Brüggenjürgen B, Eilers L, Seidinger S, Kannenberg A, Stukenborg-Colsman C
Institute for Health Services Research and Technical Orthopedics, Orthopedic Department - Medical School Hannover (MHH) at DIAKOVERE Annastift Hospital, Hannover, Germany.
Otto Bock Healthcare Products GmbH, Vienna, Austria.
Can Prosthet Orthot J. 2024 May 30;7(1):42799. doi: 10.33137/cpoj.v7i1.42799. eCollection 2024.
Patients with neuromuscular knee instability who are fitted with orthotic devices experience issues such as pain, falls, mobility limitations, and restricted participation.
To analyze the burden of disease in patients using a microprocessor-stance-and-swing-control orthosis (MP-SSCO) and, if they had a previous orthosis, to compare their outcomes to those with previous use of a traditional knee-ankle-foot-orthosis (KAFO) under real-world conditions.
A structured cross-sectional survey was conducted in six orthotic and prosthetic clinics in Germany. Individuals who had been using an MP-SSCO (C-Brace) for at least six months, answered an internet-based survey to rate their current and recall previous device outcomes and experience. The questionnaire was self-developed based on established questionnaire design principles and pretested. Patients' well-being dimensions were analyzed with Likert scales. Experiences with current and previous orthotic devices were compared. Falls were analyzed both with and without outliers.
21 individuals who had used a MP-SSCO for an average duration of two years participated. Fourteen patients had prior experience with a traditional KAFO orthosis. Among them, 78.6% recalled experiencing falls, with a combined annual frequency of 67.9 (SD=167.0, Median=12.0) events. After excluding the two outliers (624 and 182 falls), a mean of 12.1 falls per patient per year was reported (range: 0 to 54, SD=15.9, Median=8.5). With the MP-SSCO, only 42.7% reported falls with an annual frequency of 5.3 (SD=17.0, Median=0.0) falls (p<0.01). After excluding outliers for MP-SSCO users, the average number of falls was 0.5 per year (range 0 to 3, SD=0.9, Median=0.0). This value was significantly lower compared to the previous orthosis (p<0.01). With their previous KAFO, 57.1% of the participants reported being able to walk downstairs, 14.3% to descend stairs with reciprocal gait, and 42.9% to vary their walking speeds. In contrast, 90.5% of MP-SSCO users reported being capable of descending stairs, 81.0% reported to descend stairs with reciprocal gait (p<0.01), and 76.2% claimed they had the ability to walk with varying speeds (p=0.03). Additionally, 71.4% of the respondents experienced an improvement in their engagement in activities with the MP-SSCO. 50.0% reported pain with the previous orthosis, compared to 38.1% with the MP-SSCO. Pain intensity was higher for the previous orthosis use (3.8) compared to MP-SSCO use (2.8) on a 1-5 scale (p=0.06). 93.3% of the participants regarded the MP-SSCO as superior, noting an enhanced quality of life (QoL) compared to the previous orthosis.
Advanced orthotic technology may positively impact outcomes such as fall frequency, activities of daily living, fear of falling and pain. However, in this study, results from the previous orthosis use might have been influenced by recall bias.
佩戴矫形装置的神经肌肉性膝关节不稳定患者会经历疼痛、跌倒、行动受限和参与受限等问题。
分析使用微处理器站立和摆动控制矫形器（MP - SSCO）的患者的疾病负担，并将他们（如果之前使用过矫形器）的结果与之前在实际情况下使用传统膝踝足矫形器（KAFO）的患者的结果进行比较。
在德国的六家矫形和假肢诊所进行了一项结构化横断面调查。使用MP - SSCO（C型支具）至少六个月的个体回答了一项基于互联网的调查，以对他们当前的情况进行评分，并回忆之前使用设备的结果和体验。该问卷是根据既定的问卷设计原则自行编制并进行了预测试。使用李克特量表分析患者的幸福感维度。比较了当前和之前矫形装置的使用体验。对有和没有异常值的跌倒情况都进行了分析。
21名平均使用MP - SSCO两年的个体参与了调查。14名患者以前有使用传统KAFO矫形器的经历。其中，78.6%的人回忆起曾经历过跌倒，每年的总跌倒频率为67.9次（标准差 = 167.0，中位数 = 12.0）。排除两个异常值（624次和182次跌倒）后，报告的每位患者每年平均跌倒次数为12.1次（范围：0至54次，标准差 = 15.9，中位数 = 8.5）。使用MP - SSCO时，只有42.7%的人报告有跌倒情况，每年跌倒频率为5.3次（标准差 = 17.0，中位数 = 0.0）（p < 0.01）。排除MP - SSCO使用者的异常值后，每年的平均跌倒次数为0.5次（范围0至3次，标准差 = 0.9，中位数 = 0.0）。与之前的矫形器相比，这个值显著更低（p < 0.01）。使用之前的KAFO时，57.1%的参与者报告能够走下楼梯，14.3%的人能够以交替步态下楼梯，42.9%的人能够改变行走速度。相比之下，90.5%的MP - SSCO使用者报告能够下楼梯，81.0%的人报告能够以交替步态下楼梯（p < 0.01），76.2%的人声称他们有能力以不同速度行走（p = 0.03）。此外，71.4%的受访者表示使用MP - SSCO后他们参与活动的情况有所改善。50.0%的人报告使用之前的矫形器时有疼痛，而使用MP - SSCO时这一比例为38.1%。在1 - 5的量表上，之前使用矫形器时的疼痛强度（3.8）高于使用MP - SSCO时（2.8）（p = 0.06）。93.3%的参与者认为MP - SSCO更优越，指出与之前的矫形器相比生活质量（QoL）有所提高。
先进的矫形技术可能会对跌倒频率、日常生活活动、跌倒恐惧和疼痛等结果产生积极影响。然而，在本研究中，之前使用矫形器的结果可能受到回忆偏差的影响。
