Long term locomotor function in individuals with lower limb amputation following discharge from rehabilitation

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Authors: Roffman,C. E.;Buchanan,J.;Allison,G. T.

Publication: Prosthetics and orthotics international

Year: 2015

Volume: 39

Start Page: 64

ABSTRACT:

Background: In Australia there is limited information on long term locomotor outcomes of people with lower limb amputation after rehabilitation discharge1,2. Roffman et al1 demonstrated that indigenous status was not predictive of prosthetic non-use however locomotor function of Aboriginal people has not been reported despite high rates of diabetes related amputation and poor health outcomes. The Locomotor Capabilities Index 5 (LCI5) is a reliable and valid measure of self reported locomotor function for people with lower limb amputation3.

Aim: The study aims were to: 1. Quantify prosthetic use for locomotor activities in people with lower limb amputation who have been discharged from rehabilitation in Western Australia. 2. Determine if self reported locomotor function after rehabilitation discharge was different between prosthetic users and non-users; and diagnostic user groups including those with Aboriginal ethnicity, age >58 years, amputation above transtibial level, bilateral amputation, diabetes, high comorbidities, atraumatic amputation, males and the remaining prosthetic user cohort.

Method: 201 consecutive participants with lower limb amputation from Royal Perth Hospital, the state amputee rehabilitation centre were recruited. Medical records were audited for descriptive characteristics. Participants were prospectively interviewed at median, 1.5 (IQR, 1.2 to 2.2) years after discharge using the LCI5 and a previously piloted questionnaire regarding their prosthetic use, falls history, functional ability, amputation, general health and demographic details. Time prosthetic use ceased relative to physiotherapy discharge and reasons for prosthetic non-use were recorded for non-users. Descriptive statistics and Mann Whitney U Tests were used to determine if locomotor capabilities were significantly different between prosthetic users and non-users and the diagnostic user groups.

Results: A total of 26% (52) of participants were prosthetic non-users and 74% (149) users. Prosthetic non-users (median, 4 IQR, 1 to 11) reported significantly lower Basic, Advanced and Total locomotor capabilities (z = 8.13, p 2.10, p < .036) for all diagnostic groups except the Aboriginal (z = 1.17, p = .25) and amputation above transtibial level (z = 1.56, p = .12) sub-groups. Ceiling effect was 25% for Total LCI5 score and greatest in the <58 years and traumatic amputation sub-groups.

Discussion & Conclusion: This was the first study in an Australian cohort with lower limb amputation to report long term locomotor function after rehabilitation discharge and demonstrate that locomotor function was not significantly different for Aboriginal people. Ceiling effect in younger participants with traumatic amputation and significantly poorer LCI5 scores for prosthetic non-users and the diagnostic user groups were consistent with past findings. Self reported locomotor performance after rehabilitation discharge using the LCI5 may inform clinical decision making and service model planning.

  • Listing ID: 4651
  • Author/s: Roffman,C. E.;Buchanan,J.;Allison,G. T.
  • Publication: Prosthetics and orthotics international
  • Year: 2015
  • Volume: 39
  • Start Page: 64
  • Article Keywords: rehabilitation;leg amputation;human;amputation;indigenous people;diagnosis;Australia;health;traumatic amputation;diabetes mellitus;diagnosis related group;rank sum test;ethnicity;statistics;physiotherapy;locomotion;questionnaire;medical record;disabled person;planning;hospital;model;clinical decision making;Australian;male;leg