Measures and procedures utilized to determine the added value of microprocessor-controlled prosthetic knee joints: a systematic review

BMC Musculoskeletal Disorders

Henk AM Seelen¹  Rob JEM Smeets¹  Peter RG Brink³  Bea Hemmen²  Patrick JR Theeven¹ 

[1] Department of Rehabilitation Medicine, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands;Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands;Department of Traumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands

关键词: Microprocessor-controlled knee joint;    Lower extremities;    Amputation;    Classification;    Review;    Functioning;    Rehabilitation;   

Others  :  1129124
DOI  :  10.1186/1471-2474-14-333

 received in 2012-06-06, accepted in 2013-11-05,  发布年份 2013

【 摘 要 】

Background

The effectiveness of microprocessor-controlled prosthetic knee joints (MPKs) has been assessed using a variety of outcome measures in a variety of health and health-related domains. However, if the patient is to receive a prosthetic knee joint that enables him to function optimally in daily life, it is vital that the clinician has adequate information about the effects of that particular component on all aspects of persons’ functioning. Especially information concerning activities and participation is of high importance, as this component of functioning closely describes the person’s ability to function with the prosthesis in daily life. The present study aimed to review the outcome measures that have been utilized to assess the effects of microprocessor-controlled prosthetic knee joints (MPK), in comparison with mechanically controlled prosthetic knee joints, and aimed to classify these measures according to the components and categories of functioning defined by the International Classification of Functioning, Disability and Health (ICF). Subsequently, the gaps in the scientific evidence regarding the effectiveness of MPKs were determined.

Methods

A systematic literature search in 6 databases (i.e. PubMed, CINAHL, Cochrane Library, Embase, Medline and PsychInfo) identified scientific studies that compared the effects of using MPKs with mechanically controlled prosthetic knee joints on persons’ functioning. The outcome measures that have been utilized in those studies were extracted and categorized according to the ICF framework. Also, a descriptive analysis regarding all studies has been performed.

Results

A total of 37 studies and 72 outcome measures have been identified. The majority (67%) of the outcome measures that described the effects of using an MPK on persons’ actual performance with the prosthesis covered the ICF body functions component. Only 31% of the measures on persons’ actual performance investigated how an MPK may affect performance in daily life. Research also typically focused on young, fit and active persons.

Conclusions

Scientifically valid evidence regarding the performance of persons with an MPK in everyday life is limited. Future research should specifically focus on activities and participation to increase the understanding of the possible functional added value of MPKs.

【 授权许可】

   
2013 Theeven et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Michael JW: Modern prosthetic knee mechanisms. Clin Orthop Relat Res 1999, 361:39-47.
• [2]World Health Organisation: International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organisation; 2001.
• [3]Centers for Medicare and Medicaid Services. U.S. Department of Health and Human Services: HCFA Common Procedure Coding System (HCPCS). Springfield (VA): U.S. Department of Commerce, National Technical Information Service; 2001.
• [4]Protocol verstrekkingsproces beenprothesen (Protocol for Prescribing Leg Prostheses) http://www.orthopeden.org/uploads/cn/y3/cny3JZduoBe68eJzUy8KJA/Protocolverstrekkingsprocesbeenprothesen1november2010.pdf webcite
• [5]van Tulder M, Furlan A, Bombardier C, Bouter L: Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 2003, 28(12):1290-1299.
• [6]van Tulder MW, Assendelft WJ, Koes BW, Bouter LM: Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine (Phila Pa 1976) 1997, 22(20):2323-2330.
• [7]Kirker S, Keymer S, Talbot J, Lachmann S: An assessment of the intelligent knee prosthesis. Clin Rehabil 1996, 10(3):267-273.
• [8]Taylor MB, Clark E, Offord EA, Baxter C: A comparison of energy expenditure by a high level trans-femoral amputee using the Intelligent Prosthesis and conventionally damped prosthetic limbs. Prosthet Orthot Int 1996, 20(2):116-121.
• [9]Buckley JG, Spence WD, Solomonidis SE: Energy cost of walking: comparison of “intelligent prosthesis” with conventional mechanism. Arch Phys Med Rehabil 1997, 78(3):330-333.
• [10]Datta D, Howitt J: Conventional versus microchip controlled pneumatic swing phase control for trans-femoral amputees: user’s verdict. Prosthet Orthot Int 1998, 22(2):129-135.
• [11]Heller BW, Datta D, Howitt J: A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees. Clin Rehabil 2000, 14(5):518-522.
• [12]Stinus H: Biomechanics and evaluation of the microprocessor-controlled C-leg. [German] Biomechanik und beurteilung des exoprothesenkniegelenkes C-leg. Z Orthop Ihre Grenzgeb 2000, 138(3):278-282.
• [13]Schmalz T, Blumentritt S, Jarasch R: Energy expenditure and biomechanical characteristics of lower limb amputee gait: the influence of prosthetic alignment and different prosthetic components. Gait Posture 2002, 16(3):255-263.
• [14]Perry J, Burnfield JM, Newsam CJ, Conley P: Energy expenditure and gait characteristics of a bilateral amputee walking with C-leg prostheses compared with stubby and conventional articulating prostheses. Arch Phys Med Rehabil 2004, 85(10):1711-1717.
• [15]Yokogushi K, Narita H, Uchiyama E, Chiba S, Nosaka T, Yamakoshi KI: Biomechanical and clinical evaluation of a newly designed polycentric knee of transfemoral prosthesis. J Rehabil Res Dev 2004, 41(5):675-681.
• [16]Datta D, Heller B, Howitt J: A comparative evaluation of oxygen consumption and gait pattern in amputees using Intelligent Prostheses and conventionally damped knee swing-phase control. Clin Rehabil 2005, 19(4):398-403.
• [17]Johansson JL, Sherrill DM, Riley PO, Bonato P, Herr H: A clinical comparison of variable-damping and mechanically passive prosthetic knee devices. Am J Phys Med Rehabil 2005, 84(8):563-575.
• [18]Wetz HH, Hafkemeyer U, Drerup B: [The influence of the C-leg knee-shin system from the Otto Bock Company in the care of above-knee amputees. A clinical-biomechanical study to define indications]. Orthopade 2005, 34(4):298, 300-314, 316-299.
• [19]Klute GK, Berge JS, Orendurff MS, Williams RM, Czerniecki JM: Prosthetic intervention effects on activity of lower-extremity amputees. Arch Phys Med Rehabil 2006, 87(5):717-722.
• [20]Orendurff MS, Segal AD, Klute GK, McDowell ML, Pecoraro JA, Czerniecki JM: Gait efficiency using the C-Leg. J Rehabil Res Dev 2006, 43(2):239-246.
• [21]Segal AD, Orendurff MS, Klute GK, McDowell ML, Pecoraro JA, Shofer J, Czerniecki JM: Kinematic and kinetic comparisons of transfemoral amputee gait using C-Leg and Mauch SNS prosthetic knees. J Rehabil Res Dev 2006, 43(7):857-870.
• [22]Williams RM, Turner AP, Orendurff M, Segal AD, Klute GK, Pecoraro J, Czerniecki J: Does having a computerized prosthetic knee influence cognitive performance during amputee walking? Arch Phys Med Rehabil 2006, 87(7):989-994.
• [23]Bunce DJ, Breakey JW: The impact of C-Leg on the physical and psychological adjustment to transfemoral amputation. J Prosthet Orthot 2007, 19(1):7-14.
• [24]Chin T, Maeda Y, Sawamura S, Oyabu H, Nagakura Y, Takase I, Machida K: Successful prosthetic fitting of elderly trans-femoral amputees with Intelligent Prosthesis (IP): a clinical pilot study. Prosthet Orthot Int 2007, 31(3):271-276.
• [25]Hafner BJ, Willingham LL, Buell NC, Allyn KJ, Smith DG: Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil 2007, 88(2):207-217.
• [26]Kaufman KR, Levine JA, Brey RH, Iverson BK, McCrady SK, Padgett DJ, Joyner MJ: Gait and balance of transfemoral amputees using passive mechanical and microprocessor-controlled prosthetic knees. Gait Posture 2007, 26(4):489-493.
• [27]Seymour R, Engbretson B, Kott K, Ordway N, Brooks G, Crannell J, Hickernell E, Wheeler K: Comparison between the C-leg microprocessor-controlled prosthetic knee and non-microprocessor control prosthetic knees: a preliminary study of energy expenditure, obstacle course performance, and quality of life survey. Prosthet Orthot Int 2007, 31(1):51-61.
• [28]Stevens PM, Carson R: Case report: Using the Activities-Specific Balance Confidence Scale to quantify the impact of prosthetic knee choice on balance confidence. J Prosthet Orthot 2007, 19(4):114-116.
• [29]Jepson F, Datta D, Harris I, Heller B, Howitt J, McLean J: A comparative evaluation of the Adaptive knee and Catech knee joints: a preliminary study. Prosthet Orthot Int 2008, 32(1):84-92.
• [30]Kahle JT, Highsmith MJ, Hubbard SL: Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev 2008, 45(1):1-14.
• [31]Kaufman KR, Levine JA, Brey RH, McCrady SK, Padgett DJ, Joyner MJ: Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Arch Phys Med Rehabil 2008, 89(7):1380-1385.
• [32]Berry D, Olson MD, Larntz K: Perceived stability, function, and satisfaction among transfemoral amputees using microprocessor and nonmicroprocessor controlled prosthetic knees: a multicentre survey. J Prosthet Orthot 2009, 21:32-42.
• [33]Blumentritt S, Schmalz T, Jarasch R: The safety of C-leg: biomechanical tests. J Prosthet Orthot 2009, 21:2-15.
• [34]Hafner BJ, Smith DG: Differences in function and safety between Medicare Functional Classification Level-2 and -3 transfemoral amputees and influence of prosthetic knee joint control. J Rehabil Res Dev 2009, 46(3):417-433.
• [35]Mâaref K, Martinet N, Grumillier C, Ghannouchi S, Andre JM, Paysant J: Kinematics in the terminal swing phase of unilateral transfemoral amputees: microprocessor-controlled versus swing-phase control prosthetic knees. Arch Phys Med Rehabil 2010, 91(6):919-925.
• [36]Petersen AO, Comins J, Alkjaer T: Assessment of gait symmetry in transfemoral amputees using C-leg compared with 3R60 prosthetic knees. J Prosthet Orthot 2010, 22:106-112.
• [37]Highsmith MJ, Kahle JT, Carey SL, Lura DJ, Dubey RV, Csavina KR, Quillen WS: Kinetic asymmetry in transfemoral amputees while performing sit to stand and stand to sit movements. Gait Posture 2011, 34(1):86-91.
• [38]Theeven P, Hemmen B, Rings F, Meys G, Brink P, Smeets R, Seelen H: Functional added value of microprocessor-controlled knee joints in daily life performance of Medicare Functional Classification Level-2 amputees. J Rehabil Med 2011,  :906-915.
• [39]Burnfield JM, Eberly VJ, Gronely JK, Perry J, Yule WJ, Mulroy SJ: Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees. Prosthet Orthot Int 2012, 36(1):95-104.
• [40]Kaufman KR, Frittoli S, Frigo CA: Gait asymmetry of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees. Clin Biomech (Bristol, Avon) 2012, 27(5):460-465.
• [41]Schaarschmidt M, Lipfert SW, Meier-Gratz C, Scholle HC, Seyfarth A: Functional gait asymmetry of unilateral transfemoral amputees. Hum Mov Sci 2012, 31(4):907-917.
• [42]Theeven PJ, Hemmen B, Geers RP, Smeets RJ, Brink PR, Seelen HA: Influence of advanced prosthetic knee joints on perceived performance and everyday life activity level of low-functional persons with a transfemoral amputation or knee disarticulation. J Rehabil Med 2012, 44(5):454-461.
• [43]Wong CK, Wilska J, Stern M: Balance, Balance Confidence, and Falls Using Nonmicroprocessor and Microprocessor Knee Prostheses: A Case Study After Vascular Amputation With 12-Month Follow-Up. J Prosthet Orthot (JPO) 2012, 24(1):16-18.
• [44]Phillips B, Zhao H: Predictors of assistive technology abandonment. Assist Technol 1993, 5(1):36-45.
• [45]Riemer-Reiss ML, Wacker RR: Factors associated with assistive technology discontinuance among individuals with disabilities. J Rehabil 2000, 66:44-50.
• [46]Condie E, Scott H, Treweek S: Lower limb prosthetic outcome measures: a review of the literature 1995 to 2005. JPO 2006, 18(1S):13-45.
• [47]Theeven PJR, Hemmen B, Stevens CHC, Ilmer EC, Brink PRG, Seelen HAM: Feasibility of a new concept for measuring actual functional performance in daily life of transfemoral amputees. J Rehabil Med 2010, 42(8):744-751.
• [48]Buell NC, Willingham LL, Allyn KJ, Hafner BJ, Smith DG: Evaluation of gait style to ascend and descend stairs for lower limb amputees. In 11th World Congress of the International Society of Prosthetics and Orthotics. Hong Kong; 2004:367.
• [49]Buell NC, Willingham LL, Allyn KJ, Hafner BJ, Smith DG: Evaluation of gait style for hill descent for lower limb amputees. In 11th World Congress of the International Society of Prosthetics and Orthotics. Hong Kong; 2004:53.
• [50]Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R: Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008, 89(3):422-429.
• [51]Rommers GM, Vos LD, Groothoff JW, Schuiling CH, Eisma WH: Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997, 21(2):92-99.
• [52]English RD, Hubbard WA, McElroy GK: Establishment of consistent gait after fitting of new components. J Rehabil Res Dev 1995, 32(1):32-35.