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What the Editor is Reading

In the August issue of Prosthetics and Orthotics International, we have published an article by Gaunaurd and colleagues (2015)on use of and confidence in administering clinical outcome measures. The authors have shown that over 60% of prosthetists do not routinely use outcome measures to evaluate function in their clients. They have also shown that simple training can substantially and significantly increase confidence in administering outcome measures which may facilitate increased use. The study focuses on the Timed-up and Go (TUG) test and the Amputee Mobility Predictor (AMP) both of which have been shown to be valid and reliable tests of function. Incorporating efficient, valid and reliable outcome measures such as these into routine assessments can only improve clinical practice.

Another article in the August issue outlines an attempt to distinguish biomechanical differences in stair descent between amputees who were fallers and those who were not (Vanicek, Strike, & Polman, 2015). Although the sample size was small, the researchers found that fallers tended to adopt a less cautious stair descent strategy involving greater speed and a tendency to ‘roll-over’ the nose of the stair with the prosthesis.  Physical injuries associated with falls and the fear of falling are factors which adversely affect quality of life for amputees. Much of the falls research has been directed at identifying fallers on the basis of screening tests. Research such as that of Vanicek and colleagues may help in training amputees to use adaptive movement patterns which reduce their risk of falls.

A paper recently published in OnlineFirst addresses a similar issue (Hadadi et al., 2015). The authors examined the effect of an ankle support on balance in a sample with chronic ankle instability. They designed an ankle orthosis which incorporated a foot plate to maintain alignment of the hindfoot, a stirrup to provide medio-lateral stability and a calf sleeve to secure the orthosis and improve sensorimotor frunction. Although they did not test these supposed mechanisms directly, they found that the orthosis significantly improved one-legged standing balance to levels comparable to a control group. Re-injury rates after ankle sprain are high if rehabilitation does not fully restore function. The device described by Hadadi and co-workers may offer some hope to people with chronic instability.

Tim Bach