Browsing by Author "Smit, Elmari"

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    Self-reported function and hip extension gait biomechanics in adults with unilateral trans-femoral amputations using different socket designs in two South African metropoles : a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2024-03) Smit, Elmari; Berner, Karina; Fisher, Dominic; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: Background: Unilateral trans-femoral (TF) amputation significantly impacts mobility and biomechanics, often leading to secondary complications like lower back pain. In South Africa, Ischial Containment (IC) is the standard prosthetic socket design, but it may restrict hip mobility during gait. The Direct Socket (DS) design is proposed as an alternative, aiming to improve hip mobility and patient satisfaction. However, limited evidence exists on how DS design impacts subjective and objective mobility outcomes for TF amputees. Aim: This study aimed to describe self-reported mobility function and objectively-measured sagittal plane hip extension gait biomechanics based on different prosthetic socket designs (IC and DS) in adults with unilateral TF amputations in Cape Town and Tshwane. Additionally, it aimed to correlate objective and subjective results and compare the groups (intra- and intergroup). Methods: This cross-sectional study, with an analytical component, sampled participants with TF amputations through quota sampling. Participants underwent eligibility screening, including determining K-levels, measurements of hip range of motion (ROM) and dynamometry. Participants completed questionnaires (Walking (WQ35), Climbing Stairs (CSQ15), Rising and Sitting Down (R&SDQ39)) to assess perceived disability. All participants were fitted with a loaner Rheo knee and Vari-Flex foot before optoelectronic motion capture (OMC) gait analysis. OMC outcomes included temporospatial parameters (TSP) and stance phase hip extension kinematics and kinetics. Results from the screening and OMC were correlated with the subjective findings. Statistical significance was considered at 5% and effect sizes (ES) were calculated to evaluate clinical significance. Data were described using medians and interquartile ranges (IQR). Statistical analyses included Wilcoxon signed-rank tests, Mann-Whitney U-tests, Kruskal-Wallis H-tests, and Symmetry Index (SI) calculations. Results: Ten predominantly male adults (median age 54 (IQR 39-57)) participated, with three using IC and seven using DS sockets. Percentage of perceived disability showed a moderate ES (ES = -0.470, p = 0.183) favouring the IC socket design. Gait speed, cadence, stride length, step length and step time did not differ significantly between socket designs. Significant differences in ES were observed for step length and step time (ES = -0.748; p = 0.018) when comparing within the same group SI values showed the IC design to be more symmetrical for all TSP except step time, where DS was more symmetrical. Worse self-reported function was strongly correlated to longer step time (rS = 0.754, p = 0.012), lower cadence, shorter step length from amputated-to-sound limb, and slower average gait speed (range rS = -0.681 to -0.723, all p<0.02). Maximum hip extension for amputated and sound limbs showed moderate and small ES, favouring IC (ESs 0.324 to 0.252, p = 0.383 to 0.517), while hip flexion-to-extension ROM and kinetics showed small effect sizes without statistical significance. Conclusions: No definitive superior socket design emerged. This study highlights the complexity of selecting a prosthetic socket design (IC or DS) for TF amputees, emphasising the need to consider individual patient factors and functional status (K-level). However, due to the small sample size and restricted generalisability, further research with larger cohorts is necessary to validate these findings and provide more robust evidence for clinical decision-making.