RESUMEN
Introduction: Bilateral microprocessor-controlled prosthetic knee (MPK) users have unique needs in traversing environmental barriers compared to unilateral users. An enhancement to the Genium™/Genium X3™ MPK which included an updated ruleset, hydraulics, and new bilateral parameter presets was made to improve safety while stumbling and the smoothness of gait for all users while also improving the experience of bilateral users. The purpose of the study was to evaluate the effectiveness of the enhancements in a sample with unilateral and bilateral amputation. Methods: A convenience sample of MPK users was recruited from two sites in the USA in two phases. Assessments included the L-Test of Functional Mobility, Activity-specific Balance Confidence Scale, Prosthetic Limb User Survey of Mobility, a study-specific questionnaire, and the Comparative Activities of Daily Living (ADL) Questionnaire. Statistical significance of extracted data was tested with the Wilcoxon Rank-Sum Test for independent data and Wilcoxon Signed-Rank for paired data with an a priori significance level of p < 0.05. Unilateral subjects were age-matched to the group of bilateral subjects for between-groups and within-groups analyses. Results: Twenty-six subjects (n = 26) were enrolled. Stumble frequency reduced 85% from 16.0 ± 39.7 to 2.4 ± 2.3 (p = 0.008) between baseline and final assessment overall. The bilateral group reported 50% (p = 0.009) and 57% (p = 0.009) greater relative improvement in patient-reported ease and safety, respectively, of completing ADLs compared to the unilateral group. The unilateral group reported residual limb pain and low back pain reduced from 2.3 to 1.4 (p = 0.020) and 3.8 to 1.8 (p = 0.027), respectively, whereas the bilateral group did not. Discussion: Substantial reductions in stumbles, residual limb pain, and back pain were shown overall. These reductions were driven by the unilateral group who also showed improvements in comfort, exertion, and concentration while walking. The enhancements to the knee likely reduced some gait asymmetry for unilateral users. Improvements in patient-reported ease and safety of completing ADLs were shown overall and were driven by the bilateral group. This study shows further improvement in patient experience is achievable through innovation in MPK technology even for patients who appear to be functioning well.
RESUMEN
AIM: To evaluate changes in patient compliance with medical treatment while using the Proview Eye Pressure Monitor. METHODS: A crossover study design was used to compare the compliance of patients with established use of topical medication to lower intraocular pressure in the treatment of primary open-angle glaucoma. Thirty-two patients currently managed with latanoprost 0.005%, brimonidine 0.15%, travoprost 0.004% or bimatoprost 0.03% as monotherapy or in combination were randomly assigned to two study groups. Group 1 was instructed in the use of Proview Eye Pressure Monitor three times daily for 30 days as an adjunct to the glaucoma regimen. Group 2 was observed with no change in the patients' treatment regimen during this phase of study. A crossover occurred at 30 days. Compliance was monitored by assigning new bottles of topical medication during each phase of study. Bottles were weighed with a Mettler balance (Mettler Toledo Co.) at the initiation and completion of each phase. The changes in bottle-weight determined the amount of medication consumed by each patient for each phase of the study. The weights were analysed to estimate changes in compliance. RESULTS: A paired samples Student t-test compared the consumed bottle weights with and without Proview Eye Pressure Monitor usage. No statistical significance or trend was identifiable (p = 0.98). Use of the Proview Eye Pressure Monitor did not significantly change compliance with adjunct eye drop medication. CONCLUSION: The use of the Proview Eye Pressure Monitor use did not improve but appeared to hinder compliance with glaucoma treatment in this study.