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CompletedNCT03446131RapidRehabUpdated Jan 7, 2021

Improved Training Program for Fall Prevention of War Fighters

An observational study in Limb Injury, sponsored by Mayo Clinic. Completed at 4 sites in United States. Open to participants aged 18 Years to 55 Years. Per ClinicalTrials.gov, last updated 2021-01-07.

Sponsored by Mayo Clinic · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
45
Ages
18 Years to 55 Years
Sex
All
01

Study summary

This study will train War Fighters with lower extremity trauma to decrease fall risk.

Read the detailed description

Eligible active duty service members, retired or veterans who participated in rehabilitation programs at Department of Defense Advanced Rehabilitation Centers (Walter Reed National Military Medical Center, Center for the Intrepid-San Antonio Military Medical Center and/or the Naval Medical Center San Diego) will be considered for enrollment in this study. This study will look at service members who have undergone transfemoral, transtibial or bilateral lower extremity amputation or limb salvage procedures. Participants will receive fall prevention training on an instrumented treadmill (6, training sessions). Participants will receive three performance assessments:-immediately following completion of the treadmill training and at three and six months following the completion of the training. Post training, twice per month subjects will receive an email containing a follow up fall questionnaire monitoring if they have fallen and the circumstances surrounding their fall. If they do not have access to email, or if a timely response is not received from the email questionnaire which was sent out, subjects will be contacted by phone.

02

Conditions studied

  • Limb Injury

Keywords

  • transfemoral amputation
  • limb salvage
  • bilateral amputation
  • Department of Defense
  • orthosis
  • prosthesis
  • rehabilitation
  • military treatment facilities
  • military
  • injured lower extremity
  • prevent falls
  • trauma lower extremity
  • service members
  • retired service members
  • active service members
  • unilateral lower extremity trauma
  • limb amputation
  • limb preservation
  • preserved limb
  • trips
  • slips
  • transtibial amputation
03

Who can participate

Ages eligible
18 Years to 55 Years
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

This study plans to recruit both male and female military beneficiaries with a unilateral or bilateral transtibial or transfemoral amputation or salvaged and preserved limbs. The subjects will be present or past patients in the Naval Medical Center San Diego, C5 Rehabilitation Program, Center for the Intrepid Rehabilitation Program or Walter Reed National Military Medical Center Rehabilitation Program. Subjects will be contacted by the respective site study coordinator and asked to participate in the study.

Inclusion criteria

  • Eligible active duty and retired service members and veterans with lower limb trauma
  • Transfemoral amputation, transtibial amputation, bilateral amputation and or limb salvage
  • Participated in conventional rehab at one of the following rehab centers: Walter Reed National Medical Center, Center for the Intrepid Brooke Army Medical Center, Naval Medical Center San Diego
  • Community ambulator
  • Prosthesis / Orthosis use daily

Exclusion criteria

  • Dysvascular disease
  • Excessive pain
  • Neuromuscular problems preventing the performance of study protocol
04

Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
45 participants (actual)
Patient registry
No
05

What researchers measure

Primary outcomes

  1. Change in Trunk Position

    Trunk Position (referenced to vertical) at recovery step completion

    Time frame: Change from baseline at 0, 3, and 6 months after completing training

  2. Change in Trunk Velocity

    Trunk Velocity at recovery step completion

    Time frame: Change from baseline at 0, 3, and 6 months after completing training

Secondary outcomes

  1. Falls

    Falls per month reported in the Prosthesis Evaluation Questionnaire - Addendum

    Time frame: Change from baseline at 0, 3, and 6 months after completing training

  2. FSST

    Four-Square Step Test

    Time frame: Change from baseline at 0, 3, and 6 months after completing training

06

Study locations

4 sites
  • Naval Medical Center San Diego
    San Diego, California 92134, United States
  • Walter Reed National Military Medical Center
    Bethesda, Maryland 20889, United States
  • Mayo Clinic in Rochester
    Rochester, Minnesota 55905, United States
  • Center for the Intrepid Brooke Army Medical Center
    San Antonio, Texas 78234, United States
07

References and documents

Publications

  • Armed Forces Health Surveillance Center (AFHSC). Medical evacuations from Operation Iraqi Freedom/Operation New Dawn, active and reserve components, U.S. Armed Forces, 2003-2011. MSMR. 2012 Feb;19(2):18-21. PubMed 22372753 ↗
  • Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, Keeling JJ, Pasquina PF, Wain HJ, Carlini AR, MacKenzie EJ. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013 Jan 16;95(2):138-45. doi: 10.2106/JBJS.K.00734. PubMed 23324961 ↗
  • Gooday HM, Hunter J. Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle. Clin Rehabil. 2004 Jun;18(4):379-90. doi: 10.1191/0269215504cr738oa. PubMed 15180121 ↗
  • Pauley T, Devlin M, Heslin K. Falls sustained during inpatient rehabilitation after lower limb amputation: prevalence and predictors. Am J Phys Med Rehabil. 2006 Jun;85(6):521-32; quiz, 533-5. doi: 10.1097/01.phm.0000219119.58965.8c. PubMed 16715022 ↗
  • Miller WC, Deathe AB, Speechley M, Koval J. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation. Arch Phys Med Rehabil. 2001 Sep;82(9):1238-44. doi: 10.1053/apmr.2001.25079. PubMed 11552197 ↗
  • Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001 Aug;82(8):1050-6. doi: 10.1053/apmr.2001.24893. PubMed 11494184 ↗
  • Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist. 1994 Feb;34(1):16-23. doi: 10.1093/geront/34.1.16. PubMed 8150304 ↗
  • Dite W, Connor HJ, Curtis HC. Clinical identification of multiple fall risk early after unilateral transtibial amputation. Arch Phys Med Rehabil. 2007 Jan;88(1):109-14. doi: 10.1016/j.apmr.2006.10.015. PubMed 17207685 ↗
  • Franchignoni F, Orlandini D, Ferriero G, Moscato TA. Reliability, validity, and responsiveness of the locomotor capabilities index in adults with lower-limb amputation undergoing prosthetic training. Arch Phys Med Rehabil. 2004 May;85(5):743-8. doi: 10.1016/j.apmr.2003.06.010. PubMed 15129398 ↗
  • van Velzen JM, van Bennekom CA, Polomski W, Slootman JR, van der Woude LH, Houdijk H. Physical capacity and walking ability after lower limb amputation: a systematic review. Clin Rehabil. 2006 Nov;20(11):999-1016. doi: 10.1177/0269215506070700. PubMed 17065543 ↗
  • Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001 Aug;82(8):1031-7. doi: 10.1053/apmr.2001.24295. PubMed 11494181 ↗
  • Krimmer H, Wiemer P, Kalb K. [Comparative outcome assessment of the wrist joint--mediocarpal partial arthrodesis and total arthrodesis]. Handchir Mikrochir Plast Chir. 2000 Nov;32(6):369-74. doi: 10.1055/s-2000-10915. German. PubMed 11189889 ↗
  • Macefield VG. Physiological characteristics of low-threshold mechanoreceptors in joints, muscle and skin in human subjects. Clin Exp Pharmacol Physiol. 2005 Jan-Feb;32(1-2):135-44. doi: 10.1111/j.1440-1681.2005.04143.x. PubMed 15730450 ↗
  • Lin YT, Berger RA, Berger EJ, Tomita K, Jew JY, Yang C, An KN. Nerve endings of the wrist joint: a preliminary report of the dorsal radiocarpal ligament. J Orthop Res. 2006 Jun;24(6):1225-30. doi: 10.1002/jor.20166. PubMed 16705705 ↗
  • Lewallen RP, Johnson EW Jr. Fractures in amputation stumps: review of treatment of 16 fractures. Mayo Clin Proc. 1981 Jan;56(1):22-6. PubMed 7453246 ↗
  • PALMER I. Pathophysiology of the medical ligament of the knee joint. Acta Chir Scand. 1958 Aug 30;115(4):312-8. No abstract available. PubMed 13582512 ↗
  • Bedigrew KM, Patzkowski JC, Wilken JM, Owens JG, Blanck RV, Stinner DJ, Kirk KL, Hsu JR; Skeletal Trauma Research Consortium (STReC). Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma? Clin Orthop Relat Res. 2014 Oct;472(10):3017-25. doi: 10.1007/s11999-014-3609-7. PubMed 24744130 ↗
  • Patzkowski JC, Blanck RV, Owens JG, Wilken JM, Blair JA, Hsu JR. Can an ankle-foot orthosis change hearts and minds? J Surg Orthop Adv. 2011 Spring;20(1):8-18. PubMed 21477527 ↗
  • Patzkowski JC, Blanck RV, Owens JG, Wilken JM, Kirk KL, Wenke JC, Hsu JR; Skeletal Trauma Research Consortium. Comparative effect of orthosis design on functional performance. J Bone Joint Surg Am. 2012 Mar 21;94(6):507-15. doi: 10.2106/JBJS.K.00254. PubMed 22437999 ↗
  • Panwalkar N, Aruin AS. Role of ankle foot orthoses in the outcome of clinical tests of balance. Disabil Rehabil Assist Technol. 2013 Jul;8(4):314-20. doi: 10.3109/17483107.2012.721158. Epub 2012 Oct 19. PubMed 23078248 ↗
  • Guillebastre B, Rougier P. [Effects of rigid-ankle and ankle-foot orthoses in the control of asymetrical undisturbed upright stance]. Ann Readapt Med Phys. 2007 Mar;50(2):70-7. doi: 10.1016/j.annrmp.2006.09.002. Epub 2006 Oct 12. French. PubMed 17070953 ↗
  • Guillebastre B, Calmels P, Rougier P. Effects of rigid and dynamic ankle-foot orthoses on normal gait. Foot Ankle Int. 2009 Jan;30(1):51-6. doi: 10.3113/FAI.2009.0051. PubMed 19176186 ↗
  • Owens JG. Physical therapy of the patient with foot and ankle injuries sustained in combat. Foot Ankle Clin. 2010 Mar;15(1):175-86. doi: 10.1016/j.fcl.2009.10.005. PubMed 20189123 ↗
  • Owens JG, Blair JA, Patzkowski JC, Blanck RV, Hsu JR; Skeletal Trauma Research Consortium. Return to running and sports participation after limb salvage. J Trauma. 2011 Jul;71(1 Suppl):S120-4. doi: 10.1097/TA.0b013e3182219225. PubMed 21795870 ↗
  • Ramstrand N and Ramstrand S. (2010). The effect of ankle-foot orthoses on balance - Asystematic Review. Journal of Prosthetics and Orthotics; 22(4S): p4-p23.
  • Hijmans JM, Geertzen JH, Dijkstra PU, Postema K. A systematic review of the effects of shoes and other ankle or foot appliances on balance in older people and people with peripheral nervous system disorders. Gait Posture. 2007 Feb;25(2):316-23. doi: 10.1016/j.gaitpost.2006.03.010. Epub 2006 May 9. PubMed 16687248 ↗
  • Shumway-Cook A, Woollacott MH. (1995). Motor learning and recovery of function. InMotor Control: Theory and Practical Application (pp. 23-443). Baltimore, MD:Williams & Wilkens.

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03446131
Lead sponsor
Mayo Clinic
Collaborators
United States Naval Medical Center, San Diego, Walter Reed National Military Medical Center, Brooke Army Medical Center, University of Illinois at Chicago
Responsible party
Kenton R. Kaufman, Ph.D. (P.E. Director Motion Analysis Laboratory, Mayo Clinic) — Principal investigator
First posted
Feb 26, 2018
Start date
Mar 12, 2018
Primary completion
Sep 30, 2020
Completion
Dec 31, 2020
Last update
Jan 7, 2021

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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