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ORIGINAL ARTICLE
Bodyweight distribution between limbs, muscle strength, and proprioception in traumatic transtibial amputees: a cross-sectional study
Carlos Henrique da Silva Fontes FilhoI, Conrado Torres LaettII,III,VI, Ubiratã Faleiro GavilãoII,III,VI, José Carlos de Campos JrIV, Dângelo José de Andrade AlexandreV, Victor R.A. CossichII,III,VI,
Corresponding author
victor.cossich@gmail.com

Corresponding author.
, Eduardo Branco de SousaVI
I Centro de Amputados, Unidade de Reabilitacao, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, BR.
II Laboratorio de Pesquisa Neuromuscular, Divisao de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, BR.
III Laboratorio de Biomecanica, Escola de Educacao Fisica e Desportos (EEFD), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, BR.
IV Programa de Pos-graduacao em Ciencia da Reabilitacao, Centro Universitario Augusto Motta (UNISUAM), Rio de Janeiro, RJ, BR.
V Area de Fisioterapia, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, BR.
VI Divisao de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, BR.
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Overview of the experimental conditions&#46; a&#41; Representative set-up to video recording during the joint position sense and strength evaluation&#46; The black circles represent the Styrofoam balls used to measure distance and angles&#46; The squares represent the positions used to set the hand-held dynamometer&#46; b&#41; Step-by-step representation of the joint position sense&#44; b-1&#58; demonstrated the start position &#8764;90&#176; of knee flexion&#44; b-2&#58; the experienced position&#44; b-3&#58; the subject returning to the start position and waiting for the evaluator&#39;s subsequent commands&#44; b-4&#58; the reproduced position&#46; The difference between the reproduced and experienced positions were used for calculating proprioception indices&#46; The angles 45&#176; and 30&#176; are example values&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Lower limb amputation is a life-changing event that modifies from basic locomotion &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#41; to social and psychological aspects &#40;<a class="elsevierStyleCrossRef" href="#bib3">3</a>&#41;&#46; Approximately 40-80&#37; of lower limb amputations are due to vasculopathy and diabetes &#40;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#44;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#41;&#46; However&#44; in younger individuals&#44; lower limb loss occurs mainly due to traumatic events&#44; such as road traffic or gunshot injuries &#40;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#44;<a class="elsevierStyleCrossRef" href="#bib6">6</a>&#41;&#46; Trauma-related amputations are the primary etiology in developing countries and represent a substantial cause of amputation worldwide &#40;<a class="elsevierStyleCrossRef" href="#bib4">4</a>&#44;<a class="elsevierStyleCrossRef" href="#bib5">5</a>&#41;&#46; Despite the limitations imposed on the patient&#44; transtibial amputation &#40;TT&#41;&#44; at least when performed at the distal third of the lower leg&#44; enables the patient to have a physically active lifestyle after proper prosthetic fitting and rehabilitation &#40;<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib8">8</a>&#41;&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">Limb amputation was previously associated with thigh muscle atrophy and fat permeation in the stump compared with the sound limb and able-bodied subjects &#40;<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#41;&#44; modified knee joint kinematics during gait and stair climbing &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#44;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#41;&#44; and an augmented muscle voluntary activation of the biceps femoris&#8212;measured as the integrated surface electromyography signal&#8212;during gait &#40;<a class="elsevierStyleCrossRef" href="#bib8">8</a>&#41;&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">Several studies have investigated the muscle strength of TT patients &#40;<a class="elsevierStyleCrossRefs" href="#bib12">12&#8211;17</a>&#41;&#46; Besides the methodological differences&#8212;isokinetic <span class="elsevierStyleItalic">vs&#46;</span> isometric evaluation&#44; different velocities&#44; and devices&#8212;in general&#44; the studies suggested a reduced strength of both knee extensors and flexors in comparison with the sound limb &#40;<a class="elsevierStyleCrossRefs" href="#bib12">12&#8211;17</a>&#41;&#46; This is a clinically relevant finding&#44; given that thigh muscle weakness could lead to poor performance during standing and gait&#44; thus compromising the execution of daily functional tasks &#40;<a class="elsevierStyleCrossRef" href="#bib12">12</a>&#41;&#46;</p><p id="para40" class="elsevierStylePara elsevierViewall">The TT procedure leads to loss of all muscles&#44; tendons&#44; ligaments&#44; and articular capsule&#44; seriously affecting the lower limb&#44; and consequently&#44; body function &#40;<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib18">18</a>&#41;&#46; These structures are essential not only for locomotion but they also function as sensory receptors&#44; which&#44; when absent&#44; may compromise proprioception &#40;<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#44;<a class="elsevierStyleCrossRef" href="#bib18">18</a>&#41;&#46; Conscious proprioception involves kinesthesia&#44; force sense&#44; and joint position sense &#40;JPS&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib19">19</a>&#41;&#46; Few studies have investigated proprioception alterations in TT patients and they have presented different results &#40;<a class="elsevierStyleCrossRefs" href="#bib20">20&#8211;22</a>&#41;&#46; These conflicting findings are probably due to different methodological approaches &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; joint angular reproduction and passive movement detection&#41; and not to standardized amputation procedures &#40;<a class="elsevierStyleCrossRef" href="#bib23">23</a>&#41;&#46; Although the knee joint capsule is kept intact&#44; the interaction between the stump and the prosthetic limb may alter the JPS by merely changing the effort needed to move the limb due to changes in its mass &#40;<a class="elsevierStyleCrossRef" href="#bib24">24</a>&#41;&#46; JPS can be assessed using both involuntary &#40;passive&#41; and voluntary movements&#44; the latter being more useful because it mimics the joint motion in real-life situations &#40;<a class="elsevierStyleCrossRef" href="#bib25">25</a>&#44;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#41;&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">Bodyweight is supported by the non-amputated &#40;NAMP&#41; limb in the orthostatic position&#44; not only at rest &#40;<a class="elsevierStyleCrossRefs" href="#bib27">27&#8211;29</a>&#41; but also during gait &#40;<a class="elsevierStyleCrossRef" href="#bib30">30</a>&#41;&#44; increasing the mechanical load at its joints &#40;<a class="elsevierStyleCrossRefs" href="#bib12">12&#8211;17</a>&#41;&#46; At early rehabilitation stages&#44; the NAMP limb supports up to 60&#37; of the bodyweight &#40;<a class="elsevierStyleCrossRefs" href="#bib27">27&#8211;29</a>&#44;<a class="elsevierStyleCrossRef" href="#bib31">31</a>&#41;&#46; This asymmetrical weight distribution also produces balance changes&#44; which increase the risk of falling&#44; while the higher mechanical demand placed on the sound limb is suggested as the main factor for osteoarthritis development and the overuse symptoms observed in TT patients &#40;<a class="elsevierStyleCrossRef" href="#bib32">32</a>&#44;<a class="elsevierStyleCrossRef" href="#bib33">33</a>&#41;&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">A better understanding of neuromuscular changes due to traumatic TT is paramount to the development of comprehensive and meaningful clinical interventions&#46; Although changes in bodyweight distribution after TT are well documented &#40;<a class="elsevierStyleCrossRefs" href="#bib27">27&#8211;29</a>&#41;&#44; few studies have aimed to assess voluntary knee JPS &#40;<a class="elsevierStyleCrossRef" href="#bib21">21</a>&#41; and knee extensor and flexor strength together&#44; therefore&#44; justifying further investigations&#46; Thus&#44; the goals of this study were to verify the effect of TT on bodyweight distribution&#44; voluntary knee JPS&#44; and quadriceps &#40;QUA&#41; and hamstrings &#40;HAM&#41; strength in prosthetized patients&#46; As some intervening variables &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; stump length&#44; age&#44; and time from prosthesis use&#41; could influence the outcome&#44; we chose to control those variables&#46; We hypothesized that alterations in bodyweight distribution&#44; knee JPS&#44; and QUA and HAM strength should be observed when compared with the sound limb and with age-paired healthy subjects&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">MATERIALS AND METHODS</span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Participants</span><p id="para70" class="elsevierStylePara elsevierViewall">The TT group included patients aged between 18 and 50 years&#44; who underwent unilateral amputation due to traumatic etiology&#44; and had been using the prosthesis for at least one year&#46; Patients were excluded if they were diabetic&#44; reported previous knee injury or surgery in any of the limbs&#44; or presented with neurological&#44; vascular&#44; vestibular&#44; or visually diagnosed disorders&#46; All patients wore the same standard lower limb endoskeletal prosthesis &#40;Ethnos&#44; Brazil&#41; with a dynamic foot &#40;Ossur&#44; Iceland&#41;&#46; Control subjects were age-paired and recruited from the staff of the hospital&#39;s rehabilitation division&#46; The Tegner score was used to measure work level&#44; physical activity&#44; and sport-related activity engagement in both groups &#40;<a class="elsevierStyleCrossRef" href="#bib34">34</a>&#41;&#44; and the dominant &#40;DON&#41; leg was self-defined as the preferred kicking leg &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#46; This study was approved by the hospital&#39;s ethics committee &#40;process &#35;01128818&#46;0&#46;0000&#46;5273&#41;&#46; All volunteers were previously informed about the procedures and goals of the study and they provided written consent to participate&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Procedures</span><p id="para80" class="elsevierStylePara elsevierViewall">This was an analytical&#44; controlled cross-sectional with control group study&#46; All the procedures were performed during a single testing session&#44; lasting no longer than two hours&#44; on a day that the patient usually had a routine medical screening scheduled &#40;conducted between April-June 2019&#41;&#46; First&#44; the participants were asked to complete the bodyweight distribution test&#44; followed by knee extension JPS&#44; and by maximal voluntary isometric contractions of QUA and HAM&#46; Bodyweight distribution was measured while the subject wore the prosthetic leg&#46; On other hand&#44; JPS and muscle strength evaluations were conducted on both limbs &#40;without the prosthesis&#41;&#46; All devices and methods used were highly reliable&#44; as reported elsewhere &#40;<a class="elsevierStyleCrossRefs" href="#bib35">35&#8211;37</a>&#41;&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Assessment of bodyweight distribution</span><p id="para90" class="elsevierStylePara elsevierViewall">We used a set of two separate 24&#215;40 cm force plates &#40;Globus Ergo System&#44; Italy&#41; to quantify bodyweight distribution&#46; Volunteers were asked to stand still in an orthostatic position with one foot on each force plate for 60s&#46; They were then instructed to look forward to a fixed point at the eye level on the wall&#44; 2m away&#46; This was performed three times&#44; with a 30s rest period between each measurement&#46; Ground reaction force was calculated as an average of the three measurements for each limb&#44; and bodyweight distribution was defined as a percentage of the total ground reaction force&#46;</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Assessment of proprioception</span><p id="para100" class="elsevierStylePara elsevierViewall">Knee proprioception was assessed using JPS&#46; The subjects were seated on a chair with their backs entirely supported&#44; their hips flexed at approximately 90&#176; &#40;0&#176;&#61;full extension&#41;&#44; and their lower legs hanging freely &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46; The test consisted of the experience and reproduction of a joint position through voluntary movements with the participants blindfolded&#44; as described in a previous study &#40;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#41;&#46; Briefly&#44; the test began with the volunteers&#39; lower legs hanging relaxed&#44; then the evaluator asked the volunteers to slowly extend their knees until the command to &#8220;stop&#8221; and keep that position for three seconds &#40;experienced position&#41;&#46; Then&#44; the evaluator asked the volunteers to &#8220;return to the start position and relax&#44;&#8221; and after 3 seconds of rest&#44; the command &#8220;show me where your knee was before&#8221; was given&#44; so the volunteers slowly extended their knees&#44; trying to reach the experienced position &#40;reproduced position&#41; while holding their limbs for more than 3s&#46; This procedure was performed four times for each limb after three unrecorded familiarization trials&#44; and the knee angles tested were randomly assigned&#46; All procedures were video-recorded on the sagittal plane using a smartphone camera &#40;Motorola Moto X Play&#44; 21 Mpx&#44; Full HD&#41;&#46; The camera was positioned 1&#46;1m from the ground level in a stable tripod kept 1&#46;5m from the subject&#46; Styrofoam balls were fixed at the hip&#44; femur lateral epicondyle&#44; and at the most distal portion of the stump or in the malleolus of the fibula &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46; The knee joint angle was measured from the footage using ImageJ software &#40;National Institutes of Health&#44; Bethesda&#44; Maryland&#44; USA&#41;&#46; The difference between the reproduced and experienced positions was used to calculate the absolute error &#40;AE&#41;&#44; variable error &#40;VE&#41;&#44; and constant error &#40;CE&#41;&#44; where AE corresponds to the absolute average&#44; VE to the standard deviation&#44; and CE to the average of the attempts &#40;<a class="elsevierStyleCrossRef" href="#bib25">25</a>&#44;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#41;&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Assessment of muscle strength</span><p id="para110" class="elsevierStylePara elsevierViewall">We used a hand-held dynamometer &#40;Nicholas MMt Handheld Dynamometer&#44; Model 001160&#44; Lafayette Instrument Company&#44; USA&#41; to assess the QUA and HAM muscle strength&#46; The participants were positioned in the same way as for the JPS test&#46; The dynamometer was positioned anteriorly or posteriorly on the most distal portion of the stump&#47;leg &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1a</a>&#41;&#46; For each test&#44; volunteers were asked to isometrically perform the maximum voluntary contraction &#40;MVC&#41; against the dynamometer&#44; which was held with the aid of an inelastic strap&#46; MVC was conducted with the knee flexed at 90&#176; &#40;0&#176;&#61;knee fully extended&#41; and kept for at least 5s&#46; Three attempts were performed with a 30s rest period between each&#44; and only the maximum value was used for the analyses&#46; The test order between muscle groups and limbs was randomized&#44; and before each test&#44; three submaximal trials &#40;50&#37;&#44; 75&#37;&#44; and 100&#37; of perceived maximum effort&#41; were performed for familiarization and warm-up&#46; All procedures were video-recorded&#44; and images were used to measure the lever arm to calculate the joint torque &#40;product of force by the lever arm&#41;&#46; The lever arm was defined as the distance between the femoral lateral epicondyle and the most distal part of the stump or limb where the dynamometer was positioned&#46; The peak torque value was recorded for further statistical analyses&#46;</p></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Statistical analysis</span><p id="para120" class="elsevierStylePara elsevierViewall">Data were presented as mean&#177;SD&#46; Data distribution was verified and classified as normal &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41; using the Shapiro-Wilk test&#46; First&#44; the DON and non-dominant &#40;NDON&#41; limbs of the control group were compared using Students <span class="elsevierStyleItalic">t</span>-test for independent samples to evaluate if the DON limb could be used for subsequent analysis as the control limb &#40;CTL&#41;&#46; One-way ANOVA for independent samples was used to compare the amputated &#40;AMP&#41; and NAMP limbs with the CTL&#46; The Bonferroni <span class="elsevierStyleItalic">post-hoc</span> test was adopted when needed to verify the differences between pairs of limbs&#46; The effect size was assessed by <span class="elsevierStyleItalic">&#951;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic"><span class="elsevierStyleInf">p</span></span> and classified as small &#40;0&#46;01&#41;&#44; medium &#40;0&#46;06&#41;&#44; and large &#40;0&#46;14&#41;&#46; Statistical procedures were performed using the SPSS software &#40;IBM SPSS Inc&#46;&#44; version 19&#44; Chicago&#44; IL&#44; USA&#41;&#44; and data were considered statistically significant at <span class="elsevierStyleItalic">p</span>&#8804;0&#46;05&#46;</p></span></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">RESULTS</span><p id="para130" class="elsevierStylePara elsevierViewall">A total of 88 consecutive patients were selected from the hospital&#39;s amputee center rehabilitation program&#46; The first attempt of contact with the patients was made by a standardized telephone call &#40;conducted by CHSFF&#41; between April and June 2019 to collect preliminary data and ask for interest in participating in the study&#46; Of the total&#44; 36 patients had a TT with non-traumatic etiology&#44; 16 were older than the pre-defined inclusion age range&#44; 18 of the patients could not be reached&#44; and two subjects refused to participate in the study&#46; A total of 16 TT patients and 16 control subjects participated in this study &#40;<a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p id="para140" class="elsevierStylePara elsevierViewall">We did not observe differences in the demographic characteristics between the amputees and control groups &#40;<a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#41;&#46; None of the TT required walking aids &#40;<span class="elsevierStyleItalic">e&#46;g&#46;</span>&#44; cane or crutches&#41;&#44; reported phantom limb&#44; or stump pain&#46; Also&#44; we did not observe significant differences between the DOM and NDOM limbs of the control group for any studied variable&#58; bodyweight distribution &#40;mean&#177;SD&#44; DOM&#58; 37&#46;4&#177;6&#46;8 kg&#44; NDOM&#58; 37&#46;7&#177;7&#46;1 kg&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;88&#41;&#44; AE &#40; DOM&#58; 2&#46;0&#177;0&#46;9&#176;&#44; NDOM&#58; 2&#46;6&#177;1&#46;1&#176;&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;98&#41;&#44; VE &#40;DOM&#58; 1&#46;4&#177;0&#46;4&#176;&#44; NDOM&#58; 1&#46;8&#177;0&#46;8&#176;&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;92&#41;&#44; CE &#40;DOM&#58; -1&#46;1&#177;1&#46;7&#176;&#44; NDOM&#58; -1&#46;9&#177;1&#46;8&#176;&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;22&#41;&#44; QUA peak torque &#40;DOM&#58; 112&#46;3&#177;26&#46;5 Nm&#44; NDOM&#58; 120&#46;0&#177;29&#46;4 Nm&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;44&#41;&#44; and HAM peak torque &#40;DOM&#58; 55&#46;1&#177;16&#46;3 Nm&#44; NDOM&#58; 55&#46;3&#177;9&#46;5 Nm&#44; <span class="elsevierStyleItalic">p</span>&#61;0&#46;98&#41;&#46; The TT group demonstrated an asymmetrical bodyweight distribution&#44; with more weight on the NAMP limb &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46; We did not observe significant differences in any of the proprioception measures between the limbs &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46; For both QUA and HAM peak torque&#44; the AMP limb demonstrated a lower value than the NAMP and CTL &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">DISCUSSION</span><p id="para150" class="elsevierStylePara elsevierViewall">The goals of this study were to verify the effect of TT on bodyweight distribution&#44; proprioception&#44; and thigh muscle strength&#46; The main findings were that amputee patients demonstrated an asymmetrical bodyweight distribution&#44; with no differences in knee JPS&#46; Nevertheless&#44; both the QUA and HAM muscles were weaker in the amputated limb than in the sound limb and control subjects&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">Lower limb amputation imposes changes on the body&#39;s mechanical behavior during tasks in standing position&#44; characterized by altered kinematics of ambulation &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#44;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#41; and obstacle crossing &#40;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#41;&#46; An asymmetrical weight distribution increases the mechanical load on the joint surface&#44; which is a factor for osteoarthritis &#40;<a class="elsevierStyleCrossRef" href="#bib17">17</a>&#44;<a class="elsevierStyleCrossRef" href="#bib38">38</a>&#41;&#46; Our results confirm the previously reported asymmetrical bodyweight distribution &#40;<a class="elsevierStyleCrossRefs" href="#bib27">27&#8211;29</a>&#41;&#44; with the prosthetic limb usually carrying approximately 45&#37; of the total bodyweight &#40;<a class="elsevierStyleCrossRef" href="#bib28">28</a>&#44;<a class="elsevierStyleCrossRef" href="#bib29">29</a>&#41;&#46; Previously&#44; pain&#44; discomfort&#44; and insecurity have been suggested as factors for bodyweight asymmetry &#40;<a class="elsevierStyleCrossRef" href="#bib39">39</a>&#41;&#46; However&#44; since none of our TT patients reported pain&#44; discomfort on the stump-prosthetic interface&#44; or insecurity&#44; we cannot directly link those factors with the bodyweight distribution results&#46; Although we cannot discard that at a subconscious level&#44; patients still have unreported issues&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">We did not observe differences in JPS between the AMP and NAMP limbs&#44; as with the control subjects&#46; This corroborates previous studies that also did not observe proprioception deficits in amputee patients &#40;<a class="elsevierStyleCrossRef" href="#bib20">20</a>&#44;<a class="elsevierStyleCrossRef" href="#bib21">21</a>&#41;&#46; It is expected that TT results in the loss of entire populations of mechanoreceptors during both the traumatic event and the surgery&#46; Theoretically&#44; a decrease in the number of mechanoreceptors alone is sufficient for proprioception impairment&#46; Moreover&#44; joint capsule mechanoreceptors are considered the main structures responsible for measuring joint motion&#44; and voluntary muscle contraction allows the assessment of sensory information coming from the muscle spindles and Golgi tendon organs &#40;<a class="elsevierStyleCrossRef" href="#bib24">24</a>&#41;&#46; We suggest that the lack of proprioception deficits can be explained by maintaining the knee joint structures &#40;<span class="elsevierStyleItalic">i&#46;e&#46;</span>&#44; joint capsule&#44; ligaments&#44; and tendons&#41; and by the voluntary muscle actions used during the JPS test&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">Previous observations have reported weaker QUA and HAM on the AMP limb &#40;<a class="elsevierStyleCrossRef" href="#bib12">12</a>&#44;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#44;<a class="elsevierStyleCrossRef" href="#bib17">17</a>&#41;&#46; Loyd et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib17">17</a>&#41; analyzed subjects with multi-cause amputations&#44; ranging from trauma to peripheral vascular diseases&#46; However&#44; given the high coefficient of variation &#40;approximately 60&#37;&#41;&#44; the effects of comorbidities and advanced age of the non-traumatic patients confounded the results&#46; Isakov et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib12">12</a>&#41; used an adapted isokinetic dynamometer device to measure knee isometric extension and flexion of TT amputees of unreported etiology&#44; reporting values similar to ours &#40;QUA&#58; 35&#46;6&#177;25&#46;4&#44; and HAM&#58; 25&#46;1&#177;13&#46;5 Nm&#41;&#46; Moirenfeld et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#41; also used a standard isokinetic device to measure the QUA and HAM strength &#40;velocity of 120&#176;&#47;s&#41; of traumatic TT amputees&#46; They reported that the patients used the prosthesis during the test to allow proper fitting of the device&#44; thus reducing the QUA and HAM strengths to 50&#37; and 35&#37;&#44; respectively&#44; compared with the sound limb&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">The hand-held dynamometer used in this study has already been demonstrated to be a feasible and reliable method to measure muscle strength &#40;<a class="elsevierStyleCrossRef" href="#bib36">36</a>&#41;&#46; This approach was adopted because the stump length did not fit the standard isokinetic dynamometer device&#46; In addition&#44; we preferred to measure strength without the prothesis to directly assess the subject&#39;s limb&#44; preventing torque production between the prosthesis and the stump&#44; which could be painful and generate biased results&#46; Interestingly&#44; the QUA seems to be more affected than the HAM&#44; corroborating previous observations &#40;<a class="elsevierStyleCrossRef" href="#bib13">13</a>&#41;&#46; The QUA and HAM were&#44; respectively&#44; 3&#46;8 and 2&#46;6 times stronger in the sound limb than in the AMP limb&#46; We hypothesized that this smaller difference in HAM muscle strength could emerge from the prosthesis weight working as resistance to knee flexion during ambulation &#40;<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#44;<a class="elsevierStyleCrossRef" href="#bib11">11</a>&#41;&#46; This resistance probably produces an increase in the mechanical demand of the HAM&#44; reducing the strength impairment&#46; Although these ideas are solely speculative&#44; the atrophy of the QUA was previously reported to be greater than that in the semitendinosus muscle &#40;16-31&#37; <span class="elsevierStyleItalic">vs</span>&#46; 5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#bib40">40</a>&#41;&#44; reinforcing this idea&#46; However&#44; future investigations should be performed to confirm this&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">This is the first study that concomitantly assessed bodyweight distribution&#44; knee active JPS&#44; and QUA and HAM strength in traumatic TT amputees&#46; Together&#44; the tests provide more information about the clinical status of these patients&#44; which may help physicians and physical therapists in the development of new rehabilitation programs&#46; This study presents as strong points that all patients presented with the same etiology &#40;traumatic&#41;&#44; which influenced the surgical technique&#44; and wore the same kind of prosthetic limb&#44; which influenced gait pattern&#46; In addition&#44; we used standardized&#44; replicable&#44; and widely reported methods for all tests &#40;<a class="elsevierStyleCrossRef" href="#bib25">25</a>&#44;<a class="elsevierStyleCrossRef" href="#bib26">26</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib35">35&#8211;37</a>&#41;&#44; allowing experimental set replication even in a clinical environment&#46; Moreover&#44; the present study had a larger sample size than other studies &#40;<a class="elsevierStyleCrossRefs" href="#bib20">20&#8211;22</a>&#41;&#46; On the other hand&#44; the fact that patients underwent amputation and immediate postoperative rehabilitation in different centers are weak points&#44; although these were minimized by the fact that all patients received the same pre- and immediate post-prosthetic rehabilitation protocols&#46; Although the patients did not demonstrate proprioceptive deficits&#44; this result should be considered with caution&#46; We only evaluated a single conscious proprioception sub-modality&#44; and we are unaware of studies that evaluated the sense of force in this population&#46; The improvement of lower limb strength should be continuously addressed in this population&#44; which probably will affect in the bodyweight asymmetry and gait patterns&#46; We evaluated only post-traumatic amputees&#44; well-adapted to wearing a prosthesis for a long time&#44; without pain&#44; discomfort&#44; or any rehabilitation-related problems&#46; Thus&#44; the results should be analyzed in terms of the sample characteristics and not by generalization&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">In conclusion&#44; bodyweight was asymmetrically distributed between the AMP and NAMP limbs&#46; However&#44; no alterations in the ability to sense and reproduce knee joint angles were demonstrated using an active test&#46; QUA and HAM weakness observed in the AMP limb suggests that&#44; although the patients were wearing the prosthetic limb for a long time&#44; their strength level was still low&#46;</p></span><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">AUTHOR CONTRIBUTIONS</span><p id="para220" class="elsevierStylePara elsevierViewall">Fontes Filho CHS was responsible for the study conception&#44; data collection&#44; manuscript writing&#44; review and approval of the final version&#46; Laett CT was responsible for the data collection and analysis&#44; manuscript writing&#44; review and approval of the final version&#46; Gavil&#227;o UF was responsible for the data collection and analysis&#44; manuscript review and approval of the final version&#46; Campos Jr JC was responsible for the data collection and analysis&#44; manuscript review and approval of the final version&#46; Alexandre DJA was responsible for the study conception&#44; manuscript review and approval of the final version&#46; Cossich VRA was responsible for the study conception&#44; data collection and analysis&#44; manuscript writing&#44; review and approval of the final version&#46; Sousa EB was responsible for the study conception&#44; manuscript writing&#44; review and approval of the final version&#46;</p></span></span>"
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    "resumen" => array:1 [
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">To evaluate how transtibial amputation &#40;TT&#41; affects bodyweight distribution&#44; voluntary knee joint position sense &#40;JPS&#41;&#44; and quadriceps &#40;QUA&#41; and hamstrings &#40;HAM&#41; strength in prosthetized patients&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Only TT patients who had been prosthetized for more than one year were included&#44; and an age-paired able-bodied group was used as control&#46; The participants stood on force plates with their eyes open to measure bodyweight distribution between the limbs&#46; Knee voluntary JPS was assessed by actively reproducing a set of given arbitrary joint angles using a video analysis approach&#44; and QUA and HAM strength were assessed isometrically with a hand-held dynamometer&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Sixteen TT subjects &#40;age&#58; 39&#46;4&#177;4&#46;8 years&#41; and sixteen age-paired control subjects &#40;age&#58; 38&#46;4&#177;4&#46;3 years&#41; participated in the study&#46; The amputees supported their bodyweight majorly on the sound limb &#40;54&#46;8&#177;8&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#46; The proprioceptive performance was similar between the amputated &#40;absolute error &#40;AE&#41;&#58; 2&#46;2&#177;1&#46;6&#176;&#44; variable error &#40;VE&#41;&#58; 1&#46;9&#177;1&#46;6&#176;&#44; constant error &#40;CE&#41;&#58; -0&#46;7&#177;2&#46;0&#176;&#41; and non-amputated limbs &#40;AE&#58; 2&#46;6&#177;0&#46;9&#176;&#44; VE&#58; 2&#46;1&#177;0&#46;9&#176;&#44; CE&#58; 0&#46;02&#177;2&#46;3&#176;&#41;&#44; and was not different from that of control subjects &#40;AE&#58; 2&#46;0&#177;0&#46;9&#176;&#44; VE&#58; 1&#46;4&#177;0&#46;4&#176;&#44; CE&#58; -1&#46;1&#177;1&#46;7&#176;&#41;&#46; There was a considerable weakness of the QUA and HAM in the amputated limb compared with the sound limb and control subjects &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;001 both&#41;&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">The asymmetric bodyweight distribution in the transtibial amputees was not accompanied by a reduction in knee proprioception&#46; There was significant weakness in the amputated limb&#44; which could be a potential issue when designing rehabilitation programs&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "ceabs10"
            "titulo" => "OBJECTIVES&#58;"
          ]
          1 => array:2 [
            "identificador" => "ceabs20"
            "titulo" => "METHODS&#58;"
          ]
          2 => array:2 [
            "identificador" => "ceabs30"
            "titulo" => "RESULTS&#58;"
          ]
          3 => array:2 [
            "identificador" => "ceabs40"
            "titulo" => "CONCLUSIONS&#58;"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:1 [
        "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig1"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 779
            "Ancho" => 650
            "Tamanyo" => 48916
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Overview of the experimental conditions&#46; a&#41; Representative set-up to video recording during the joint position sense and strength evaluation&#46; The black circles represent the Styrofoam balls used to measure distance and angles&#46; The squares represent the positions used to set the hand-held dynamometer&#46; b&#41; Step-by-step representation of the joint position sense&#44; b-1&#58; demonstrated the start position &#8764;90&#176; of knee flexion&#44; b-2&#58; the experienced position&#44; b-3&#58; the subject returning to the start position and waiting for the evaluator&#39;s subsequent commands&#44; b-4&#58; the reproduced position&#46; The difference between the reproduced and experienced positions were used for calculating proprioception indices&#46; The angles 45&#176; and 30&#176; are example values&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig2"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 618
            "Ancho" => 750
            "Tamanyo" => 45528
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">A flow diagram of the recruitment&#44; total eligible participants&#44; and the final sample in the study&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl1"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">BMI&#58; body mass index&#46; NA&#58; not applicable&#46; The <span class="elsevierStyleItalic">p</span>-value were obtained using t-tests for independent measures&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Amputees &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control &#40;n&#61;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;4 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;4 &#40;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sex&#44; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;56&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;44&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Weight &#40;kg&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;3 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#46;1 &#40;14&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Height &#40;m&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;70 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;70 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;3 &#40;6&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;5 &#40;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Amputated limb&#44; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;62&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dominance&#44; number &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Right&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;87&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Left&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Tegner score &#40;pts&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;6 &#40;1&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;8 &#40;2&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Minimum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Maximum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of the amputees and control groups&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl2"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">AMP&#44; amputated limb&#46; NAMP&#44; non-amputated limb&#46; CTL&#44; control limb &#40;control group dominant leg&#41;&#46; AE&#44; absolute error&#46; VE&#44; variable error&#46; CE&#44; constant error&#46; QUA&#44; quadriceps&#46; HAM&#44; hamstrings&#46; &#42;Significantly different from NAMP&#46; <span class="elsevierStyleSup">&#35;</span>Significantly different from the NAMP and CTL groups&#46; The <span class="elsevierStyleItalic">p</span>-values were obtained using one-way ANOVA&#46; The <span class="elsevierStyleItalic">&#951;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleItalic"><span class="elsevierStyleInf">p</span></span> represents the effect size measure&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">VE &#40;&#176;&#41;&nbsp;\t\t\t\t\t\t\n
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                              \t\t\t\t\t\t\t\t
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                              M MacLachlan \n
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                              \t\t\t\t\t\t\t\t
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                              PL Ephraim \n
                              \t\t\t\t\t\t\t\t
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                              TG Travison \n
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                              R Brookmeyer \n
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Article information
ISSN: 18075932
Original language: English
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