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At least 199 records · Page 11Linked to original sources

PubMed2004

Screening for poor performance of lower extremity in primary care: the Camucia Project.

BACKGROUND AND AIMS: Individuals with poor lower extremity performance are prime candidates for disability prevention. The Camucia Project is a collaborative study between geriatricians and primary care physicians (PCPs) testing the hypothesis that PCPs can use a simple performance-based test to identify older persons with poor lower extremity function, without excessive interference with their clinical routine. We also hypothesized that the number needed to screen (NNTS) a positive case would be lower in physicians' clinics than in the general population. METHODS: 23 PCPs administered the short physical performance battery (SPPB) to 360 consecutive, non-disabled and non-demented, 70- to 79-year-old outpatients. PCPs were asked to: 1) evaluate the feasibility and usefulness of administering the SPPB; 2) ascertain selected diseases according to predefined criteria; 3) identify causes of poor lower extremity function in patients with a SPPB score < or =9. NNTS from this study were compared with those estimated in non-disabled and non-demented, 70- to 79-year-old persons randomly selected from the InCHIANTI study population. RESULTS: The majority of PCPs (20/23) reported that using the SPPB to evaluate older patients was feasible and useful. The NNTS in the outpatient clinics was lower than in the InCHIANTI participants (1.6 vs 4.3). Poor lower extremity performance was attributed to musculo-skeletal diseases in 75%, to more than one cause in 55% (128/234), and to no specific cause in 16.2% (37/234) of the participants with SPPB < or =9. CONCLUSIONS: Screening of older persons with poor lower extremity perfomance by PCPs is feasible and efficient.

Aged↗

PubMed2000

Age increases the skeletal versus muscular component of lower extremity stiffness during stepping down.

Elderly adults step down with greater lower extremity stiffness than young adults. The purpose of this study was to compare skeletal and muscular components of lower extremity stiffness between elderly and young adults during stepping down. Fourteen elderly (age, 70.1 years) and 16 young (age, 20.8 years) adults stepped down onto a force plate from 10% and 20% body heights while being videotaped. Lower extremity stiffness was defined as the ratio between the floor reaction force directed along the limb and limb compression. It was partitioned into skeletal and muscular components using the angular relationship (phi) between the direction of the force and the line of the leg. Our results showed that phi was 21% smaller (p < .03), the skeletal component was 48% larger (p < .025), and the ratio of skeletal to muscular components was 32% larger (p < .01) in elderly adults compared with young adults. Elderly adults rely more on their skeletal and less on their muscular systems when stepping down compared with young adults, producing a stiffer lower extremity.

Adult↗

PubMed2004

Postoperative mortality after nontraumatic lower extremity amputation in patients with renal insufficiency.

Mortality rates after lower extremity amputation are extremely high among dialysis patients. However, the impact of milder degrees of renal insufficiency on death rates after lower extremity amputation has not been carefully examined. In this study, the authors used data from the Department of Veterans Affairs' National Surgical Quality Improvement Program (NSQIP) to measure the association between renal dysfunction and 30-d mortality after nontraumatic amputation adjusted for confounders. The study population consisted of 16,994 patients undergoing their first NSQIP recorded amputation from January 1, 1994 through September 30, 2001. Thirty-five percent of all cohort patients had at least moderate renal insufficiency, and 52% of all postoperative deaths occurred in this group. Postoperative mortality was 9% in patients with moderate renal insufficiency, 15% in patients with severe renal insufficiency, and 16% in dialysis patients, compared with 6% in patients with normal or mildly reduced renal function. Renal insufficiency remained associated with death after adjustment for confounders (adjusted odds ratio [OR] 3.36, 95% confidence interval [CI] 2.75 to 4.10 [dialysis patients]; OR 2.54, CI 2.06 to 3.14 [severe renal insufficiency]; and OR 1.52, CI 1.32 to 1.76 [moderate renal insufficiency]). In conclusion, even moderate renal insufficiency is independently associated with postoperative death after lower extremity amputation. This finding highlights the need for a targeted approach to improving the care of patients with renal insufficiency undergoing lower extremity amputation.

Aged↗

PubMed2003

Sonographic evaluation of lower extremity interosseous membrane injuries: retrospective review in 3 patients.

OBJECTIVE: To describe the sonographic findings of lower extremity interosseous membrane disruption with computed tomographic and surgical correlation. METHODS: Three patients with sonographic evaluation of the lower extremity interosseous membrane were identified through the clinical experience of 1 author over a 5-year period. Sonographic images of the symptomatic and unaffected lower extremities were retrospectively characterized and correlated with computed tomographic and surgical findings by 2 fellowship-trained musculoskeletal radiologists. RESULTS: The normal interosseous membrane was identified in the asymptomatic lower extremities in all 3 patients, which appeared as a thin, hyperechoic (nearly equal to bone cortex) line, continuous from the tibia to the fibula. The abnormal interosseous membrane in all 3 cases appeared abnormally hypoechoic, poorly defined, and discontinuous at the tibia. A proximal fibular fracture was shown on sonography in 1 of 3 symptomatic lower extremities with radiographic evidence of a fracture. The sonographic findings correlated with the computed tomographic images. Distal tibiofibular syndesmosis injuries were confirmed and treated at surgery in 2 patients. CONCLUSIONS: Sonography can show both normal and injured interosseous membranes of the lower extremity, as well as associated proximal fibular fractures.

Adult↗

PubMed2000

Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease.

BACKGROUND: More data are needed to assess lower extremity angioaccess sites for hemodialysis. METHODS: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996. RESULTS: Lower extremity grafts accounted for 16% (134/843) of patients in this series. Complications occurred in 58 of 134 patients (43%) and were more prevalent in women, blacks, diabetic, and hypertensive patients, but not of statistical significance. Dialysis was done for a mean duration of 13.3 years, with a mean graft patency rate of 13.8 months. The 12-month survival rate of lower extremity AV grafts was 62% (83/134). Complications in the lower extremity AV graft group (58 patients) included infections in 27 patients (46%), thrombosis within 30 days in 16 (28%), pseudoaneurysm in 9 (16%), and graft hemorrhage in 6 (10%). CONCLUSIONS: There is a decreased patency rate in lower extremity AV grafts.

Adult↗

PubMed2000

Lower extremity neuropathies associated with lithotomy positions.

BACKGROUND: The goal of this project was to study the frequency and natural history of perioperative lower extremity neuropathies. METHODS: A prospective evaluation of lower extremity neuropathies in 991 adult patients undergoing general anesthetics and surgical procedures while positioned in lithotomy was performed. Patients were assessed with use of a standard questionnaire and neurologic examination before surgery, daily during hospital stay in the first week after surgery, and by phone if discharged before 1 postoperative week. Patients in whom lower extremity neuropathies developed were observed for 6 months. RESULTS: Lower extremity neuropathies developed in 15 patients (1.5%; 95% confidence interval, 0.8-2.5%). Unilateral or bilateral nerves were affected in patients as follows: obturator (five patients), lateral femoral cutaneous (four patients), sciatic (three patients), and peroneal (three patients). Paresthesia occurred in 14 of 15 patients, and 4 patients had burning or aching pain. No patient had weakness. Symptoms were noted within 4 h of completion of the anesthetic in all 15 patients. These symptoms resolved within 6 months in 14 of 15 patients. Prolonged positioning in a lithotomy position, especially for more than 2 h, was a major risk factor for this complication (P = 0.006). CONCLUSIONS: In this surgical population, lower extremity neuropathies were infrequent complications that were noted very soon after surgery and anesthesia. None resulted in prolonged disability. The longer patients were positioned in lithotomy positions, the greater the chance of development of a neuropathy. These findings suggest that a reduction of duration of time in lithotomy positions may reduce the risk of lower extremity neuropathies.

Adult↗

PubMed2004

[Lower extremity amputations in diabetic patients: a case-control study].

OBJECTIVE: Lower extremity amputation is an increasing problem among diabetic patients and an important public health problem. The study purpose was to identify factors associated with lower extremity amputation. METHODS: A matched case-control study was carried out among diabetic patients. Cases were selected in public health programs of the city of São Paulo, Brazil. One hundred and seventeen cases of diabetics with lower extremity amputation were compared to 234 controls of diabetics without amputation, matched by sex, age, and duration of disease. Sociodemographic variables, life habits (smoking and alcohol drinking), clinical aspects, and health education in diabetes were included. Univariate analyses and conditional logistic regression method were applied to data. RESULTS: Data showed evidence of association for: smoking, last glucose test > or = 200 mg/dl, presence of peripheral somatic neuropathy and vibratory perception (tuning fork 128 Hz), and peripheral vascular disease. Diabetes treatment and attending nursing appointments for diabetes education were important factors for preventing lower extremity amputation in diabetic patients. CONCLUSIONS: The knowledge of determinants and intervening factors for this condition will lead to cost reduction and better quality of care delivered in public health services.

Aged↗

PubMed2004

Invasive treatment of chronic limb ischemia according to the Lower Extremity Grading System (LEGS) score: a 6-month report.

BACKGROUND: The invasive treatment of chronic lower extremity peripheral arterial disease (PAD) has become inconsistent. To standardize treatment at our institution, the Lower Extremity Grading System (LEGS) score was devised, based on arteriographic findings, symptoms, functional status, comorbid conditions, and technical factors. The scoring system was used to direct the invasive treatment approach in patients with lower extremity PAD. The purpose of this study was to prospectively assess outcomes of invasive treatment of lower extremity ischemia as directed by LEGS. METHODS: From March 2002 through December 2002, 332 limbs in 227 patients with indications for intervention were scored and treated according to the LEGS score and followed for 6 months. Of the 227 patients, 66.1% were male; median age was 65 years. Diabetes mellitus was present in 44.9% of patients, claudication in 48.5%, and limb-threatening ischemia in 51.5%. Results of treatment as directed by LEGS were judged with the treatment outcome measures of reconstruction patency, limb salvage, mortality, change in ambulatory status, change in independent living status, and change in the short-form health survey (SF-36). RESULTS: Of 332 limbs, 61.5% with a score of 10 to 19 underwent endovascular therapy; 34% with a score of 0 to 9 underwent open revascularization; and 4.5% with a score greater than 20 underwent primary limb amputation. Interventions for the entire cohort as directed by LEGS resulted in 6-month primary reconstruction patency of 82.4%; secondary reconstruction patency, 92.6%; limb salvage, 90%; survival, 89.1%; maintenance of ambulatory status, 85.6%; maintenance of independent living, 88.4%; and statistically significant improvement in health assessment, regardless of treatment type, as determined with the SF-36. There was no statistically significant variability when comparing results according to treatment (open surgery, 0-9 vs endovascular therapy, 10-19) or smaller score group categories (0-5, 6-9, 10-13, 14-19). CONCLUSIONS: At 6 months, treatment as directed by LEGS score resulted in acceptable outcomes. This project is the first reported prospectively confirmed standardization tool for treatment of lower extremity PAD, and, pending independent confirmation by others, provides a comparative baseline against which other standardization efforts can be measured.

Adult↗

PubMed1998

Three-dimensional ultrasonography of the fetal distal lower extremity: normal and abnormal.

The objective of this study was to compare two-dimensional and three-dimensional ultrasonographic evaluation of fetal distal lower extremities. Data from two-dimensional and three-dimensional ultrasonographic examinations from 40 distal lower extremities in 33 fetuses from a predominantly high-risk patient population were compared. Three-dimensional ultrasonography routinely provided three orthogonal planes (coronal, sagittal, and axial) for distal lower extremity evaluation. Specific features of distal lower extremity evaluation were not different using two-dimensional and three-dimensional ultrasonography. Rotation of the rendered volume provided assistance in assessing all but one of 40 distal lower extremities. Time from image acquisition to assessment for two views (coronal and sagittal) was longer with three-dimensional ultrasonography (8.2 min) than with two-dimensional ultrasonography (3.2 min). Confidence in the diagnosis of abnormal distal lower extremities was slightly improved using three-dimensional ultrasonography compared to two-dimensional ultrasonography. Pregnancy management was assisted in three of the four cases with isolated limb anomalies. In conclusion, three-dimensional ultrasonography improves the ability to evaluate the fetal distal lower extremity because of the multiplanar nature of volume assessment and the ability to rotate volume data sets. In addition, it provides assistance in counseling families, particularly for cases involving isolated limb anomalies.

Female↗

PubMed1993

Lower extremity hypothermia is beneficial during infra-renal aortic cross-clamping in pigs.

The effects of lower extremity hypothermia during aortic cross-clamping are unknown. To compare the effects of lower extremity hypothermia with normothermia during aortic cross-clamping, two groups of six (25-40 kg) anesthetized pigs had their aortas cross-clamped below the renal arteries for 2 h. The cold group had their lower extremities cooled during cross-clamping to a quadriceps muscle temperature of 28 degrees C by using convective cooling. The warm group had the quadriceps muscle temperature maintained at 38 degrees C with convective warming. Saline, 0.9%, was used to maintain the pulmonary capillary wedge pressures at 5 mm Hg in both groups. Reperfusion of the lower extremities resulted in a small but significant decrease in the blood temperature from 36.6 +/- 0.3 degrees C (mean +/- SE) to 35.6 +/- 0.3 degrees C 1 min after reperfusion in the cold group, but did not change the blood temperature in the warm group. Both the cardiac output and the lower extremity arterial flow were greater in the cold group at 1 and 5 min after cross-clamp release. Also one pig in the warm group required resuscitation with 1 mg of epinephrine intravenously to treat severe hypotension and myocardial depression after cross-clamp release. We conclude that hypothermia of the lower extremities may be beneficial for surgery involving aortic cross-clamping.

Animals↗

PubMed1995

Intraoperative lower extremity reflex muscle activity as an adjunct to conventional somatosensory-evoked potentials and descending neurogenic monitoring in idiopathic scoliosis.

STUDY DESIGN: Lower extremity polysynaptic reflexes and descending neurogenic motor and ascending somatosensory activity were recorded. OBJECTIVE: Two cases are presented to illustrate the intraoperative use of lower extremity reflex recordings for detecting compromise of spinal cord function. SUMMARY OF BACKGROUND DATA: Lower extremity reflex processing can be used to measure integrated spinal cord activity, whereas descending neurogenic and ascending somatosensory potentials measure only long tract function. METHODS: Eight channels of lower extremity polysynaptic reflex activity were recorded simultaneously after unilateral lower extremity mixed nerve stimulation. Sequential descending neurogenic and ascending somatosensory activity was recorded simultaneously with reflex recordings. RESULTS: In these two patients with idiopathic scoliosis, intraoperative reflexes changed before descending neurogenic and before ascending somatosensory activity changed. High-amplitude synchronous persistent reflex activity correlated with a postoperative neurologic deficit. Low-amplitude asynchronous transient reflex activity was not associated with a postoperative neurologic deficit. CONCLUSION: Intraoperative lower extremity reflex changes are more sensitive to spinal cord compromise than are changes in long tract function. Lower extremity polysynaptic reflexes monitor the integrated activity of the spinal cord that is responsible for the control of complex motor behavior.

Adolescent↗

PubMed1995

Effect of multilevel sequential stenosis on lower extremity arterial duplex scanning.

BACKGROUND: The sensitivity of lower extremity arterial duplex scanning in detecting a > 50% stenosis may be decreased in extremities with multilevel sequential stenosis. PATIENTS AND METHODS: The results of lower extremity arterial duplex scanning of the common femoral, upper and lower superficial femoral, above- and below-knee popliteal arteries, and tibioperoneal trunk in 80 extremities of 44 patients were compared to those of arteriography. Thirty-one arterial segments in 27 extremities had a > 50% stenosis. The stenoses were categorized as first order (first or only stenotic segment in the extremity, n = 23) and second order (stenosis occurring distal to a > 50% stenosis, n = 4, or occlusion, n = 4). RESULTS: The sensitivity, specificity, and positive predictive values of duplex scan detection of a > 50% arterial stenosis or occlusion were 86%, 96%, and 67% for the common femoral artery; 95%, 98%, and 95% for the upper superficial femoral artery; 97%, 90%, and 88%, for the lower superficial femoral artery; 84%, 90%, and 87% for the above-knee popliteal artery; 47%, 98%, and 90% for the below-knee popliteal artery; and 25%, 100%, and 100% for the tibioperoneal trunk. Duplex scanning detected 18 (78%) of the 23 first-order stenoses compared to only 1 (13%) of the 8 second-order stenoses in limbs with multilevel sequential disease (P < 0.01). The peak systolic velocity at the stenotic site was significantly higher for first-order (mean +/- SD 168 +/- 54 cm/s) compared to second-order (38 +/- 13 cm/s) stenoses (P < 0.00002). CONCLUSIONS: Duplex scanning was highly sensitive in detecting lower extremity first-order stenoses. Low peak systolic velocities at second-order stenoses of limbs with multilevel sequential disease significantly decreased the sensitivity of duplex scanning.

Arterial Occlusive Diseases↗

PubMed1990

[Functional cineangiography in the diagnosis of arterial occlusive diseases of the lower extremities].

An analysis of cineangiograms of lower extremity arteries of 225 patients with occlusive lesions of the abdominal aorta and lower extremity arteries has been made. Symptoms detected by cineangiography are described which allow to judge on stenotic lesions of the arteries with greater reliability than by the data of serial angiography. Quantitative analysis of cineangiograms has been performed with the determination of time of blood flow along arterial segments.

Adult↗

PubMed1998

Impact of selected medical conditions on self-reported lower-extremity function in Mexican-American elderly.

OBJECTIVE: To examine the independent impact of common medical conditions on lower-extremity function in Mexican-American elderly. DESIGN: Cross-sectional study using a probability sample of non-institutionalized Mexican Americans aged 65 or older. SETTING: The five Southwestern states, Texas, New Mexico, Arizona, Colorado and California. PARTICIPANTS: All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their homes during late 1993 and early 1994. MAIN OUTCOME MEASURES: Respondents were asked whether they could perform four activities related to lower-extremity function without help: walking across a small room, getting from a bed to a chair, walking up and down stairs, and walking half a mile. A summary measure of lower body disability created from these four items was regressed on seven common medical conditions plus five control variables using multiple logistic regression. RESULTS: Adjusted Odds Ratios (OR) suggested that impaired lower-extremity function was associated with previous diagnosis of hip fracture (OR = 4.28), stroke (OR = 3.47), lower extremity arthritis (OR = 2.60), heart attack (OR = 2.29), diabetes (OR = 2.03) and obesity (OR = 1.50). Impaired lower-extremity function was significantly associated with older age (75+ years old), gender (female) and marital status (unmarried). In addition, there was a linear increase in the risk of function loss by number of medical conditions. CONCLUSIONS: It appears that Mexican-American elderly diagnosed with medical conditions, especially stroke and hip fracture, have a high risk for lower-extremity dysfunction. These findings have implications for efforts to prevent or reduce lower-extremity dysfunction, as well as for the provision of community-based long-term care services for Mexican-American elderly.

Activities of Daily Living↗

PubMed2003

Assessment and management of patients with venous, arterial, and diabetic/neuropathic lower extremity wounds.

Most healthcare providers recognize that management of lower extremity wounds presents a difficult challenge. These chronic wounds significantly impact the quality of life for individuals and have implications for costs and utilization of healthcare resources. Lower extremity wounds can be due to a myriad of different diseases, but the primary causes are chronic venous insufficiency, lower extremity arterial disease, and diabetes/neuropathy. Differential assessment is necessary prior to implementation of management strategies in order to address the etiology and pathogenesis factors that are related to each type of leg wound. This article presents an overview of the risk and predisposing factors for venous, arterial, and diabetic/neuropathic wounds. Additionally, it addresses issues of differential assessment including typical locations, common clinical characteristics, typical wound appearance, key management issues, considerations for alternative treatments, collaborative care, and patient/family education.

Diabetic Neuropathies↗

PubMed2005

Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty.

BACKGROUND: Valid outcome measurement tools are required to reliably demonstrate the effectiveness and clinical outcomes of lower-extremity arthroplasty. Having ascertained a lack of a practical and valid measure of the change in actual daily physical activity that occurs prior to and following lower-limb arthroplasty, we developed and validated a lower-extremity activity scale. METHODS: The eighteen-level self-administered scale was developed with the aid of content experts to ensure face validity. Validity and reliability were assessed with the use of (1) pedometer measurements of seventy subjects over seven days; (2) next-of-kin proxy measurements of the activity levels of ninety patients before they underwent lower-limb arthroplasty; and (3) application, and correlation with the Western Ontario and McMaster Universities Osteoarthritis Index scores, in a prospective seventeen-center clinical study of 297 consecutive patients undergoing revision total knee arthroplasty. In this latter study, demographic and comorbidity data were also collected. Univariate and bivariate correlations were performed, and a multivariate structured equation modeling approach was used to further test responsiveness, reliability, and validity of the lower-extremity activity scale. RESULTS: Pedometer readings correlated with the activity levels derived with the lower-extremity activity scale (r = 0.79). Of note was the finding that age, weight, and body mass index did not correlate well with the average number of steps per day (r = -0.32, -0.32, and -0.25, respectively). A significant correlation was found between the lower-extremity activity scores recorded by the patients and those reported by their next of kin (Pearson correlation, r = 0.715; p = 0.0001) and between the initial lower-extremity activity scores and two-week-retest scores (intraclass correlation = 0.9147; p < 0.0001), demonstrating the validity and reliability of the scale. The lower-extremity activity scale was responsive, accurately reflecting changes in the patient's condition between baseline and the time of follow-up (p < 0.001), and it was reliable, with baseline values correlating with follow-up scores (p < 0.001). The convergent validity of the lower-extremity activity scale was established by correlations with the function scores (r = -0.301, p < 0.001) and pain scores (r = -0.241, p < 0.001) derived with the Western Ontario and McMaster Universities Osteoarthritis Index and with a higher number of comorbidities (r = -0.244, p < 0.001). Multivariate path modeling further demonstrated diminished activity in patients who had more difficulty in functioning and a greater number of comorbidities. CONCLUSIONS: We developed a lower-extremity activity scale and validated that it was an effective instrument for the assessment of patients' actual activity levels. It is easy to apply and interpret, and it is valid and ready for use in the clinical setting. This scale will allow more accurate analysis and prediction of outcomes. Consequently, it will become a useful, practical adjunct to objective clinical decision-making and intervention for patients undergoing arthroplasty.

Activities of Daily Living↗

PubMedDate not supplied

Costs and duration of care for lower extremity ulcers in patients with diabetes.

Medical and pharmaceutical insurance claims associated with lower extremity diabetic ulcers were examined retrospectively to better understand the costs and duration of treatment in clinical practice. The study population consisted of working-age individuals (18 to 64 years old) with health care benefits provided through private employer-sponsored insurance plans. Diagnostic information contained in the claims database was used to identify the severity of the ulcers, and the charges associated with treatment were based on claims data. Claims for lower extremity ulcers were found in 5.1% of individuals with diabetes. Although many lower extremity ulcers heal with standard treatment, some are more resistant to treatment and require costly ongoing medical care. Almost half of these cases were associated with deep infection, osteomyelitis, or amputation. Total payments for treatment of lower extremity ulcers in this population averaged $2687 per patient per year, or $4595 per ulcer episode, with inpatient expenditures accounting for more than 80% of these costs. Costs were significantly higher for patients with more severe ulcers or with inadequate vascular status in the affected limb. We concluded that lower extremity ulcers occur in a large number of working-age people with diabetes and contribute significantly to the morbidity associated with this disease. The high cost of treating diabetic foot ulcers suggested by this analysis argues for the development of better treatment strategies and outcomes assessments for these patients.

Adolescent↗

PubMed2001

The effect of lower-extremity position on cerebrospinal fluid pressures.

OBJECTIVE: To determine the effects of lower-extremity positioning on cerebrospinal fluid opening pressure (CSFp). The authors believed that during lumbar puncture (LP), CSFp does not meaningfully decrease when the lower extremities are extended from flexion, as is often suggested. METHODS: In a convenience sample of adult patients who clinically required LP in an urban emergency department, three sequential CSFp measurements were obtained in either sequence A (knee, hip, and neck flexion [90 degrees ], then extension, then flexion) or sequence B (extension, flexion, then extension) prior to CSF withdrawal. The neck was flexed at 30 degrees when the lower extremities were flexed, while the thoracolumbar spine was kept in the neutral position for all measurements. RESULTS: Nineteen patients were studied in each sequence. Although variable, overall within-patient changes between positions were not clinically meaningful. Mean and 95% confidence intervals (95% CIs) for the decrease in CSFp from position 1 to position 3 (same position) were 0.2 cm H(2)O (1.7%) and 0.9 to -0.6 cm H(2)O (6% to -2.7%), respectively. Changing from flexion to extension decreased pressure measurements by a mean of 0.9 cm H(2)O (2.5%) [95% CI = 2.1 to -0.1 cm H(2)O (7.6% to -2.4%)]. Changing from extension to flexion increased CSFp by a mean of 1.1 cm H(2)O (6.1%) [95% CI = 0.2 to 2.0 cm H(2)O (1.3% to 11.5%)], a statistically but not clinically meaningful change. CONCLUSIONS: Changing lower-extremity position did not meaningfully change mean CSFp. These data do not support the common suggestion that extending the lower extremities during LP meaningfully decreases CSF opening pressures.

Adolescent↗