Influence of age and level of activity on the applicability of a walker orthosis - a prospective study in different cohorts of healthy volunteers
Tóm tắt
Walker orthosis are frequently prescribed as they are removable to allow wound control, body care and physiotherapy and are adaptable to the soft tissue conditions. The prerequisite for successful treatment with any walker orthosis is a correct use by the patient. Therefore, the aim of this study was to investigate patients’ handling of a commonly used walker. Prospective observational study analyzing the applicability of a walker orthosis in different cohorts with varying age and level of activity. Volunteers were recruited from a mountain-biking-team (Sport), a cardiovascular-health-sports-group (Cardio) and a retirement home (Senior). The correct application was assessed following initial training (t0) and one week later (t1). Outcome parameters were an Application Score, strap tightness, vertical heel lift-off and subjective judgement of correct application. Thirty-three volunteers, 11 Sports group (31 ± 7a), 12 Cardio group (59 ± 11a), 10 Senior group, (82 ± 5a) were enrolled. No differences for any parameter could be observed between t0 and t1. Age showed a moderate correlation for all outcome parameters and the cohort influenced all variables. The Senior group presented significant inferior results to the Sport- and Cardio group for the Application Score (p = 0.002-p < 0.001) and strap tightness (p < 0.001). Heel lift-off was significantly inferior in the Cardio- and Senior- compared to the Sport group (p = 0.003-p < 0.001). 14% in the Sport-, 4% in the Cardio- and 83% in the Senior group achieved less than 9 points in the Application Score – which was considered insufficient. However, out of these 90% believed the application to be correct. The elderly cohort living in a retirement home demonstrated an impaired handling of the walker orthosis. Further, participants were incapable to self-assess the correct handling. These aspects should be respected when initiating treatment with a walker orthosis. Retrospectively registered on the 16th of February 2018: #
DRKS00013728
on DRKS.
Tài liệu tham khảo
Giannini S, Chiarello E, Persiani V, Luciani D, Cadossi M, Tedesco G. Ankle fractures in elderly patients. Aging Clin Exp Res. 2013;25(Suppl 1):S77–9.
Olsen JR, Hunter J, Baumhauer JF. Osteoporotic ankle fractures. Orthop Clin North Am. 2013;44(2):225–41.
Lucas Y Hernandez J, Abad J, Remy S, Darcel V, Chauveaux D, Laffenetre O. Tibiotalocalcaneal arthrodesis using a straight intramedullary nail. Foot Ankle Int. 2015;36(5):539–46.
Brechtel Thomas, Nils Kossack, Daniel Grandt. Barmer GEK Heil- und Hilfsmittelreport. Barmer GEK 2016;41:1–58.
Psatha M, Wu Z, Gammie FM, Ratkevicius A, Wackerhage H, Lee JH, et al. A longitudinal MRI study of muscle atrophy during lower leg immobilization following ankle fracture. J Magn Reson Imaging. 2012;35(3):686–95.
Stöckle U, König B, Tempka A, Südkamp NP. Cast immobilization versus vacuum stabilizing system. Early functional results after osteosynthesis of ankle joint fractures. Unfallchirurg. 2000;103(3):215–9.
Franke J, Goldhahn S, Audige L, Kohler H, Wentzensen A. The dynamic vacuum orthosis: a functional and economical benefit? Int Orthop. 2008;32(2):153–8.
Armstrong DG, Lavery LA, Wu S, Boulton AJ. Evaluation of removable and irremovable cast walkers in the healing of diabetic foot wounds: a randomized controlled trial. Diabetes Care. 2005;28(3):551–4.
Lavery LA, Higgins KR, La Fontaine J, Zamorano RG, Constantinides GP, Kim PJ. Randomised clinical trial to compare total contact casts, healing sandals and a shear-reducing removable boot to heal diabetic foot ulcers. Int Wound J. 2015;12(6):710–5.
Nagel A, Rosenbaum D. Vacuum cushioned removable cast walkers reduce foot loading in patients with diabetes mellitus. Gait Posture. 2009;30(1):11–5.
Brodziak A, Wolińska A, Kołat E, Różyk-Myrta A. Guidelines for prevention and treatment of cognitive impairment in the elderly. Med Sci Monit. 2015;21:585–97.
Jekel K, Damian M, Wattmo C, Hausner L, Bullock R, Connelly PJ, et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;7(1):17.
Björk S, Juthberg C, Lindkvist M, Wimo A, Sandman P-O, Winblad B, et al. Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study. BMC Geriatr. 2016;16(1):154.
Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the international sarcopenia initiative (EWGSOP and IWGS). Age Ageing. 2014;43(6):748–59.
Roberts HC, Syddall HE, Sparkes J, Ritchie J, Butchart J, Kerr A, et al. Grip strength and its determinants among older people in different healthcare settings. Age Ageing. 2014;43(2):241–6.