Locomotor performance characteristics following lower limb amputation
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Authors: Roffman,C. E.;Buchanan,J.;Allison,G. T.
Publication: Prosthetics and orthotics international
Start Page: 62
Background: Locomotor skills have been demonstrated as predictors of prosthetic non-use1. However, there is a lack of consensus on which performance measures should be used to evaluate people with lower limb amputation during rehabilitation2 and limited knowledge on how performance in the functional domains of velocity, distanced walked and balance during rehabilitation relates to future ability to use a prosthesis3.
Aims: The study objectives were to determine: 1. If performance measures assessed during rehabilitation could identify individuals at high risk of prosthetic non-use 12 months post-discharge. 2. If diagnostic groups at risk of prosthetic non-use including people with Aboriginal ethnicity, older age, amputation above transtibial level, bilateral lower limb amputation, atraumatic cause, diabetes and high comorbidities had poorer performance measure results.
Method: Medical records of 201 consecutive participants with lower limb amputation from Royal Perth Hospital, the state amputee rehabilitation centre, were retrospectively audited for 10m walk (10MWT), timed up and go (TUGT), 6 minute walk (6MWT) and four square step (FSST) tests and descriptive variables. Participants were interviewed at median 1.5 (interquartile range, 1.2 to 2.2) years post-discharge to identify prosthetic users, non-users and time prosthetic use ceased. Receiver operator characteristic curves were generated to determine performance measure thresholds and relative risk (RR) for prosthetic non-use. Mann Whitney U Tests were used to determine if locomotor performance of diagnostic groups at risk of non-use were significantly different from the remaining cohort.
Results: At 12 months post-discharge 18% (36) of participants were prosthetic non-users. Performance measure thresholds and RR of prosthetic non-use (95% CI) were: 10MWT: If velocity was 21.4s (AUC = 0.796), RR of non-use = 3.17 (CI, 2.17 to 4.14, p 36.6s (AUC = 0.762), RR of non-use = 2.76 (CI, 1.99 to 3.39, p 36.6s (AUC = 0.762), RR of non-use = 2.76 (CI, 1.99 to 3.39, p 58 years, high comorbidities, bilateral and above transtibial amputation but was better at predicting prosthetic non-use than locomotor performance of diagnostic groups.
Discussion & Conclusion: Locomotor performance during rehabilitation may identify future risk of prosthetic non-use. Similar to past studies locomotor performance was poorer in those with amputation above transtibial level, high comorbidities, bilateral lower limb amputation and older age3. Clinical utility was greatest for the 10MWT. Validation is warranted.