PTOtherProsthetics and orthotics international2019

Effects of activity intensity, time, and intermittent doffing on daily limb fluid volume change in people with transtibial amputation.

Robert Tyler Youngblood, Brian J Hafner, Katheryn J Allyn and 7 others

PMID 30010494

WHAT IT FOUND

Intermittent doffing did not reduce the rate of limb fluid volume loss in 13 active transtibial amputees.

Fluid loss was greater early in the day and less during high activity than low activity.

Key findings

01The study did not find a difference in the rate of limb fluid volume change between intermittent doffing and not doffing.

02Limb fluid volume loss was generally greater in earlier cycles than later cycles; the only difference that reached statistical significance was posterior between Cycle 3 and Cycle 1.

03High-activity intervals generally showed less fluid volume loss than low-activity intervals, except posterior Cycle 2.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

Only 13 participants were studied, and they were convenience sampled from a local registry and clinics, so this is a small study rather than broad evidence. Participants were active enough to complete a 6-hour protocol and were at K-level 2 or higher; the authors say the results may not apply to less active users, including some K-1 and K-2 users. Two participants had 15-minute rest periods instead of 20-minute rest periods because of a researcher time-management error. The intermittent doffing comparison was a no-difference result; the pin-suspension finding came from exploratory visual inspection, not a planned test of efficacy. The study measured limb fluid volume with custom bioimpedance instrumentation at two limb regions and did not test patient-reported fit, skin outcomes, gait, or other clinical outcomes. Measurements began after the participants had already been active and travelled to the laboratory, so early morning limb volume changes before arrival were not captured.

The easy way to misread this

Do not conclude that intermittent doffing has been shown to reduce limb fluid volume loss for all prosthesis users. The doffing comparison did not show a difference, and the apparent pin-suspension benefit was an exploratory finding in 13 participants.

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