohort study.Methods:A total of 23 patients (mean age = 80 years, standard deviation = 7.3) who underwent a major lower limb amputation were assessed within 2 weeks of admission and 6 months post-operatively. Locomotor Capabilities Index-5, the Timed-Up-and-Go Test and prosthetic use were used to evaluate functional outcomes.Results:A total of 13 participants (57%) received a prosthesis within 6 months of amputation. Mean time to prosthetic fitting was 48 days (range = 28-97). No statistically significant difference was found between prosthetic users and non-prosthetic users regarding age, time to rehabilitation and Locomotor Capabilities Index-5 (p > 0.05). Locomotor Capabilities Index-5 basic was significantly lower at 6 months than prior to amputation (p = 0.039).Conclusion:The functional outcome at 6 months indicates a sizable restriction in mobility among lower limb amputees. No variation in preoperative characteristics between prosthetic users and non-prosthetic users could be confirmed in this study.Clinical relevanceThis study highlights the need for prosthetists to better incorporate research findings into their daily practice and presents an example of how to implement a procedure for assessment and documentation of patients' functional outcomes in a clinical setting. Results confirm difficulties in identifying amputees who will become prosthetic users based on preoperative characteristics.

Background: The number of people with diabetes is rising globally, and they are at higher risk of foot complications that can ultimately result in lower limb amputation. Additionally, individuals with diabetes whoundergo amputation are more likely to lose the contralateral limb. Consistent care and preventive measuresare crucial for reducing the risk of further amputations.

Aim: This study aims to explore the current experience of certified prosthetist and orthotist in Denmarkconcerning the assessment of the contralateral limb in individuals with diabetes who utilize a lower limbprosthesis.

Method: A qualitative study with an exploratory research design was conducted. Thematic analysis, using aninductive approach was employed to analyze data from eight semi-structured interviews with CPOs from Denmark.

Findings: The analysis of the interview results revealed three main themes - responsibility, prioritization,and barriers - which frequently overlap. Each theme had multiple sub-themes which highlights the variationin the participants’ experiences.

Conclusion: The variation in responses gathered from the interviews unveiled diverse perspectives on responsibility, prioritization, and barriers which points to a lack of clear guidelines in the Danish healthcaresystem regarding this assessment of the contralateral limb in this patient group. This study offers novel insightsinto the diverse experiences and decision-making processes of Danish CPOs when it comes to the contralaterallimb assessment in diabetic foot care.

Introduction:Women with disabilities living in developing countries generally suffer from triple discrimination because of their disability, gender and socio-economic position and are therefore assumed to have a lower Quality of Life (QoL). In the present study conducted in South India, women with lower-limb disabilities using orthotic or prosthetic devices were compared to non-disabled women.

Method:119 participants. Socio-demographic data was collected and the WHOQOL-BREF in English and Kannada was used to measure QoL in four domains: physical, psychological, social relationships and environment.

Results:No statistically significant differences (p > 0.05) were found in the mean scores of the four domains between the two groups. However, differences related to socio-demographic factors were found: The married test group had lower scores in the physical, psychological and environmental domains compared to the married control group. The test group with children had lower scores in the physical domain compared to the control group with children. Women in rural areas use their assistive devices far less than women living in the city, although no difference in device satisfaction was found.

Discussion:QoL is not determined to be low when living with a physical disability. Marriage and life with children have a greater impact on the QoL of women with disabilities. Higher education levels might help to improve their status and enable full participation in society, underlining the importance of CBR work in this area. Though device satisfaction is quite high, taking environmental factors and women’s needs into consideration when developing assistive devices might increase daily use.

Conclusion:Socio-demographic variables play a significant role in determining the QoL - education, income, marriage and children affect domain scores. Methodological constraints and the small sample size suggest further investigation.

Aim: The aim of this study is to evaluate if additive manufacturing (AM) is an appropriate manufacturing method for insoles in comparison to vacuum forming (VF) and subtractive manufacturing (SM) in regards of material properties such as abrasion resistance. Background: Traditionally insoles are manufactured with either VF or SM. AM has been around for some decades but implementation into orthotic and prosthetic (O&P) business has not been accomplished yet. Therefore, the quality of the products produced with AM must be tested in comparison with traditional methods. Method: A comparison of samples for the mentioned manufacturing methods was done with the help of an abrasion testing machine with the standard ASTM G133. Two samples were produced from each manufacturing method and respectively tested for one and two hours. All the samples were weighed before and after the tests with the help of a four decimal scale. The difference in weight before and after the test and coefficient of friction was evaluated. The weight difference was analyzed to see how much material had been removed from the sample. The percentage of wear loss was calculated for each specific sample, both for one hour and two hours of testing. No statistical analysis could be made due to the limited amount of samples and testing time. Result: No statistically significant could be found for either wear loss or the coefficient of friction as mentioned above. Conclusion: A conclusion whether which material having the best abrasion resistance for respectively manufacturing method could not be drawn due to limited results. This study can be seen as a pilot study where the methodology can be used in further studies. Further research on AM needs to be conducted.

Introduction: There have not been any prosthetic feet available that can match an intact foot in functionality. Little focus has been on research on prosthetic foot performance in frontal plane motions and while most have investigated sagittal plane motions.

Background: Normal gait is an artform of falling, thus the intact anatomical foot needs to be capable of handling a wide-range of environments. A prosthesis is an external helping aid for amputees, therefore they lack the ability to adapt to different environments. Most of the researches on prosthetic feet have focused on the sagittal plane, which has limited understanding and literature towards frontal plane motions. In this study a relatively new insole measuring system was used, Vebitosolution. The Vebitosolution insole has five separate sensors. It’s made from a flexible, specially shaped material to allow the sensors to measure independently, and measures both bending and torsional moments.

Aim: The aim of the study to investigate if the Vebitosolution system is capable of measure torsional moments in frontal plane during straight line walk in two different types of prosthetic feet.

Method: The participants were two transtibial amputees of that used the same size and category foot. They walked in a straight line with two different prosthetic feet.

Results: There was a statistical significant difference (P < 0,05) for all measurements except for one (P > 0,05).

Discussion: The results give indications that the Vebitosolution system is capable in differentiating between two different types of prosthetic feet. There are also indications of both product and gait specific gait pattern, but further researches are needed.  This research is limited by its sample size and amount of measurements performed.

Conclusion: The take-away from this research is that the Vebitosolution system might be capable of measuring differences in frontal plane moments in two different types of prosthetic feet.

Background: A new method has been developed at Sahlgrenska University Hospital, enabling patients to have individually adjusted insoles delivered the same day as the initial appointment to the department of Prosthetics and Orthotics (DPO). During the manufacturing of the insoles, named the ICE-method, the patients' individually adjusted insoles are placed in the freezer for quicker solidification. The ICE-method has not yet been evaluated regarding patient satisfaction.

The purpose of this study is to evaluate if there is a difference in patient satisfaction between groups of patients with diabetes being provided with either insoles made according to the ICE-method or insoles being made with traditional plaster-based methods.

Our hypothesis is that there is a statistically significant difference in patient satisfaction, regarding services and devices, between the ICE-method and the traditional plaster-based methods.

Methods: Statistical tests will be used on data from previously conducted surveys to investigate our hypothesis.

The Results showed no statistically significant difference in patient satisfaction between groups of patients with diabetes being provided with either insoles made according to the ICE-method or traditional plaster-based methods. 

Conclusion: no statistically significant differences between the methods were found. 

ABSTRACT: BACKGROUND: Gait-lines, or the co-ordinates of the progression of the point of application of the vertical ground reaction force, are a commonly reported parameter in most in-sole measuring systems. However, little is known about what is considered a "normal" or "abnormal" gait-line pattern or level of asymmetry. Furthermore, no reference databases on healthy young populations are available for this parameter. Thus the aim of this study is to provide such reference data in order to allow this tool to be better used in gait analysis. METHODS: Vertical ground reaction force data during several continuous gait cycles were collected using a Computer Dyno Graphy in-sole system(R) for 77 healthy young able-bodied subjects. A curve (termed gait-line) was obtained from the co-ordinates of the progression of the point of application of the force. An Asymmetry Coefficient Curve (AsC) was calculated between the mean gait-lines for the left and right foot for each subject. AsC limits of +/- 1.96 and 3 standard deviations (SD) from the mean were then calculated. Gait-line data from 5 individual subjects displaying pathological gait due to disorders relating to the discopathy of the lumbar spine (three with considerable plantarflexor weakness, two with considerable dorsiflexor weakness) were compared to the AsC results from the able-bodied group. RESULTS: The +/- 1.96 SD limit suggested that non-pathological gait falls within 12-16% asymmetry for gait-lines. Those exhibiting pathological gait fell outside both the +/- 1.96 and +/- 3SD limits at several points during stance. The subjects exhibiting considerable plantarflexor weakness all fell outside the +/- 1.96SD limit from 30-50% of foot length to toe-off while those exhibiting considerable dorsiflexor weakness fell outside the +/- 1.96SD limit between initial contact to 25-40% of foot length, and then surpassed the +/- 3SD limit after 55-80% of foot length. CONCLUSION: This analysis of gait-line asymmetry provides a reference database for young, healthy able-bodied subject populations for both further research and clinical gait analysis. This information is used to suggest non-pathological gait-line asymmetry pattern limits, and limits where detailed case analysis is warranted.

Introduktion: Silversplints til personer med hypermobil Ehlers-Danlos syndrom er blevet udbredt i Danmark, men der findes ingen dokumenteret evidens for fingerortoserne til denne målgruppe. Hypermobilitet gør simple greb krævende og indikerer, at personer med EDS bruger væsentligt mere mental opmærksomhed på simple håndbevægelser sammenlignet med raske personer.

Formål: Formålet med studiet var at undersøge effekten af silversplints til personer med EDS og hypermobilitet målt på henholdsvis håndfunktion og den mentale arbejdsbyrde præfrontalt.

Metode: 5 deltagere med EDS samt 5 matchede kontrolpersoner blev rekrutteret. Den relative koncentration af O₂Hb og HHb præfrontalt blev målt med fNIRS under Box and Block testen samt 3 øvrige modificerede håndfunktionstest. Målinger af deltagerne med EDS blev foretaget under to konditioner; uden og med silversplints.

Resultat: fNIRS målingerne viste en signifikant reducering af den relative O₂Hb koncentration og en tilsvarende signifikant øgning af den relative HHb koncentration ved anvendelsen af silversplints kontra ingen ortoser. Box and Block testen viste en signifikant forskel ved de to konditioner, og mens skrivetesten demonstrerede en signifikant forskel mellem deltagerne med EDS og kontrolgruppen.

Konklusion: Silversplints reducerer den mentale arbejdsbyrde ved personer med EDS.

OBJECTIVE: To study the outcomes of a new surgical and rehabilitation program for initial unilateral transtibial amputation in patients with peripheral vascular disease. The program consists of sagittal incision, rigid dressing, compression therapy using silicone liner, and direct manufacturing prosthetic technique. DESIGN: A prospective cohort study with 1-yr follow-up. RESULTS: Of the 217 consecutive patients with peripheral vascular disease who underwent transtibial amputation (mean age, 77 yrs; 51% diabetic; 116 could walk before amputation), 119 (55%) were fitted with a prosthesis at a median time of 41 (range, 12-147) days after amputation. Of the prosthetic recipients, 76 (64%) obtained good function with the prosthesis within 6 mos. Within 1 yr, reamputation was performed on 8.2%, and contralateral amputation was performed on 5.5%. The 90-day mortality was 24% (53 patients). The total 1-yr mortality was 40% (86 patients): 17% among patients who received a prosthesis and 67% among those who did not receive a prosthesis or had undergone reamputation. CONCLUSIONS: Following this standardized surgical and rehabilitation program, prosthetic fitting was achieved in more than half of transtibial amputees, almost two-thirds of prosthetic recipients obtained good function, and the reamputation rate was low. Comparison with outcomes of alternative strategies is needed.

Objective: To compare the incidence of vascular lower limb amputation (LLA) in the diabetic and nondiabetic general population. Research design & methods: A population-based cohort study was conducted in a representative Swedish region. All vascular LLA (at or proximal to transmetatarsal level) performed from 1997 through 2006 were consecutively registered and classified into initial unilateral amputation, contralateral amputation or re-amputation. The incidence rates were estimated in the diabetic and nondiabetic general population aged 45 years or older. Results: During the 10-year period, LLA was performed on 62 women and 71 men with diabetes and on 79 women and 78 men without diabetes. The incidence of initial unilateral amputation per 100,000 person-years (95% CI) was for diabetic women 192 (145-241) and for diabetic men 197 (152-244) and for nondiabetic women 22 (17-26) and for nondiabetic men 24 (19-29). The incidence increased from the age of 75 years. 74% of all amputations were transtibial. The incidence of contralateral amputation and of re-amputation per 100 amputee-years (95% CI) in diabetic women amputees was 15 (7-27) and 16 (8-28) and in diabetic men 18 (10-29) and 21 (12-32), respectively, and in nondiabetic women amputees were 14 (7-24) and 18 (10-28) and in men 13 (6-22) and 24 (15-35), respectively. Conclusions: In the general population aged 45 years or older the incidence of vascular lower limb amputation at or proximal to transmetatarsal level is 8 times higher in diabetic than in nondiabetic persons. One in four amputees may require contralateral amputation and/or re-amputation.

Background: Prosthesis users are more frequently subjects to fall and fall-related injury than the average citizen. To prevent this, further research is needed in the field of balance in lower-extremity prosthesis users. Objective: To summarise the current research field of balance and postural control assessment in lower-extremity prosthesis users. Method: A systematic search was conducted in 11 databases, followed by a selection process to include relevant articles. The articles, together with extracted data, was presented in a table. Also, descriptive statistics were presented. Results: The summary included (n=173) articles assessing balance or postural control. The descriptive statistics suggested the current field of research was biased towards males. Several studies did not discriminate between transfemoral and knee disarticulation amputation levels. A large number of studies did not present if the chosen methods were valid and reliable for the target group. Among study limitations, small sample size was common. Conclusion: Future research should involve more participants, especially women, to reach higher statistical power, and to better represent real gender distribution in the target group. It is also important to choose, and present, methods validated for the target group. Finally, future researchers should follow a ”golden standard” in the classification of amputation levels.

Background: The task of the prosthetist is to provide an orthopaedic solution that meets the patient´s needs and wishes with expertise and experience. The discretion of action is the space that a prosthetist must make independent decisions in his professional practice and are thus the sum of skills, assessments and procedures within the discretion of the business.

Purpose: The purpose of the study was to increase knowledge of the prosthetist perceived discretion in Sweden and Norway in relation to the prescription rules for lower limb prosthetics. 

Method: The study was based on a survey that addressed questions regarding prosthetist perceived discretion for action through a mixed method. The survey was published via SOIF, the Facebook group Orthopaedics in Sweden and NITO orthopaedics.

Results: Factors that affected the action of discretion, in situations when the prosthetist experienced great influence, were mainly related to the patient. In opposite, when the prosthetist experienced less influence, the main factors that affected a decision regarding a prosthetic where economy and laws/guidelines. The majority of prosthetists felt that they were often able to fulfil the patient’s request regarding to their discretion of action. In consideration to if the prescription process were in need of change or not, the opinion was divided. Many of the prosthetists have always experienced that they’re in charge of decision making or at least have been able to affect the decision. While a small number of prosthetists have experienced one or multiple situations where they could not affect the decision. 

Conclusion: Prosthetists have varying experiences regarding their discretion, factors that shape the discretion and the ability to influence the discretion when prescribing prosthetics for lower limb.

Background: Proximal femoral focal deficiency (PFFD) is a rare congenital deficiency of the femur. The deficiency is neglected in the creation of literature as other rare diagnoses. There is a need for research regarding the prosthetic treatment and management of PFFD. This study sheds a light on the perspectives of the certified prosthetists/orthotists relating to PFFD management.     

Aim: The aim of the study will be to explore and increase knowledge about the treatment options available for patients with PFFD and to give insight into the perspectives of CPOs.

Method: This study is a qualitative interview study, where interviews were conducted by using a semi-structured technique to collect data. 5 participants were interviewed from clinics in the nordic countries. Content analysis was performed using an inductive approach to analyse the data.   

Results: The findings of interviews produced nine sub-categories which were then divided into between three categories: experience and treatment, working conditions and knowledge. Results revealed that CPOs’ perspectives differed immensely. 

Conclusions: The study revealed the importance of interprofessional teamwork, resource access and early PFFD management. Additionally, it identified the use of social media in CPO knowledge seeking. A need for a specialised support team for CPOs and immediate family of the individual with PFFD as well as the individual, was discovered.

Background: To be able to meet social harmony in a continuously globalizing world, intercultural competencies are important to possess as an individual. Thus, it is also important for Certified Prosthetists and Orthotists (CPOs) and other health care providers since they meet many diversities in connection to their work.

Aim: The aim of this study is to investigate Danish CPOs’ experience and perception of their intercultural competencies in the treatment of immigrants.

Method: This study is a qualitative interview study using a phenomenological approach. Semi-structured interviews are used to collect the data from five CPOs working in Danish clinics. A content analysis, with an inductive approach, is used for the analysis.

Findings: From the analysis of the participant interviews, seven sub-categories were found and further divided into three categories: Treatment, work environment, and development of competencies. These contribute to describe the main category and the aim of this study.

Conclusion: The Danish CPOs, who participated in this study, experienced that they did not treat immigrants differently than non-immigrants. However, they experienced that some challenges could be connected to the treatment of immigrants, such as communication difficulties, but they all had a perception, that they used specific tools and strategies to accommodate these challenges. Furthermore, they all experienced that their intercultural competencies had improved with experience, but most of them were also interested in further development of their competencies.

Purpose: The purpose of the study was to investigate if there is a difference in qualityof  life  (QoL)  between  individuals  with  a  transfemoral  amputation  usingmicroprocessor-controlled  knee  components  (MPK)  versus  mechanical  kneecomponents (Mech.).

Design: Cross-sectional study

Subjects: 14 prosthesis users with a unilateral transfemoral amputation  (10 men, 4women; 4 Mech., 10 MPK), amputated due to trauma, congenital reasons, infection ortumor and used the same prosthetic knee for at least one year.

Method: To study QoL in the  population concerned a questionnaire was carriedout, including the RAND-36 and supplementary questions. The  participants  were divided into two groups with regard to the knee component to enable the results to be analyzed.

Results: No significant difference in QoL were found between the groups. The largest differences were observed in physical (Mech.: 0 MPK: 50) and emotional (Mech.: 41.75MPK: 100) role function.

Conclusion: The result of the study showed no significant difference in QoL between the groups. Furthermore, specific measuring instruments targeting individuals with amputation should be used to investigate quality of life in the population concerned.

The aim of the thesis was to collect baseline data and to investigating suitable physical tests and a self-rapport questionnaire. Collected data was used to find a routine measurement when investigating foot health, function and mobility among clients suffering from diabetes in Samoa. Twenty-one participants suffering from diabetes were included in the study. Clients answered the Foot function index (FFI) questionnaire and performed physical tests, consisting of Bergs balance scale (BBS) and Time up and go (TUG). Results from the physical tests revealed a great balance disturbance and mobility limitations among the majority of the clients. General high weight and BMI was measured among both genders. Subjects with the highest BMI performed lowest time during TUG test. The statistic analyze revealed a strong correlation between the two physical tests, indicating that one of the tests could be applied as a routine measurement in the future, when evaluating function and mobility in Samoa. The compilation of self-report questionnaires indicated a general good foot health with a low amount of pain, disabilities and activity limitations.

Aim: This study aims to determine which treatment method, plasticity guided or non-invasive neuromodulation, presents the best result in reducing pain for amputees experiencing phantom limb pain. Method: Literature search was performed in 3 databases; MEDLINE, CINAHL and PsycINFO. Eligibility criteria were used for study selection. Critical appraisal tool by Joanna Briggs institute was used to assess the included articles’ risk of bias. Data relevant to the research question were extracted and analyzed. Result: A total of eight articles were included, where two presented results from non-invasive neuromodulation and six studies included plasticity guided methods. Pain scales ranging from 0-10 were applied as outcome measures to monitor improvements in phantom limb pain. The critical appraisal concluded lack of high-quality study designs including control groups. The evidence analysed in the present study indicate that plasticity guided methods appear to provide the best pain reduction when compared to non-invasive neuromodulation. Conclusion: Based on the results, this study does not present evidence strong enough to state which methods present the best pain reduction. Due to low amount of research within the field, combined with heterogeneity between included studies, no conclusion can be made.

Aim: The aim with this study is to compare different orthotic solutions for pediatric patients with congenital talipes equnivarus. 

Method: A search in the databases MEDLINE, CINAHL, PubMed and Scopus were made, and studies was included after the predefined criteria. The included studies were reviewed for risk of bias and validity, relevant data was extract and analyzed with regards to the research question. 

Result: The result was presented on 15 different orthotic interventions in 21 different articles. The reported outcome measures were compliance, recurrence of deformity, Pirani- and Dimeglio score, range of motion and functional outcomes. 

Conclusion: Based on the results a recommendation cannot be made on what orthosis that gives the best result. Future research should focus on developing and designing an orthosis that satisfies the patient's needs. 

Under det senaste decenniet har det blivit allt vanligare med arbetsrelaterade besvär hos uniformerad polis i yttre tjänst, främst är det besvär från nedre delen av ryggen som uppgetts. Hälsohögskolan i Jönköping har fått i uppdrag av Rikspolisstyrelsen att belysa och utreda den uppkomna problematiken. Två tidigare rapporter, Polisens fysiska arbetsmiljö och Polisens psykosociala miljö, har presenterats. I rapporten om polisens fysiska arbetsmiljö framkom en hög förekomst av besvär från muskler och leder, främst nedre delen av ryggen under förhållande med bärande av utrustningsbältet i kombination med mycket stillasittande i tjänstebilar. I den andra rapporten framkom att en stor del av poliserna arbetar treskift och i många fall långa arbetspass, vilket yttrar sig i att de har svårt att psykiskt återhämta sig, inte har tid för familj och vänner samt att de ofta upplever sig trötta. I den tredje och sammanfattande rapporten presenteras vilka bakomliggande variabler som påverkar den fysiska och psykosociala arbetsmiljön.

Syftet med studien var att analysera vilka variabler och vilka kombinationer av variabler som påverkar den fysiska och psykosociala arbetsmiljön för uniformerad polis i yttre tjänst i Sverige. Rapporten baseras på 4244 enkätsvar från poliser i yttre uniformerad tjänst.

Resultatet från föreliggande studie har visat att det finns skillnaden i besvärsfrekvens mellan myndigheterna när det gäller otillräcklig fysisk och psykisk återhämtning samt besvär ifrån nedre delen av ryggen. Orsakerna till skillnaden mellan myndigheterna är inte utredda. Studien har visat att besvärsfrekvensen ökar då det föreligger krav att arbeta på ett rullande treskiftsschema. Utifrån detta föreslår vi att man:

• utför benchmarking av polismyndigheter för att öka förståelsen för de stora skillnader som förekommer

• utvärderar olika modeller av schemaläggning avseende treskift

• fortsätter arbetet med att utreda hur polisens uniform och kroppsburna utrustning, i kombination med bilsätets utformning, påverkar besvär från nedre delen av ryggen.

Aim: Through this review we aim to investigate if there is an alternative orthotic treatment for paediatric patients with idiopathic congenital talipes equinovarus showing the same maintenance of correction as the benchmark treatment but with higher adherence.

Methods: A literature search was performed in the data bases MEDLINE, CINAHL and Scopus. Predetermined eligibility criteria were used to include and exclude articles. Critical appraisal was performed for the included articles. Relevant data was extracted, analyzed and presented to aid in answering the research question.

Results: Of the 204 articles found in databases, seven were included in the final review. Adherence rate and relapse rate was extracted from the seven orthotic interventions. Most of the orthoses presented both better adherence and maintenance of correction than the benchmark treatment. The majority were case series, not including a comparison group and with short-term follow-up.

Conclusion: The results indicate that there are orthotic designs that may be preferred over the traditional Denis Browne bar. However, the lack of high-quality evidence and standardization to detect and define a relapse and measure adherence makes it difficult to recommend an alternative orthosis with the present evidence. Factors other than the orthotic design also influence the adherence.

Background: Many individuals often the elderly suffering of gonatros, this diagnosis can cause pain and impaired function which in turn can lead to limitations in daily living. This is a systematic review of studies that have investigated lateral wedged insoles as a treatment to reduce pain and improve function in patients with medial gonartros.

Aim: To study whether lateral wedge insoles lead to reduced pain and improved function compared with neutral insoles. Furthermore, it is also investigated if the result is based on different sub-groups.

Method: A systematic search in the databases PubMed, MEDLINE, AMED, CINAHL and Cochrane Library was performed to find relevant studies which then were included based of predetermined criteria. Data from these articles where analysed to answer our question in this paper. The articles were examined for risk of bias and validity/reliability.

Results: The results show that lateral wedge insoles do not reduce pain and improve function. There are also no signs that a certain sub-group would be more suited for the treatment.

Conclusion: There is in this paper a contradictory result of whether lateral wedge insoles reduce pain and improve function. Although several studies indicate positive effects it is not enough to prove in a statistically significant way that it helps. It is not possible to say whether the treatment is more suitable for any specific subgroup.

Background: When people walk while performing a cognitive dual-task, a decrease in gait velocity will occur because of the demand for some of the same cognitive resources. However, in a previous study they found an increase instead of a decrease in gait velocity when subjects walked on a self-paced treadmill while performing a color-word Stroop task. Aim: The aim of this study was to determine if the increase found in gait velocity in the previous study was a consequence of the subjects’ position. Additionally, it was investigated whether real-time feedback about the subjects’ position could substitute the lack of a reference point. Method: Position and gait velocity was measured in twelve healthy subjects during a trial consisting of eight control conditions and eight different interventions. Results: A significant difference was found in gait velocity between the interventions where the accelerations-line was moved furthest to the front and back (IzerolineA, IzerolineB) and in position between the original intervention and one with a neutral zone (Iorginal1, Ineutralzone). No differences were found in position or velocity with any of the feedback systems. Conclusion: From the results it could be concluded that the increase in gait velocity was a consequence of the subjects positioning themselves further in the forward direction on the treadmill. No conclusions could be drawn with the feedback systems.