A study published online in the April issue of Clinical Orthopaedics and Related Research found that integrating orthotic and physical rehabilitation care improves physical performance, pain, and outcomes in patients with severe, traumatic lower-limb functional deficits. The improvements were sustained for more than two years after injury.
The research was conducted at Brooke Army Medical Center (BAMC), Fort Sam Houston, Texas, and involved a prospective evaluation of 84 service members (53 participants who were less than two years post-injury, and 31 participants who were more than two years post-injury) who enrolled in the initiative. Of the participants, 58 had sustained fractures, 53 had sustained nerve injuries with weakness, and six had arthritis. (The total is greater than the number of participants due to some participants having fractures as well as nerve injuries, according to the study’s authors.) The initiative, called the Return to Run clinical pathway, used the Intrepid Dynamic Exoskeletal Orthosis (IDEO) in the testing.
Participants completed four weeks of physical therapy without the orthosis followed by four weeks with it. Testing was conducted at weeks zero, four, and eight. Validated physical performance tests and patient-reported outcome surveys were used, as well as questions about whether patients were considering an amputation.
By eight weeks, patients improved in all physical performance measures and all relevant patient-reported outcomes. Those who were less than or greater than two years post-injury improved similarly. Of the 50 participants initially considering amputation, 41 favored limb salvage at the end of eight weeks.
According to the researchers, efforts are underway to determine whether Return to Run with the IDEO can be successfully implemented at additional military centers in patients who are more than two years post-injury while sustaining similar improvements in patient outcomes. Translating the integrated orthotic and rehabilitation program into the civilian setting is unknown, they said, and warrants further investigation.