Personalisation of Prosthetic Care for Lower- Limb Amputees


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The global rise in lower-limb amputations is mainly due to diabetes and vascular complications. Amputations cause serious physical and psycho-social disabilities which impair locomotion and compromise patients quality of life. Biopsychosocial factors such as altered gait parameters, poor prosthetic fit, depression, fear avoidance behaviours and stigma increase the risk of individuals incurring lower back pain; the leading cause of secondary disability amongst persons with lower-limb amputation. Exploring the potential mechanistic pathways of lower back pain development is important to inform timely patient-centred programmes of care. Currently, limited information exists to inform the design of such programmes. Thus, there is a pressing need to understand the bio-behavioural, psychological, and social features of individuals with lower-limb amputation in the presence of lower back pain.

Targeted Conditions

Study Overview

Start Date
September 1, 2023
Completion Date
October 1, 2026
Date Posted
February 6, 2024
Accepts Healthy Volunteers?


Full Address
Bristol Centre for Enablement
Bristol BS34 5BW, United Kingdom

Portsmouth Enablement Centre
Portsmouth PO3 6AD, United Kingdom


Study Population
Recruitment of persons with unilateral TFA and TTA of both vascular and traumatic aetiology will be attempted from the Bristol Centre for Enablement and the Portsmouth Enablement Centre (North Bristol NHS Trust and Portsmouth Hospitals University NHS Trust, respectively).
Minimum Age (years)
Eligibility Criteria
Inclusion Criteria:

Over 18 years old
Unilaterally amputated
Able to walk on level ground
Newly fitted with a prosthetic (0-3-months post-amputation)

Exclusion Criteria:

Balance disorders
Patients who lack the capacity to consent for prosthetic use
Patients at serious risk of sound foot which limits normal rehabilitation
Transfer-in patients
Persons with congenital lower-limb amputation

Study Contact Info

Study Contact Name
Alexandra Withey, Masters; Elena Seminati, PhD
Study Contact Phone

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Other Details

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FDA Regulated Device?
Detailed Description
Studies yield conclusive findings on the biomechanical characteristics of the gait of persons with lower-limb amputation wearing a prosthetic limb, however there are discrepancies between the variables analysed by different studies and the parameters that may predict the development of secondary pain conditions, such as lower back pain, knee osteoarthritis and osteoporosis and best functional outcomes are unknown.

Lower back pain and joint pain can be a symptom of musculoskeletal diseases among persons with lower-limb amputation and can influence one's gait and functional outcomes. Although the association between lower-limb amputation and lower back pain is clear, understanding the timings, the propagators and mechanisms related to lower back pain among persons with lower-limb amputation is important to inform care management and rehabilitation programmes. Currently, there is a gap in the literature regarding the role of key determinants on functional outcomes among persons with lower-limb amputation and when they start appearing. Also, it is not clear what is the association between biomechanical gait parameters, muscle activations and pain. Further multidisciplinary research is required to investigate the relationship between different forms of pain among persons with lower-limb amputation and biomechanical gait variables, and how these change over time. This knowledge can then be used to form a prognosis of functional outcomes among persons with lower-limb amputation and appropriate rehabilitation programmes can be developed for different populations of amputations.

This project aims to identify the determinants of lower back pain among persons with unilateral lower-limb amputation, over a period of 12-months after their amputation. Additionally, the relationships between gait characteristics, trunk and lower-limb muscle activations and different sources of pain will be investigated. This information will be used to identify the predictive characteristics of the musculoskeletal diseases, such as lower back pain, and will inform future care management and rehabilitation processes.
NCTid (if applicable)