Howard Charla L, Wallace Chris, Perry Bonnie, Stokic Dobrivoje S
Division of Orthotics and Prosthetics.
Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA.
Int J Rehabil Res. 2018 Mar;41(1):63-73. doi: 10.1097/MRR.0000000000000267.
Insufficient evidence of the benefits provided by costlier microprocessor knees (MPKs) over nonmicroprocessor knees (NMPKs) often causes concern when considering MPK prescription. Thus, more studies are needed to demonstrate differences between MPKs and NMPKs and define sensitive outcomes to guide MPK prescription. The aim of this study was to evaluate the impact of switching from NMPK to MPK on measures of mobility and preference. Seven long-term NMPK users (all men, ages 50-84, 3-64 years postamputation) participated in this study, which use a single-subject design (ABA or BAB; A=NMPK, B=MPK). Mobility was assessed with the Amputee Mobility Predictor, Berg Balance Scale (BBS), L-Test, 6-Min Walk Test (6MWT) with Physiological Cost Index, and self-selected normal and very fast gait speeds. The preference between NMPK and MPK was evaluated by the Prosthesis Evaluation Questionnaire (PEQ) and the visual analog scale. Mobility improved with the MPK in six of seven participants, which was most often captured with BBS (median: +6 points) and 6MWT (median: +63 m). These improvements typically exceeded minimal clinically important difference or minimal detectable change thresholds. Most participants scored the MPK higher on the PEQ (median: +20 points) and six of seven expressed a global preference toward MPK. In the BAB group, the Amputee Mobility Predictor and BBS correlated with perception of change on several PEQ domains (Ρ≥0.59). In conclusion, MPKs may provide better outcomes and user satisfaction, particularly in those with lower mobility function. BBS and 6MWT were found to be the most sensitive measures to capture changes in mobility while using MPK for several weeks.
在考虑为患者开具微处理器膝关节（MPK）处方时，往往会担心价格更高的MPK相较于非微处理器膝关节（NMPK）所带来的益处缺乏充分证据。因此，需要更多研究来证明MPK和NMPK之间的差异，并确定敏感的评估指标以指导MPK处方的开具。本研究的目的是评估从NMPK转换为MPK对活动能力指标和患者偏好的影响。七名长期使用NMPK的患者（均为男性，年龄50 - 84岁，截肢后3 - 64年）参与了本研究，研究采用单受试者设计（ABA或BAB；A = NMPK，B = MPK）。通过截肢者活动能力预测器、伯格平衡量表（BBS）、L测试、带有生理成本指数的6分钟步行测试（6MWT）以及自我选择的正常和极快步行速度来评估活动能力。通过假体评估问卷（PEQ）和视觉模拟量表评估患者对NMPK和MPK的偏好。七名参与者中有六名使用MPK后活动能力得到改善，其中最常通过BBS（中位数：+6分）和6MWT（中位数：+63米）体现。这些改善通常超过了最小临床重要差异或最小可检测变化阈值。大多数参与者在PEQ上对MPK的评分更高（中位数：+20分），七名参与者中有六名表示总体上更喜欢MPK。在BAB组中，截肢者活动能力预测器和BBS与PEQ几个领域的变化感知相关（Ρ≥0.59）。总之，MPK可能会带来更好的结果和用户满意度，尤其是对于活动功能较低的患者。研究发现，在使用MPK几周后，BBS和6MWT是捕捉活动能力变化最敏感的指标。
