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C A Abbott - One of the best experts on this subject based on the ideXlab platform.

  • effects of early mobilization on unhealed dysvascular transtibial Amputation Stumps a clinical trial
    Archives of Physical Medicine and Rehabilitation, 2009
    Co-Authors: Ernest R Vanross, Sylvia R Johnson, C A Abbott
    Abstract:

    OBJECTIVE: To observe the effects of early mobilization on unhealed transtibial (TT) Amputation Stump wounds of dysvascular etiology. An "unhealed" Stump was defined as having a wound greater than 1cm x 1cm at least 3 weeks after surgery. DESIGN: An observational cohort study. SETTING: This center receives about 250 new lower-limb amputees a year from over 50 surgeons working in 16 hospitals. Over 35% are unhealed. PARTICIPANTS: Sixty-six consecutive new TT amputees (age 62.8+/-10.8y) of dysvascular etiology (diabetes 50%) with unhealed Stumps were recruited. Sixty-one percent were current or past smokers. The mean +/- SD Stump wound size was 7.7+/-2.7cm x 3.2+/-2.0cm. INTERVENTIONS: The wound size was measured, and Stump transcutaneous oxygen (TcpO(2)) and transcutaneous carbon dioxide (TcpCO(2)) were measured. Wounds were debrided and dressed by using a standard protocol. Mobilization using a Pneumatic Post-Amputation Mobility (PPAM) Aid for approximately 3 weeks was followed by provision of a TT prosthesis. A standard physiotherapy walking training program was performed. MAIN OUTCOME MEASURES: Stump wound healing, time to achieve healing, and resting transcutaneous oxygen pressure pre- and posttherapy. RESULTS: Of the 66 amputees, 4 did not start. Sixty-two started; 6 withdrew, and 56 completed the trial. Complete wound healing was achieved in 74% (46/62) over a mean of 141 (87-270) days. The mean +/- SD Stump TcpO(2) at baseline was 41.3+/-19.8mmHg and increased significantly to 50.6+/-21.9mmHg (P<.02) after 97 (34-185) days of mobilization. Nine of 46 required revision plastic surgery. Five subjects, whose wounds were healing, became unwell, dropped out, and later deceased. Five subjects, all current smokers, did not heal and underwent higher Amputation. CONCLUSIONS: Patients with large unhealed TT Stump wounds can simultaneously undergo walking training by using a prosthesis and can achieve wound healing. Seventy-four percent of subjects achieved full wound healing. The small minority of patients who did not heal were current smokers whose TcpO(2) levels did not improve throughout the trial. Rising levels of Stump TcpO(2)were associated with wound healing.

Annemarie Bagnall - One of the best experts on this subject based on the ideXlab platform.

  • transcutaneous electrical nerve stimulation tens for phantom pain and Stump pain following Amputation in adults
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie Bagnall
    Abstract:

    Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for phantom pain and Stump pain following Amputation in adults. Pain may present in a body part that has been amputated (phantom pain) or at the site of Amputation (Stump pain), or both. Phantom pain and Stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for phantom pain and Stump pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of phantom pain and Stump pain following Amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of phantom pain and Stump pain following an Amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of phantom pain and Stump pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of phantom pain and Stump pain. The published literature on TENS for phantom pain and Stump pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.

  • transcutaneous electrical nerve stimulation tens for phantom pain and Stump pain following Amputation in adults an extended analysis of excluded studies from a cochrane systematic review
    Physical Therapy Reviews, 2014
    Co-Authors: Matthew R Mulvey, Annemarie Bagnall, Paul Marchant, Mark I Johnson
    Abstract:

    Background: Amputee pain may present in a body part that has been amputated (phantom pain) and/or at the site of Amputation (Stump pain). Mainstay treatments are pharmacological although the need for non-pharmacological management strategies has been recognized. Transcutaneous electrical nerve stimulation (TENS) is recommended as a treatment option. Objective: The aim of this systematic review was to inform TENS technique and dosages by undertaking an extended descriptive analysis of findings from case reports, non-randomized studies, and uncontrolled studies excluded from our previous Cochrane Review. Methods: A search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, AMED, CINAHL, PEDro, and SPORTDiscus was performed for randomized controlled trials (RCTs) using any surface electrical nerve stimulation for amputee pain. Two review authors screened potential studies for inclusion. Results: Of the 72 articles identified by the searches, 14 were considered relevant. A ...

Mark I Johnson - One of the best experts on this subject based on the ideXlab platform.

  • transcutaneous electrical nerve stimulation tens for phantom pain and Stump pain following Amputation in adults
    Cochrane Database of Systematic Reviews, 2015
    Co-Authors: Mark I Johnson, Matthew R Mulvey, Annemarie Bagnall
    Abstract:

    Background This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for phantom pain and Stump pain following Amputation in adults. Pain may present in a body part that has been amputated (phantom pain) or at the site of Amputation (Stump pain), or both. Phantom pain and Stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non-drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for phantom pain and Stump pain is currently unknown. Objectives To assess the analgesic effectiveness of TENS for the treatment of phantom pain and Stump pain following Amputation in adults. Search methods For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015. Selection criteria We only included RCTs investigating the use of TENS for the management of phantom pain and Stump pain following an Amputation in adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS. Main results In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of phantom pain and Stump pain in adults. For this update, we did not identify any additional RCTs for inclusion. Authors' conclusions There were no RCTs to judge the effectiveness of TENS for the management of phantom pain and Stump pain. The published literature on TENS for phantom pain and Stump pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.

  • transcutaneous electrical nerve stimulation tens for phantom pain and Stump pain following Amputation in adults an extended analysis of excluded studies from a cochrane systematic review
    Physical Therapy Reviews, 2014
    Co-Authors: Matthew R Mulvey, Annemarie Bagnall, Paul Marchant, Mark I Johnson
    Abstract:

    Background: Amputee pain may present in a body part that has been amputated (phantom pain) and/or at the site of Amputation (Stump pain). Mainstay treatments are pharmacological although the need for non-pharmacological management strategies has been recognized. Transcutaneous electrical nerve stimulation (TENS) is recommended as a treatment option. Objective: The aim of this systematic review was to inform TENS technique and dosages by undertaking an extended descriptive analysis of findings from case reports, non-randomized studies, and uncontrolled studies excluded from our previous Cochrane Review. Methods: A search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, AMED, CINAHL, PEDro, and SPORTDiscus was performed for randomized controlled trials (RCTs) using any surface electrical nerve stimulation for amputee pain. Two review authors screened potential studies for inclusion. Results: Of the 72 articles identified by the searches, 14 were considered relevant. A ...

Michael Saleh - One of the best experts on this subject based on the ideXlab platform.

  • peri operative ultrasound guided needle localisation of Amputation Stump neuroma
    Injury-international Journal of The Care of The Injured, 1999
    Co-Authors: Alan J Thomas, Matthew J Bull, Andrew C Howard, Michael Saleh
    Abstract:

    Ten patients with clinically suspected neuromas following Amputation were submitted for ultrasound examination. Neuromas in seven of the ten patients were identified as the cause of pain with ultrasound guided infiltration of local anaesthetic. Pre operative localisation, using breast localisation wires allowed the neuromas to be surgically excised with reduced dissection. This small study demonstrates that ultrasound is an effective method for identifying and localising neuromas in Amputation Stumps. This leads to reduced dissection and may lead to a better outcome in these patients.

Chinedu Gregory Nwigwe - One of the best experts on this subject based on the ideXlab platform.