{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:40:58Z","timestamp":1787755258418,"version":"build-2784847793"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,10,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom energy-storing carbon fiber ankle-foot orthosis developed for lower-extremity trauma patients. Studies conducted at the military treatment facility where the IDEO was developed demonstrated benefits of the IDEO when used with the Return to Run Physical Therapy (RTR PT) program. The current study was designed to determine if results could be replicated at other military treatment facilities and to examine whether early performance gains in patient-reported functional outcomes remained at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Study participants included service members who had functional deficits that interfered with daily activities at least 1 year after a traumatic unilateral lower-extremity injury at or below the knee. Participants were evaluated before receiving the IDEO, immediately following completion of RTR PT, and at 6 and 12 months. Agility, strength\/power, and speed were assessed using well-established performance tests. Self-reported function was measured using the Short Musculoskeletal Function Assessment (SMFA). The Orthotics and Prosthetics Users\u2019 Survey was administered to assess satisfaction with the IDEO. Of 87 participants with complete baseline data, 6 did not complete any physical therapy and were excluded from the analysis. Follow-up rates immediately following completion of the RTR PT and at 6 and 12 months were 88%, 75%, and 79%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Compared with baseline, improvement at completion of RTR PT was observed in all but 1 performance test. SMFA scores for all domains except hand and arm function were lower (improved function) at 6 and 12 months. Satisfaction with the IDEO was high following completion of RTR PT, with some attenuation at the time of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study adds to the evidence supporting the efficacy of the IDEO coupled with RTR PT. However, despite improvement in both performance and self-reported functioning, deficits persist compared with population norms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.18.00213","type":"journal-article","created":{"date-parts":[[2018,10,17]],"date-time":"2018-10-17T18:44:14Z","timestamp":1539801854000},"page":"1781-1789","source":"Crossref","is-referenced-by-count":33,"title":["Multisite Evaluation of a Custom Energy-Storing Carbon Fiber Orthosis for Patients with Residual Disability After Lower-Limb Trauma"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8771-0317","authenticated-orcid":false,"given":"Benjamin K.","family":"Potter","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-4624","authenticated-orcid":false,"given":"Robert G.","family":"Sheu","sequence":"additional","affiliation":[{"name":"Naval Medical Center San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8981-6262","authenticated-orcid":false,"given":"Daniel","family":"Stinner","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Center, Fort Sam Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9029-0835","authenticated-orcid":false,"given":"John","family":"Fergason","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Center, Fort Sam Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9341-2554","authenticated-orcid":false,"given":"Joseph R.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Carolinas Medical Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4570-7803","authenticated-orcid":false,"given":"Kevin","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Naval Medical Center San Diego, San Diego, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-782X","authenticated-orcid":false,"given":"Johnny G.","family":"Owens","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Center, Fort Sam Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5040-9678","authenticated-orcid":false,"given":"Jessica","family":"Rivera","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Center, Fort Sam Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2489-3267","authenticated-orcid":false,"given":"Scott B.","family":"Shawen","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5556-7667","authenticated-orcid":false,"given":"Jason M.","family":"Wilken","sequence":"additional","affiliation":[{"name":"San Antonio Military Medical Center, Fort Sam Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6499-9536","authenticated-orcid":false,"given":"Jennifer","family":"DeSanto","sequence":"additional","affiliation":[{"name":"METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9536-9622","authenticated-orcid":false,"given":"Yanjie","family":"Huang","sequence":"additional","affiliation":[{"name":"METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7482-9653","authenticated-orcid":false,"given":"Daniel O.","family":"Scharfstein","sequence":"additional","affiliation":[{"name":"METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5480-8502","authenticated-orcid":false,"given":"Ellen J.","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the METRC PRIORITI-MTF Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,10,17]]},"reference":[{"issue":"1","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/BOT.0b013e31825121b6","article-title":"LEAP Study Group. The mangled foot and ankle: results from a 2-year prospective study","volume":"27","author":"Ellington","year":"2013","journal-title":"J Orthop Trauma."},{"issue":"24","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1924","DOI":"10.1056\/NEJMoa012604","article-title":"An analysis of outcomes of reconstruction or amputation after leg-threatening injuries","volume":"347","author":"Bosse","year":"2002","journal-title":"N Engl J Med."},{"issue":"3","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"S315","DOI":"10.1136\/jramc-157-03s-11","article-title":"Limb salvage of severely injured extremities after military wounds","volume":"157","author":"Brown","year":"2011","journal-title":"J R Army Med Corps."},{"issue":"1","key":"bib4-20230810","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.fcl.2009.11.005","article-title":"The mangled foot and leg: salvage versus amputation","volume":"15","author":"Shawen","year":"2010","journal-title":"Foot Ankle Clin."},{"issue":"1","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.fcl.2009.10.001","article-title":"Recent advances in lower extremity amputations and prosthetics for the combat injured patient","volume":"15","author":"Fergason","year":"2010","journal-title":"Foot Ankle Clin."},{"issue":"2","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.gaitpost.2006.08.003","article-title":"How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study","volume":"24","author":"Desloovere","year":"2006","journal-title":"Gait Posture."},{"issue":"4","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.gaitpost.2006.07.013","article-title":"A new carbon fibre spring orthosis for children with plantarflexor weakness","volume":"25","author":"Bartonek","year":"2007","journal-title":"Gait Posture."},{"issue":"1","key":"bib9-20230810","first-page":"46","article-title":"Clinical applications of the Veterans Administration prosthetics center Patellar-Tendon-Bearing brace","volume":"15","author":"Kay","year":"1971","journal-title":"Artif Limbs."},{"issue":"5","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1016\/j.apmr.2005.12.043","article-title":"Effects of ankle-foot orthoses on ankle and foot kinematics in patient with ankle osteoarthritis","volume":"87","author":"Huang","year":"2006","journal-title":"Arch Phys Med Rehabil."},{"issue":"1","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.fcl.2009.10.005","article-title":"Physical therapy of the patient with foot and ankle injuries sustained in combat","volume":"15","author":"Owens","year":"2010","journal-title":"Foot Ankle Clin."},{"issue":"6","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"507","DOI":"10.2106\/JBJS.K.00254","article-title":"Skeletal Trauma Research Consortium. Comparative effect of orthosis design on functional performance","volume":"94","author":"Patzkowski","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"10","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1007\/s11999-014-3609-7","article-title":"Skeletal Trauma Research Consortium (STReC). Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma?","volume":"472","author":"Bedigrew","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib14-20230810","first-page":"S120","article-title":"Skeletal Trauma Research Consortium. Return to running and sports participation after limb salvage","volume":"71","author":"Owens","year":"2011","journal-title":"J Trauma."},{"issue":"4","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1097\/BOT.0000000000000006","article-title":"Skeletal Trauma Research Consortium (STReC). Return to duty after integrated orthotic and rehabilitation initiative","volume":"28","author":"Blair","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"S4","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"69","DOI":"10.7205\/MILMED-D-16-00280","article-title":"Outcomes associated with the Intrepid Dynamic Exoskeletal Orthosis (IDEO): a systematic review of the literature","volume":"181","author":"Highsmith","year":"2016","journal-title":"Mil Med."},{"issue":"Suppl 1","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1097\/BOT.0000000000000795","article-title":"METRC. Patient Response to an Integrated Orthotic and Rehabilitation Initiative for Traumatic Injuries: The PRIORITI-MTF Study","volume":"31","author":"Hsu","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"Suppl 1","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.5435\/JAAOS-20-08-S42","article-title":"Physical performance assessment in military service members","volume":"20","author":"Wilken","year":"2012","journal-title":"J Am Acad Orthop Surg."},{"issue":"9","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.2106\/00004623-199909000-00006","article-title":"Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness","volume":"81","author":"Swiontkowski","year":"1999","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1080\/03093640308726682","article-title":"Development and measurement properties of the Orthotics and Prosthetics Users\u2019 Survey (OPUS): a comprehensive set of clinical outcome instruments","volume":"27","author":"Heinemann","year":"2003","journal-title":"Prosthet Orthot Int."},{"issue":"1","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11136-008-9418-2","article-title":"Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12)","volume":"18","author":"Selim","year":"2009","journal-title":"Qual Life Res."},{"issue":"9","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med."},{"issue":"8","key":"bib23-20230810","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/S0005-7967(00)00084-X","article-title":"The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD","volume":"39","author":"Forbes","year":"2001","journal-title":"Behav Res Ther."},{"issue":"5","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1097\/01.MLR.0000062554.74615.4C","article-title":"Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation","volume":"41","author":"Norman","year":"2003","journal-title":"Med Care."},{"issue":"1","key":"bib25-20230810","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/jor.1100170116","article-title":"Musculoskeletal function assessment: reference values for patient and non-patient samples","volume":"17","author":"Engelberg","year":"1999","journal-title":"J Orthop Res."},{"issue":"1","key":"bib26-20230810","first-page":"8","article-title":"Can an ankle-foot orthosis change hearts and minds?","volume":"20","author":"Patzkowski","year":"2011","journal-title":"J Surg Orthop Adv."},{"issue":"S4","key":"bib27-20230810","doi-asserted-by":"crossref","first-page":"77","DOI":"10.7205\/MILMED-D-16-00281","article-title":"Descriptive characteristics and amputation rates with use of Intrepid Dynamic Exoskeleton Orthosis","volume":"181","author":"Hill","year":"2016","journal-title":"Mil Med."},{"issue":"S1","key":"bib28-20230810","doi-asserted-by":"crossref","first-page":"10","DOI":"10.7205\/MILMED-D-16-00138","article-title":"Major Extremity Trauma Research Consortium (METRC). Military and civilian collaboration: the power of numbers","volume":"182","author":"Stinner","year":"2017","journal-title":"Mil Med."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201810170-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:15Z","timestamp":1787751615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201810170-00009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,17]]},"references-count":27,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.18.00213","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,17]]}}}