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      Assessment of isokinetic hip muscle strength and predictors in patients with lower limb amputation: A cross-sectional study

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          Abstract

          Objectives

          The purpose of the study was to determine isokinetic features and analyze significant predictors related to activity level of patients with lower limb amputation.

          Patients and methods

          Forty-three male patients (mean age: 32.9±8.8 years; range, 21 to 50 years) with lower limb amputation were recruited consecutively for this cross-sectional study between March 1, 2022, and June 30, 2022. The hip flexor and extensor peak torques and total work were evaluated by an isokinetic dynamometer. The secondary outcome measure was the Amputee Mobility Predictor. A linear regression analysis was used to determine factors independently affecting Amputee Mobility Predictor scores.

          Results

          All data of patients with unilateral amputation, except for flexor (p=0.285) and extensor (p=0.247) peak torques on the dominant side, were higher than those of patients with amputation. Dominant side extensor peak torque was statistically higher than nondominant side extensor peak torque (59.4±30.7 vs. 43.4±32.0) in patients with bilateral amputation. No difference was detected between amputated and intact sides of patients with unilateral amputation. Both flexor and extensor total work on the amputated side of the patients with below-knee amputation were higher than the patients with above-knee amputations (63.5±21.1 vs. 94.1±34.3 and 67.1±34.0 vs. 113.0±51.5, respectively). Unilateral amputation (odds ratio: 7.442) and nondominant side extensor total work (odds ratio: 0.615) were found to be significant predictors related with amputee mobility predictor scale.

          Conclusion

          It is possible to have an idea about the possible activity level of the patients with lower limb amputation with the help of the predictors obtained in the current study.

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          Most cited references31

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          Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review.

          To examine the current evidence regarding the reliability and validity of hand-held dynamometry for assessment of muscle strength in the clinical setting. A search was conducted of the following databases: Cochrane, MEDLINE, PubMed, PEDro, OTseeker, Index to Chiropractic Literature (ICL), and MANTIS, from inception until January 29, 2010. The MeSH subject heading "muscle strength dynamometer" was searched, in isolation and in combination with the text word phrases "hand-held dynamometer" and "isokinetic." Four hundred fifty-four different studies met this search and were reviewed for possible inclusion. Two independent reviewers assessed the quality of the included manuscripts. The PEDro data collection system was used in conjunction with the Cochrane Diagnostic Test Accuracy Description. A third reviewer was used when there was disagreement between the primary reviewers. Seventeen manuscripts met the inclusion criteria for this review, with a total of 19 studies (2 of the manuscripts involved 2 separate studies) that compared hand-held dynamometry with an identified reference standard (isokinetic muscle strength testing). The results demonstrated minimal differences between hand-held dynamometry and isokinetic testing. Considering hand-held dynamometry's ease of use, portability, cost, and compact size, compared with isokinetic devices this instrument can be regarded as a reliable and valid instrument for muscle strength assessment in a clinical setting. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
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            The relationship of lower-extremity muscle torque to locomotor performance in people with stroke.

            Improved walking is a common goal after stroke. The purpose of this study was to examine the relationship between the torque generated by the muscles of both lower extremities and 2 locomotor tasks: gait on level surfaces and stair climbing in people who had strokes. Twenty community-dwelling individuals (mean age=61.2 years, SD=8.4, range=52-82) who had strokes and who were able to walk independently participated in the study. The mean time since stroke was 4.0 years (SD=2.6, range=1.5-10.0). Pearson correlations and multiple regression were used to measure the relationship between concentric isokinetic torque of the flexor and extensor muscles of the hip, knee, and ankle bilaterally and locomotor performance (gait on level surfaces and stair-climbing speed). The isokinetic torques of the paretic ankle plantar flexors, hip flexors, and knee flexors had moderate to high correlations (r=.5-.8) with gait and stair-climbing speeds. Muscle force could explain 66% to 72% of the variability in gait and stair-climbing speeds. Correlations for the nonparetic side were as high as or higher than those for the paretic side for some muscle groups. Muscle performance measurements of both limbs should be included in the evaluation of locomotion and treatment of people following a stroke.
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              Leg muscle strength is reduced in Parkinson's disease and relates to the ability to rise from a chair.

              Individuals with Parkinson's disease (PD) have difficulties rising from a chair; however, factors contributing to this inability have never been investigated. We compared lower extremity strength between individuals with PD and healthy controls and quantified the relationships between strength and the ability to rise from a chair. Ten men with mild PD and 10 sex- and age-matched controls performed maximal concentric, isokinetic knee and hip extensor torque on an isokinetic dynamometer to quantify muscle strength. Subjects also rose from a chair at their comfortable pace without the use of their arms and the duration of this task provided a measure of sit-to-stand (STS) ability. Subjects with PD were tested in an on- and off-medication state on different days. Mean hip and knee extensor torques were lower in subjects with PD, with greater deficits found at the hip. Greater hip strength was related to better STS ability in subjects with PD while greater knee strength was related to better STS ability in controls. These results show that individuals with mild PD generate smaller extremity forces compared to controls. Reduced strength, particularly at the hip, may be one factor that contributes to the difficulty of persons with PD to rise from a chair.
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                Author and article information

                Journal
                Turk J Phys Med Rehabil
                Turk J Phys Med Rehabil
                Turkish Journal of Physical Medicine and Rehabilitation
                Bayçınar Medical Publishing
                2587-0823
                2587-1250
                December 2023
                12 October 2023
                : 69
                : 4
                : 526-534
                Affiliations
                [1 ] Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Türkiye
                [2 ] Department of Physical Medicine and Rehabilitation, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital, Ankara, Türkiye
                [3 ] Department of Orthopedics and Traumatology, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Türkiye
                [4 ] Department of Physical Medicine and Rehabilitation, Gülhane Medical School, Health Sciences University, Ankara, Türkiye
                Author notes
                Yasin Demir, MD. SBÜ, Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi, Fiziksel Tıp ve Rehabilitasyon Kliniği, 06800 Çankaya, Ankara, Türkiye. dr_yasindemir@ 123456yahoo.com .
                Author information
                http://orcid.org/0000-0002-0978-6826
                http://orcid.org/0000-0002-7268-3846
                http://orcid.org/0000-0002-6439-8818
                http://orcid.org/0000-0002-7477-7758
                http://orcid.org/0000-0001-5192-4324
                http://orcid.org/0000-0001-9501-6942
                http://orcid.org/0000-0002-0148-2254
                http://orcid.org/0000-0002-4378-9377
                http://orcid.org/0000-0003-3316-4151
                http://orcid.org/0000-0002-9325-3888
                http://orcid.org/0000-0002-6672-5237
                http://orcid.org/0000-0001-6752-0607
                Article
                10.5606/tftrd.2023.13098
                11099856
                bb90a857-1e2a-4d6e-a419-65e7ae2fcdcd
                Copyright © 2023, Turkish Society of Physical Medicine and Rehabilitation

                This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 16 May 2023
                : 12 September 2023
                Categories
                Original Article

                amputation,amputee mobility predictor,gait,isokinetic,mobility,strength.

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