Low back pain (LBP) can be an elusive and difficult-to-treat condition for healthcare providers. Danielle Mortorano, an alumna of the George Washington University Doctor of Physical Therapy program, is tackling the limited research around LBP in a unique patient population: individuals with lower limb amputation.
LBP can affect a person’s ability to engage in activities from exercise to bathing, dressing, and accessing their home. Specifically, for people with limb loss, LBP often stems from an ill-fitting prosthesis or adaptations in walking patterns as a result of using a prosthetic limb.
“Mechanical LBP of these causes often discourages patients from wearing their prosthesis regularly,” said Mortorano, DPT ’16. “This, in turn, restricts them from actively engaging in walking and daily activities. It can be argued that mechanical (LBP) may have a greater impact on the function and quality of individuals with lower limb amputation compared to others with the condition.”
Mortorano’s patient care experiences in an inpatient limb loss unit and an outpatient prosthetic gait training program drove her desire to change current clinical practice. She is currently performing a scoping review on the topic. Scoping reviews involve a systematic process of thoroughly evaluating the existing literature in a given field to identify areas that need further research,
Three primary areas of limb loss literature are being examined: the causes of LBP in individuals with limb loss and how they differ compared to the general population with LBP; interventions implemented in the treatment of LBP for individuals with transtibial and transfemoral amputations, and the efficacy of back-schools for the treatment of LBP in people with limb loss.
Equipped with the results of this scoping review, Mortorano has begun implementing a back-school program for patients with mechanical [LBP] and a transtibial or transfemoral extremity amputation at the Washington DC Veterans Affairs Medical Center as part of her orthopaedic residency program there.
The back-school program consists of an initial evaluation, an education class, and six follow up physical therapy sessions. The program incorporates education, manual techniques, and exercises that work to address risk factors, prevention, and remediation of LBP for those with limb loss.
Mortorano notes, “The back-school program is in the early stages of implementation with patients, but I hope to expand it over the next few months.” She’s excited for the chance to fill some of the noticeable gaps in research and to help change the way physical therapists treat LBP in this population in the future.