IDEO Use Reduces Desire for Amputation

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The Intrepid Dynamic Exoskeletal Orthosis (IDEO) brace is a custom energy-storing orthosis design meant to improve gait, stability, and function after lower-limb injury or limb salvage. A study investigated which patients may benefit most from IDEO bracing and what factors of the IDEO design and rehabilitation program are most important for improved outcomes. The research team concluded that, among patients who initially desired amputation, only 36.4 percent continued to desire amputation after receiving an IDEO brace.

The researchers performed a retrospective review of all patients treated with a IDEO style brace at a single military lower-limb trauma referral center between May 2003 and November 2017 and reviewed the medical records for initial diagnosis, post-orthotic rehabilitation program, IDEO use characteristics, pain, change in desire for amputation, and whether patient underwent eventual amputation.

Of 213 patients with 222 lower extremities treated with IDEO brace, 76 limbs were treated for combat-related injuries. At one-year follow-up, of 185 limbs with use data available, 116 (61.1 percent) continued regular brace use, and 37 (15.7 percent) reported intermittent use.

Patients diagnosed with foot drop or weakness were more likely to continue use, while patients with a previous ankle or hindfoot fusion were less likely to continue use. Undergoing any dedicated therapy increased chances of continued use. At final follow-up, 16 patients (7.5 percent) underwent amputations following IDEO treatment. Overall, 27.2 percent of patients who initially desired amputation eventually underwent amputation despite IDEO brace use. Patients who underwent amputation reported higher pain levels.

From the data collected, the research team concluded that the IDEO may decrease the desire for delayed amputation and permit higher levels of activity; however, its efficacy appears tied to the rehabilitative regimen, pain levels, and initial diagnosis.

The study, "IDEO energy-storing orthosis: Effects on lower extremity function and preservation," was published in Injury.