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AmputationNCT06433648

Understanding How Powered Componentry Impacts K2-Level Transfemoral Amputee Gait

A study testing Ottobock CLeg4 + Ottobock foot, SRALAB Hybrid Knee + Polycentric Ankle and SRALAB Hybrid Knee + Passive Ankle in people with Amputation and Amputation, Traumatic, run by Shirley Ryan AbilityLab at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this study is to understand how providing power at the knee or ankle individually, or providing power at both the knee and ankle, impacts ambulation for K2 level transfemoral amputees. Read more about this study

Who is it for?
Ages 18 to 95 years
What is being tested?
Ottobock CLeg4 + Ottobock foot, SRALAB Hybrid Knee + Polycentric Ankle and SRALAB Hybrid Knee + Passive Ankle
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteUnited States
Study dates
1 May 2023to 30 Jun 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 95 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Ages 18-95
  • A unilateral transfemoral amputation
  • At least 6 months since definitive prosthesis fitting
  • Able to walk 50 meters (55 yards) with a prosthesis without the assistance of another person.
  • Medically cleared by physician to participate in study
  • English speaking

Who cannot join

  • Weight greater than 250 pounds
  • Significant new injury that would prevent use of a prosthesis: The ability to consistently wear a prosthesis and perform activities of daily living and specific performance tasks is necessary to evaluate the relative benefits of the interventions.
  • Cognitive impairment sufficient to adversely affect understanding of or compliance with study requirements, ability to communicate experiences, or ability to give informed consent: The ability to understand and comply with requirements of the study is essential in order for the study to generate useable, reliable data. The ability to obtain relevant user feedback through questionnaires and informal discussion adds significant value to this study.
  • Significant other comorbidity: Any other medical issues or injuries that would preclude completion of the study, use of the prostheses, or that would otherwise prevent acquisition of useable data by researchers.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Suzanne Finucane, MS, PTA contact

312-238-0937

sfinucane@sralab.org

Levi Hargrove, PhD contact

312-238-2080

lhargrove@sralab.org

United States1 site, 1 recruiting
  • Shirley Ryan AbilityLab

    Chicago, Illinois, 60611

    Suzanne Finucane, MS, PTA, 312-238-0937, sfinucane@sralab.org

    Levi Hargrove, PhD, 312-238-2080, lhargrove@sralab.org

    Recruiting

Other trials in United States

About this study

The goal of this study is to understand how providing power at the knee or ankle individually, or providing power at both the knee and ankle, impacts ambulation for K2 level transfemoral amputees.

Aim 1: measure functional performance of K2 level ambulators when using a commercially available passive microprocessor knee prosthesis (Ottobock Cleg/Ottobock foot) or a powered knee and ankle prosthesis (SRALab Hybrid Knee and SRAlab Polycentric Powered Ankle.

Read more

Aim 2: Participants will be evaluated on the contribution of adding power at the knee only or the ankle only.

Aim 3: The investigators will evaluate the functional performance after intensive clinical gait training on the powered knee and ankle prosthesis (SRALab Hybrid Knee and SRALab Polycentric Powered Ankle).

Our hypothesis is that providing powered componentry will improve function and that intensive training will magnify those improvements.

Read the detailed description

Amputation of the lower limb causes profound disability, significantly limiting mobility, independence, and the ability to pursue employment or leisure activities. Nearly 90% of all lower limb amputations in the United States occur in older persons, mostly due to vascular disease, and this population is expected to triple by 2050. After lower limb loss, individuals walk more slowly and more asymmetrically are less stable, and expend more metabolic energy during walking than persons with intact limbs. Even when using state-of-the-art microprocessor-controlled prostheses (typically a microprocessor knee with a passive ankle), persons with transfemoral amputations expend approximately 60% more energy than able-bodied individuals during ambulation. In addition to the physical limitations caused by the amputation, the increased energy requirements affect performance of everyday activities, including getting up out of a chair or off the toilet, or stepping up or down a curb.

Most commercially available prosthetic legs are passive. The movement of a passive prosthetic joint relies on the properties of its mechanical components, such as hydraulic or pneumatic valves or sliding joints, together with compensatory adjustments made by the user. Since these computerized prostheses are passive, the user cannot efficiently negotiate stairs, an incline, or the numerous other functions that require net knee and/or ankle power.

Powered prostheses can actively generate joint torque, allowing easy and efficient performance of more demanding activities, such as ascending stairs and hills. Powered knees and ankles, may allow for better outcomes in both older and younger individuals with transfemoral amputation; this powered componentry may enable more energy efficient walking, allow users to stand up from a seated position with ease, and enable them to walk across more challenging terrains-such as up and down hills, ramps, and stairs-safely and with more normal and symmetric gait kinematics and kinetics.

This study will demonstrate the functional benefits of adding power at an individual joint. This knowledge will be critical for prioritizing future device development and will provide valuable information for clinicians and individuals on selecting appropriate componentry for transfemoral K2 amputees.

Being tested
Ottobock CLeg4 + Ottobock foot, SRALAB Hybrid Knee + Polycentric Ankle, SRALAB Hybrid Knee + Passive Ankle, Ottobock CLeg 4 + Polycentric Ankle
Medical subject headings
Amputation, Traumatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ottobock CLeg4 + Ottobock footDevice

    Commercially available Ottobock CLeg 4 microprocessor knee unit and Ottobock foot.

  • SRALAB Hybrid Knee + Polycentric AnkleDevice

    Experimental powered prosthesis: SRALAB Hybrid Knee and powered polycentric ankle.

  • SRALAB Hybrid Knee + Passive AnkleDevice

    Experimental powered prosthesis: SRALAB Hybrid Knee and passive ankle.

  • Ottobock CLeg 4 + Polycentric AnkleDevice

    Commercially available Ottobock CLeg 4 prosthetic knee and SRALAB powered polycentric ankle.

Study groups in NCT06433648
Study groupRoleWhat they receive
Transfemoral Amputee participants: Ottobock Cleg4 + Ottobock foot; Hybrid Knee + Polycentric AnkleActive comparatorParticipant is fit with the commercially available device (Ottobock Cleg 4/Ottobock foot), they will receive standard of care clinical training for 3-4 sessions over 4 weeks, plus 1 session for outcome assessments. Participant is then fit with the SRALAB Hybrid knee and SRALAB Polycentric Ankle prosthesis, they again will receive clinical training for 3-4 sessions over 4 weeks, plus 1 session for outcome assessments.
Receives: Device: Ottobock CLeg4 + Ottobock foot; Device: SRALAB Hybrid Knee + Polycentric Ankle
Transfemoral Amputee participants: Ottobock CLeg4 + Polycentric Ankle, Hybrid Knee + Passive AnkleExperimentalFor this arm, transfemoral amputees will participate in an AB/BA randomized crossover study. Before each arm of the cross-over, baseline data will be taken with the Ottobock Cleg 4/Ottobock foot or their clinically prescribed microprocessor knee unit/foot. Condition A is CLeg + Polycentric Ankle Condition B is SRALab Hybrid knee + Passive Ankle Subjects will participate in 2 sessions over 2 weeks, each lasting 2-3 hours to have the device tuned for the specific condition (A or B). On the third week, they will participate in 2 visits to complete functional outcome measures, biomechanical and metabolic assessments. They will then switch conditions, and repeat the protocol for the second condition. There will not be a washout period between conditions, but subjects will complete outcome measures with the Ottobock Cleg 4/Ottobock foot or their clinically prescribed microprocessor knee unit/foot prior to each arm of the crossover to obtain baseline data.
Receives: Device: SRALAB Hybrid Knee + Passive Ankle; Device: Ottobock CLeg 4 + Polycentric Ankle
Transfemoral Amputee participants: SRALAB Hybrid knee + Polycentric Ankle, Ottobock Cleg4 + OB footExperimentalDuring this arm, participants will receive intensive clinical training with the SRALAB Hybrid knee + Polycentric Ankle twice per week over 8 weeks, lasting 2-3 hours. Training will include patient-driven therapy to achieve participants' individual therapy goals, functional mobility and community skills. At the end of the 8-week training period, subjects will complete the same set of functional outcome measures, biomechanical and metabolic assessments in previous arms. To complete this arm, participants will again complete training and outcome measures with the Ottobock Cleg4/Ottobock or their clinically prescribed microprocessor knee unit/foot over 3 visits.
Receives: Device: Ottobock CLeg4 + Ottobock foot; Device: SRALAB Hybrid Knee + Polycentric Ankle

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Amputee Mobility Predictor with Prosthesis (AMPRO) score

    The AMPRO measures the ambulatory potential of lower limb amputees. It is used to assess functional mobility through a standardized sequence of mobility tests while using a prosthesis. Individual tasks are scored and combined, resulting in a total assessment score out of a possible 47; the minimum score is zero. Higher scores indicate better mobility.

    The AMPPRO is a reliable performance measure that has been validated for those with lower limb loss; it measures several functional mobility tasks that are needed during activities of daily living; it has been used to identify limitations in prosthetic mobility, including tasks that require both vertical mobility (sit/stand), horizontal mobility (walking), and balance. The AMPPRO scores have been shown to differentiate between Medicare K-levels and to provide information to guide therapeutic exercise techniques and document change after clinical instruction.

    Measured: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38.

Secondary outcomes (4)
  1. 6 Minute Walk Test (6MWT)

    The 6 minute walk test (6MWT) assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance.

    Measured: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38.

  2. Timed Up and Go (TUG)

    The Timed Up and Go Test (TUG) assesses mobility, balance, walking ability, and fall risk in older adults.

    Measured: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38.

  3. Four Square Step Test (FSST)

    A test of dynamic balance and coordination that clinically assesses the participant's ability to step over objects forward, sideways, and backwards.

    Measured: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38.

  4. Metabolic Testing

    Subjects will be instrumented with the COSMED® K5 system (COSMED, Rome, Italy). Baseline metabolic data prior to each walking bout will be recorded for 2 minutes of sitting and quiet rest. Metabolic data will then be collected during 6 minutes of walking at a constant self-selected walking velocity on a treadmill. After each walking bout, subjects will rest for 20 minutes to allow their heart rate to return to their baseline level.

    Measured: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 May 2024
  2. Study start1 May 2023
  3. Primary completion30 Jun 2028 (estimated)
  4. Study completion30 Jun 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Crossover
Model description
The goal of this study is to understand how providing power at the knee or ankle individually, or providing power at both the knee and ankle, impacts ambulation for transfemoral amputees with limited community mobility. Aim 1: measure functional performance of transfemoral ambulators when using a commercially available passive microprocessor knee prosthesis (Ottobock Cleg/Ottobock foot) or a powered knee and ankle prosthesis (SRALab Hybrid Knee and SRAlab Polycentric Powered Ankle. Aim 2: Participants will be evaluated on the contribution of adding power at the knee only or the ankle only. Aim 3: The investigators will evaluate the functional performance after intensive clinical gait training on the powered knee and ankle prosthesis (SRALab Hybrid Knee and SRALab Polycentric Powered Ankle).
Masking
None (open label)
Enrolment
20 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06433648
Sponsor's protocol ID
STU00217960
Status last verified
May 2024
First submitted
16 May 2024
Last updated
30 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil. 2008 Mar;89(3):422-9. doi: 10.1016/j.apmr.2007.11.005.

    PubMed 18295618
  • Gailey RS, Wenger MA, Raya M, Kirk N, Erbs K, Spyropoulos P, Nash MS. Energy expenditure of trans-tibial amputees during ambulation at self-selected pace. Prosthet Orthot Int. 1994 Aug;18(2):84-91. doi: 10.3109/03093649409164389.

    PubMed 7991365
  • Hafner BJ, Sanders JE, Czerniecki J, Fergason J. Energy storage and return prostheses: does patient perception correlate with biomechanical analysis? Clin Biomech (Bristol). 2002 Jun;17(5):325-44. doi: 10.1016/s0268-0033(02)00020-7.

    PubMed 12084537
  • Burger H, Marincek C. The life style of young persons after lower limb amputation caused by injury. Prosthet Orthot Int. 1997 Apr;21(1):35-9. doi: 10.3109/03093649709164528.

    PubMed 9141124
  • Fey NP, Simon AM, Young AJ, Hargrove LJ. Controlling Knee Swing Initiation and Ankle Plantarflexion With an Active Prosthesis on Level and Inclined Surfaces at Variable Walking Speeds. IEEE J Transl Eng Health Med. 2014 Jul 25;2:2100412. doi: 10.1109/JTEHM.2014.2343228. eCollection 2014.

    PubMed 27170878
  • Adamczyk PG, Kuo AD. Mechanisms of Gait Asymmetry Due to Push-Off Deficiency in Unilateral Amputees. IEEE Trans Neural Syst Rehabil Eng. 2015 Sep;23(5):776-85. doi: 10.1109/TNSRE.2014.2356722. Epub 2014 Sep 12.

    PubMed 25222950

Questions about this trial

What is this clinical trial studying?

A study testing Ottobock CLeg4 + Ottobock foot, SRALAB Hybrid Knee + Polycentric Ankle and SRALAB Hybrid Knee + Passive Ankle in people with Amputation and Amputation, Traumatic, run by Shirley Ryan AbilityLab at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Suzanne Finucane, MS, PTA (312-238-0937, sfinucane@sralab.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Amputee Mobility Predictor with Prosthesis (AMPRO) score (time frame: Completed at visit during week 5, week 10, week 11, week 14, week 15, week 18, week 35 and week 38.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06433648, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 May 2024.

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