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Insight in the burden of disease of transfemoral amputees

Insight in the burden of disease of transfemoral amputees
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Ottobock Virtual Symposium: “Real World Evidence – insight in the burden of disease of transfemoral amputees”

The live virtual symposium “Real World Evidence – insight in the burden of disease of transfemoral amputees” hosted by Ottobock, attracted about 340 participating experts involved in modern assistive devices in the field of transfemoral amputation from 47 countries on 4/4/23. The conference focused on innovative methods for gathering data on the burden of disease in patients with transfemoral amputations and offered the opportunity for best practices exchange about patient surveys.

Prof. Bernd Brüggenjürgen, MD, head of the Institute for Health Services, Research and Technical Orthopedics in the Orthopedic Department of Medical School Hannover at Diakovere Annastift Hospital, provided insights into the first evaluation of a digital patient survey on the burden of disease experienced by them following transfemoral amputation. 536 patients who have been using a microprocessor-controlled knee joint (MPK) for at least three months participated and answered up to 184 questions. First results of selected topics as quality of life, participation in society, body image and gender aspects were presented.

The data shows that although patients' participation in daily and occupational life is limited to some degree, it can be improved with MPK. The quality of life of patients with a microprocessor-controlled knee joint is comparatively high. The expert in health services also considers the innovative approach to the survey and data analysis for the study a success: "A digital survey is feasible and provides relevant insights into patients’ burden of disease following transfemoral amputation or knee exarticulation," says Prof. Brüggenjürgen.

MPK prostheses have a positive influence on susceptibility to falls

Dr. Pierpaolo Palumbo, a bioengineer at the Personal Health Systems Lab of the University of Bologna specializing in falls in people with lower limb amputations, presented his retrospective observational study1. In it, he examined how four different knee joint prostheses affect the risk of falling in transfemoral amputees. Dr. Palumbo analyzed 1,482 rehabilitation stays (32,213 hospital days) of 815 patients.

The study shows that MPK are the model of choice for the first fitting of a prosthesis user: "MPK provide safety mechanisms that allow blocking the knee when an incipient fall is detected," Dr. Palumbo reports. In addition, the Italian researcher identified risk factors that may influence susceptibility to falls. Age and gender are not risk factors for falls, but the use of antidepressants and antiepileptic drugs in particular have a significant impact: "In our dataset, antidepressants and antiepileptics usage rates were 8.6% and 9.8%, respectively. Particular attention must be paid to those patients under risk-associated pharmacological treatments, and future research should investigate the best prosthetic options for them."

Standardized questionnaire for root cause analysis

Andrew Sawers, PhD, Associate Professor at the University of Illinois Chicago in the Department of Kinesiology, focuses his research on reducing the frequency and consequences of falls in lower limb prosthesis users. He presented a study2 that closely characterized details of fall events experienced by lower limb prostheses (LLP) users. "Falls in LLP users remain as common and consequential today as 25 years ago," Sawers says. “We lack the foundational epidemiological data (why, where how and when) required to inform the design, testing and implementation of effective fall prevention initiatives,” he says.

In order to address this gap, Sawers created a structured, amputee-specific fall survey using best practices to comprehensively characterizing circumstances and consequences of falls events in lower limb amputees. The structured, 37-question lower limb prosthesis user fall event survey is a standardized tool to document fall-related activity, surroundings, situations, mechanics and consequences. It can be used on a large scale, Sawers explains, and "offers clinicians and researchers the means to document, monitor, and compare fall details that are meaningful and relevant to lower limb prosthesis users in a standardized and consistent manner. Data that can be collected with the developed survey are essential to establishing specific goals for fall prevention initiatives in lower limb prosthesis users."

The event was moderated by Prof. Frank Braatz, MD, a specialist in orthopedics and trauma surgery, physical and rehabilitative medicine, and pediatric orthopedics. Before he became a Professor for Orthobionics at the Private University Göttingen 2013, he was head of the Technical Orthopedics and Infantile Cerebral Palsy Section at the Clinic for Orthopedics and Trauma Surgery at Heidelberg University Hospital.

1 Palumbo P, Randi P, Moscato S, Davalli A, Chiari L. Degree of Safety Against Falls Provided by 4 Different Prosthetic Knee Types in People With Transfemoral Amputation: A Retrospective Observational Study. (2022) Phys Ther. Apr 1;102(4):pzab310. doi: 10.1093/ptj/pzab310. PMID: 35079822; PMCID: PMC8994512.

2 Sawers A, McDonald CL, Hafner BJ (2022) A survey for characterizing details of fall events experienced by lower limb prosthesis users. PLoS ONE 17(7): e0272082.

About Ottobock

For more than 100 years, Ottobock has been developing innovative fitting solutions for people with reduced mobility. As a Human Empowerment Company, Ottobock promotes freedom of movement, quality for life and independence. This is supported by more than 9,000 employees. With innovative power, outstanding technical solutions and services in the fields of Prosthetics, Orthotics, NeuroMobility and Patient Care, they enable people in 135 countries to live their lives the best possible way they want them to. As the world market leader in wearable human bionics, the company founded in 1919 is constantly setting new standards and pushing ahead with the digitalisation of the industry – together with its partners, the medical supply companies and international research institutions. Since 2018, Ottobock has been transferring its expertise in biomechanics to exoskeletons for ergonomic workplaces. The international activities of the company are coordinated from the head office in Duderstadt (state of Lower Saxony). Ottobock has been supporting the Paralympic Games with its technical expertise since 1988.

Contact person:

Ottobock SE & Co. KGaA 
Merle Florstedt  
Head of Corporate Communications  
Phone: +49 151 4416 1625