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  1. Article ; Online: Women with limb loss

    Roxanne Disla / Alison L Pruziner / Alexis N Sidiropoulos / Kathryn M Ellis / Tamara Bushnik / Michael J Hyre / Leif M Nelson / Heidi Klingbeil / Jason T Maikos

    BMJ Open, Vol 13, Iss

    rationale, design and protocol for a national, exploratory needs assessment to evaluate the unique physical and psychosocial needs of women with limb loss

    2023  Volume 9

    Abstract: Introduction There is a growing population of women with limb loss, yet limited research is available to provide evidentiary support for clinical decision-making in this demographic. As such, there is a critical gap in knowledge of evidence-based ... ...

    Abstract Introduction There is a growing population of women with limb loss, yet limited research is available to provide evidentiary support for clinical decision-making in this demographic. As such, there is a critical gap in knowledge of evidence-based healthcare practices aimed to maximise the physical and psychosocial needs of women with limb loss. The objective of this study is to develop a comprehensive, survey-based needs assessment to determine the unique impact of limb loss on women, including physical and psychosocial needs.Methods and analysis A bank of existing limb loss-specific and non-limb loss-specific surveys were arranged around domains of general health, quality of life, prosthetic use and needs, psychosocial health and behaviours and body image. These surveys were supplemented with written items to ensure coverage of relevant domains. Written items were iteratively refined with a multidisciplinary expert panel. The interpretability of items and relevance to limb loss were then internally tested on a small group of rehabilitation, engineering and research professionals. A diverse sample of 12 individuals with various levels of limb loss piloted the instrument and participated in cognitive interviews. Items from existing surveys were evaluated for relevance and inclusion in the survey, but not solicited for content feedback. Pilot testing resulted in the removal of 13 items from an existing survey due to redundancy. Additionally, 13 written items were deleted, 42 written items were revised and 17 written items were added. The survey-based needs assessment has been crafted to comprehensively assess the wide spectrum of issues facing women with limb loss. The final version of the survey-based needs assessment included 15 subsections.Ethics and dissemination This study was approved by the Veterans Affairs Central Institutional Review Board. The results will be disseminated through national and international conferences, as well as through manuscripts in leading peer-reviewed journals.Trial registration ...
    Keywords Medicine ; R
    Language English
    Publishing date 2023-09-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article: Guidelines for Using Adjusted versus Unadjusted Body Weights When Conducting Clinical Evaluations and Making Clinical Recommendations

    Andrews, Anne M / Alison L. Pruziner

    Journal of the Academy of Nutrition and Dietetics. 2017 July, v. 117, no. 7

    2017  

    Abstract: It’s universally understood that accurate measurements are crucial to providing the best possible clinical care. However, practitioners who work with patients who have lost a limb or have congenital limb loss know that being able to accurately measure ... ...

    Abstract It’s universally understood that accurate measurements are crucial to providing the best possible clinical care. However, practitioners who work with patients who have lost a limb or have congenital limb loss know that being able to accurately measure body weight and estimate other anthropometric measurements can be problematic because these patients are missing mass that would typically affect their metabolism, and there is often a lack of understanding of why various measurement recommendations are appropriate for one situation but not another. This unique population requires clinical decision making to determine if an actual versus an adjusted body weight should be used for the evaluation or recommendation, for example in calculating and evaluating body mass index (BMI) or resting energy expenditure (REE). Actual body weight allows for appropriate assessments when only metabolically active tissue should be considered, while an adjusted body weight, which factors back in the patient’s lost mass, may be more appropriate when using measurements with population standards that are based on overall body weight.
    Keywords body mass index ; body weight ; decision making ; guidelines ; metabolism ; patients ; resting energy expenditure
    Language English
    Dates of publication 2017-07
    Size p. 1011-1015.
    Publishing place Elsevier Inc.
    Document type Article
    ZDB-ID 2646718-5
    ISSN 2212-2672
    ISSN 2212-2672
    DOI 10.1016/j.jand.2016.07.003
    Database NAL-Catalogue (AGRICOLA)

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  3. Article ; Online: Exploring relationships among multi-disciplinary assessments for knee joint health in service members with traumatic unilateral lower limb loss

    Joseph G. Wasser / Brad D. Hendershot / Julian C. Acasio / Lauren D. Dodd / Rebecca L. Krupenevich / Alison L. Pruziner / Ross H. Miller / Stephen M. Goldman / Michael S. Valerio / Lien T. Senchak / Mark D. Murphey / David A. Heltzel / Michael G. Fazio / Christopher L. Dearth / Nelson A. Hager

    Scientific Reports, Vol 13, Iss 1, Pp 1-

    a two-year longitudinal investigation

    2023  Volume 11

    Abstract: Abstract Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb ...

    Abstract Abstract Motivated by the complex and multifactorial etiologies of osteoarthritis, here we use a comprehensive approach evaluating knee joint health after unilateral lower limb loss. Thirty-eight male Service members with traumatic, unilateral lower limb loss (mean age = 38 yr) participated in a prospective, two-year longitudinal study comprehensively evaluating contralateral knee joint health (i.e., clinical imaging, gait biomechanics, physiological biomarkers, and patient-reported outcomes); seventeen subsequently returned for a two-year follow-up visit. For this subset with baseline and follow-up data, outcomes were compared between timepoints, and associations evaluated between values at baseline with two-year changes in tri-compartmental joint space. Upon follow-up, knee joint health worsened, particularly among seven Service members who presented at baseline with no joint degeneration (KL = 0) but returned with evidence of degeneration (KL ≥ 1). Joint space narrowing was associated with greater patellar tilt (r[12] = 0.71, p = 0.01), external knee adduction moment (r[13] = 0.64, p = 0.02), knee adduction moment impulse (r[13] = 0.61, p = 0.03), and CTX-1 concentration (r[11] = 0.83, p = 0.001), as well as lesser KOOSSport and VR-36General Health (r[16] = − 0.69, p = 0.01 and r[16] = − 0.69, p = 0.01, respectively). This longitudinal, multi-disciplinary investigation highlights the importance of a comprehensive approach to evaluate the fast-progressing onset of knee osteoarthritis, particularly among relatively young Service members with lower limb loss.
    Keywords Medicine ; R ; Science ; Q
    Subject code 796
    Language English
    Publishing date 2023-12-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Medial knee joint contact force in the intact limb during walking in recently ambulatory service members with unilateral limb loss

    Ross H. Miller / Rebecca L. Krupenevich / Alison L. Pruziner / Erik J. Wolf / Barri L. Schnall

    PeerJ, Vol 5, p e

    a cross-sectional study

    2017  Volume 2960

    Abstract: Background Individuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading ... ...

    Abstract Background Individuals with unilateral lower limb amputation have a high risk of developing knee osteoarthritis (OA) in their intact limb as they age. This risk may be related to joint loading experienced earlier in life. We hypothesized that loading during walking would be greater in the intact limb of young US military service members with limb loss than in controls with no limb loss. Methods Cross-sectional instrumented gait analysis at self-selected walking speeds with a limb loss group (N = 10, age 27 ± 5 years, 170 ± 36 days since last surgery) including five service members with transtibial limb loss and five with transfemoral limb loss, all walking independently with their first prosthesis for approximately two months. Controls (N = 10, age 30 ± 4 years) were service members with no overt demographical risk factors for knee OA. 3D inverse dynamics modeling was performed to calculate joint moments and medial knee joint contact forces (JCF) were calculated using a reduction-based musculoskeletal modeling method and expressed relative to body weight (BW). Results Peak JCF and maximum JCF loading rate were significantly greater in limb loss (184% BW, 2,469% BW/s) vs. controls (157% BW, 1,985% BW/s), with large effect sizes. Results were robust to probabilistic perturbations to the knee model parameters. Discussion Assuming these data are reflective of joint loading experienced in daily life, they support a “mechanical overloading” hypothesis for the risk of developing knee OA in the intact limb of limb loss subjects. Examination of the evolution of gait mechanics, joint loading, and joint health over time, as well as interventions to reduce load or strengthen the ability of the joint to withstand loads, is warranted.
    Keywords Load ; Gait ; Prosthesis ; Transtibial ; Transfemoral ; Osteoarthritis ; Medicine ; R ; Biology (General) ; QH301-705.5
    Subject code 796
    Language English
    Publishing date 2017-02-01T00:00:00Z
    Publisher PeerJ Inc.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Metabolic and body composition changes in first year following traumatic amputation

    Carly S. Eckard, MS, RD / Alison L. Pruziner, PT, DPT, ATC / Allison D. Sanchez, MS, RD / Anne M. Andrews, PhD, RD

    Journal of Rehabilitation Research and Development, Vol 52, Iss 5, Pp 553-

    2015  Volume 562

    Abstract: Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first ... ...

    Abstract Body composition and metabolism may change considerably after traumatic amputation because of muscle atrophy and an increase in adiposity. The purpose of this study was to quantify changes in weight, body composition, and metabolic rate during the first year following traumatic amputation in military servicemembers. Servicemembers without amputation were included for comparison. Participants were measured within the first 12 wk after amputation (baseline) and at 6, 9, and 12 mo after amputation. Muscle mass, fat mass, weight, and metabolic rate were measured at each time point. There was a significant increase in weight and body mass index in the unilateral group between baseline and all follow-up visits (p < 0.01). Over the 12 mo period, total fat mass and trunk fat mass increased in both unilateral and bilateral groups; however, these changes were not statistically significant over time. Muscle mass increased in both the unilateral and bilateral groups despite percent of lean mass decreasing. No changes in resting metabolism or walking energy expenditure were observed in any group. The results of this study conclude that weight significantly increased because of an increase in both fat mass and muscle mass in the first year following unilateral and bilateral amputation.
    Keywords amputation ; atrophy ; body composition ; body mass index ; DXA ; fat mass ; metabolism ; muscle mass ; trauma ; unilateral ; weight gain ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R
    Subject code 796
    Language English
    Publishing date 2015-09-01T00:00:00Z
    Publisher Rehabilitation Research and Development Service, Department of Veterans Affairs
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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