This randomized controlled trial (n=25 enrolled, n=15 expected to complete) will 1) determine the feasibility of a 40-week limb-load biofeedback training intervention, 2) determine if there is an intervention signal of efficacy, and 3) identify functional movement priorities for people with transfemoral osseointegrated (OI) prostheses. A limb-load biofeedback training group (EXP (n=10)) will be compared to a standard of care attention-control group without limb-load biofeedback training (CTL (n=5)). Outcomes will be assessed at standard of care pre-habilitation end (Week 5), standard of care rehabilitation end (Week 24), and one year after OI Stage 2 surgery (Week 64).
This will be a randomized controlled trial with a limb-load biofeedback training (EXP) group and an attention control standard-of-care (CTL) group (2:1 allocation ratio). Outcomes will be assessed prior to surgery (Week 5), start of the limb-load biofeedback training (Week 24), and one year after surgery (Week 64). This Phase I clinical trial will be among the first randomized controlled rehabilitation trials for people with transfemoral OI prostheses. There is an immediate need to better understand the physical health benefits and factors that contribute to poor outcomes for this population. A critical step in developing rehabilitation guidelines is to identify optimal methods for people to regain active lifestyles, best use their prostheses, and avoid secondary comorbidities. This novel limb-load biofeedback training program will provide the empirical evidence necessary to inform post-OI rehabilitation regimens designed to optimize outcomes. Importantly, data from this trial will also guide intervention refinement as the investigators move toward a Phase II trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
25
Loadsol data will be used to inform the EXP telehealth sessions, as the interventionist guides the participant to self-monitor their movement, problem solve movement patterns that promote asymmetrical limb loading, and create weekly action plans for improving limb load symmetry. Weekly goals will be made in the context of functional task progression over the 40-week intervention.
The 12 sessions of EXP group limb-load biofeedback training sessions will be replaced by education-only session in the CTL group. The CTL group sessions will include a review of the standard of care home-exercises, a summary of healthcare visits and falls, and interventionist-delivered education on safety topics (e.g., fall prevention, wound care, assistive device use, home safety).
CU Physical Therapy
Aurora, Colorado, United States
Intervention Feasibility
Intervention feasibility is measured by retention rate, the percentage of people that complete the study. A score can range between 0 and 100 percent with 100 percent meaning all randomized participants completed the study.
Time frame: Week 64
Intervention Participant Acceptability
Acceptability of an intervention is the perception among stakeholders (e.g., patients and clinicians) that the intervention is agreeable or satisfactory. To measure participant acceptability, the investigators will use the Acceptability of Intervention Measure, a 30 four-item survey of stakeholder perception of intervention acceptability that asks participants to provide their approval as well as intervention appeal, likability, and agreeability. The scores range from 1 (completely disagree) to 5 (completely agree). The investigators expect the Acceptability of Intervention Measure score (average of the four items on a 1-5 scale) for the EXP group to be at least 4 (agree).
Time frame: Week 64
Intervention Fidelity
This will be evaluated based on whether EXP group interventionists deliver the intervention as planned and quantified in three ways: adherence, delivery quality, and patient engagement. The investigators will use the overall results of these three fidelity components to create a total score. Fidelity scores are reported as a percentage from 0 to 100 with 100 representing full fidelity. The investigators will consider \>85% fidelity (average across all three components) to intervention delivery as a positive result.
Time frame: Week 64
Change in Cumulative Loading
Free-living physical activity will be objectively monitored over a 10-day period using an activPAL micro accelerometer-based sensor (PAL Technologies, Glasgow, UK). Interlimb cumulative loading will be measured as a product of daily step count and ground reaction force impulse. Cumulative loading = (Daily Steps/2)\*ground reaction force impulse.
Time frame: Week 5, Week 64
Change in Multi-Domain Biomechanics during Tasks of Increasing Biomechanical Demand
Bilateral hip movement patterns (joint angles), muscle forces, and joint reaction forces will be calculated during functional tasks of increasing biomechanical demand (walking, sitting, stepping, turning) using a combination of motion capture and subject-specific musculoskeletal models. Whole-body motion capture will be collected from 70 reflective markers (Fs=120 Hz) (Vicon, Centennial, CO) with ground reaction forces simultaneously collected from six embedded force platforms (Fs=2,160 Hz) (Bertec, Columbus, OH). A subject-specific musculoskeletal model will be created using OpenSim software.
Time frame: Week 5, Week 64
Change in World Health Organization-Disability Assessment Schedule 2.0
Self reported questionnaire measuring disability in adults age 18 years and older. Final scores range from 0 (no disability) to 100 (full disability).
Time frame: Week 5, Week 24 and Week 64
Change in Activities Specific Balance Confidence Scale
Self reported measure of balance confidence. Final scores range from 0% (no confidence in balance) to 100% (complete confidence in balance).
Time frame: Week 5, Week 24 and Week 64
Change in Prosthetic Limb Users Survey of Mobility
A 12 item self report questionnaire measuring participants mobility when using a prosthesis. Final scores range from 12 to 60 points with higher scores indicating greater mobility.
Time frame: Week 5, Week 24 and Week 64
Change in Patient Specific Function Scale
Self reported questionnaire measuring the ability of the participant to do 3 self identified activities. Scores of each of the 3 activities range from 0 (unable to perform) to 10 (able to perform without difficulty). Total scores range from 0 to 30 points, with higher scores indicating higher function.
Time frame: Week 5, Week 24 and Week 64
Change in Self Selected Gait Speed
Test to quantify walking ability as it is associated with health outcomes, fall risk, and mobility levels and is also a frequent indicator of intervention effectiveness. The time it takes each participant to walk 5-meters (after 3-meter acceleration zone, followed by 3-meter deceleration zone). The self selected gait speed will be averaged over three trials.
Time frame: Week 5 and Week 64
Change in 30 Second Sit - Stand Test
Test to assess lower-extremity strength and endurance. The number of times the participant can rise from sitting in 30 seconds.
Time frame: Week 5, Week 64
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Change in Colorado Osseointegrated Limb Donning and Timed Up and Go Test
A specific test to measure physical function and balance. The time it takes a participant to don their prosthesis, rise from sitting, walk 10 feet and turn, walk back to the chair and return to seated position.
Time frame: Week 5, Week 64