Microprocessor Knee Versus Non-Microprocessor Knee for Backup Device in Lower Limb Prostheses: A Qualitative Study
Abstract: Current policy in the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC) is to provide individuals who require a prosthesis for a knee disarticulation (KD) or transfemoral (TF)-level amputation a microprocessor knee (MPK) unit for daily use and a non-microprocessor knee unit (N-MPK) as a backup prosthesis. Given the known functional differences between these two types of prosthetic knee units, the purpose of this study was to gain an understanding of user device preference and the impact of switching between the MPK and N-MPK. Four currently serving CAF members and two Veterans with unilateral TF or KD amputation participated in semi-structured interviews. Qualitative content analysis identified key themes reflecting their experiences using prostheses. Seven major categories emerged that helped shape prosthesis preferences: functionality, physical aspects, mental aspects, activity, maintenance, safety, and health-related quality of life. The MPK was superior in all categories, resulting in considerably fewer falls and improved cognitive and physical performance. The four participants who had an N-MPK backup did not use this device and instead received a loaner MPK from their prosthetist when required. For individuals who do not have ready access to their prosthetist to obtain a loaner knee unit, consideration should be given for a backup prosthesis with the same MPK unit as their daily-use prosthesis, as participants identify significant issues when trying to function with an N-MPK unit. Individuals with ready access to a loaner knee unit through their prosthetist may not require a backup prosthesis.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.