RESUMEN
Objective: To determine normal variation in walking metrics in a population of lower limb amputees who use lower limb prostheses over a 6-month period and to provide a means to interpret clinically meaningful change in those community walking metrics. Design: Prospective cohort study monitoring walking behavior and subjective and objective measures of activity. Setting: Veterans Administration and university amputee clinics. Participants: 86 individuals with lower limb amputation who use protheses. Interventions: StepWatch activity monitor tracked subjects' walking for 24 weeks; Global Mobility Change Rating collected weekly. Main Outcome Measures: Association between change in Global Mobility Change Rating and change in any of the walking metrics. Results: Walking metrics including step count, cadence, cadence variability, and walking distance in a population of lower limb prosthesis users were obtained. There was a high correlation in the walking metrics indicating higher function with higher functional classification level (K-levels) but also substantial overlap in all metrics and a very weak correlation between subject-reported activity level and objective measures of walking performance. Conclusion: The overlap in walking metrics with all K-levels demonstrates that no single metric measured by StepWatch can determine K-level with 100% accuracy. As previously demonstrated in other populations, subjects' interpretations of their general activity level was inaccurate, regardless of their age or activity level. Objective measures of walking appear to provide a more accurate representation of patients' activity levels in the community than self-report. Therefore, objective measures of walking are useful in supporting K-level determinations. However, clinicians cannot rely on a single metric to determine K-level.
RESUMEN
PURPOSE: Hyperhidrosis is a common problem for amputees. The iodine-starch test is frequently used to assess hyperhidrosis, but a method for its application has not been described for amputees. METHODS: We performed an unblinded comparison of the iodine-starch test using various methods to protect the prosthesis in 10 prosthetic limb users with hyperhidrosis. RESULTS: Plastic wrap produced a diffuse pattern of sweating in 70% of subjects. Forty percent had complaints about this method, and 50% experienced leakage of iodine stain onto prosthetic liners. The prosthetic sheath produced a focal or multifocal reaction in 100% of subjects after 10 min of ambulation. Eighty percent had minor leakage onto the liner, and complaints were noted in 10%. The proportion that experienced diffuse sweating was significantly higher in the plastic wrap condition (p = 0.016; difference in proportions = 70%; 95% confidence interval = 32-100%). The prosthetic sock was tested in four subjects and all had at least mild complaints; three had minor leakage onto the liner. Repeated complaints and lack of stain prevention led to discontinuation with this method. CONCLUSIONS: Of the three methods, the sheath produces a focal or multifocal reaction after 10 min of ambulation and tends to cause less subject complaints. It should be the preferred method to apply the iodine-starch test to amputees. Implications for rehabilitation Hyperhidrosis is a common problem in amputees which negatively affects quality of life. The iodine-starch test is commonly used to guide treatment decisions for hyperhidrosis, but a preferred method for applying it in amputees has not been described. This study describes different methods for applying the iodine-starch test. A prosthetic sheath covering should be the preferred method for the iodine-starch test in amputees.
Asunto(s)
Amputados , Hiperhidrosis , Calidad de Vida , Almidón/análogos & derivados , Adulto , Muñones de Amputación/fisiopatología , Amputados/psicología , Amputados/rehabilitación , Miembros Artificiales , Femenino , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/etiología , Masculino , Ajuste de Prótesis/métodos , Autocuidado/métodos , Almidón/farmacología , Sudoración/fisiología , Caminata/fisiologíaRESUMEN
Hyperhidrosis of the residual limb is a common condition affecting patients with amputations. The iodine-starch test is used by dermatologists to identify focal areas of hyperhidrosis before treatment with botulinum toxin. Here, we describe a case of a patient with a transtibial amputation with moderate-to-severe hyperhidrosis who received intradermal botulinum toxin injections to treat residual limb hyperhidrosis, with particular emphasis given to the utility of the iodine-starch test in managing this common condition. The iodine-starch test successfully identified hyperhidrotic areas before treatment as well as confirmed the physiologic anhidrotic effect of the botulinum toxin treatment. LEVEL OF EVIDENCE: V.
Asunto(s)
Muñones de Amputación/fisiopatología , Amputación Quirúrgica/efectos adversos , Amputación Traumática/cirugía , Toxinas Botulínicas Tipo A/administración & dosificación , Hiperhidrosis/tratamiento farmacológico , Amputación Quirúrgica/métodos , Pruebas Diagnósticas de Rutina , Estudios de Seguimiento , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/etiología , Inyecciones Intradérmicas , Masculino , Medición de Riesgo , Almidón/análogos & derivados , Tibia/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.