Association Between Changes in Subjective and Objective Measures of Mobility in People With Lower Limb Amputations After Inpatient Rehabilitation

Cieslak, Gabrielle; Omaña, Humberto; Madou, Edward; Frengopoulos, Courtney; Viana, Ricardo; Payne, Michael; Hunter, Susan

doi:10.1097/phm.0000000000001490

Cited by 9 publications

(8 citation statements)

References 23 publications

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“…However, making inferences on objective mobility from self-reported assessments, or vice versa, is not recommended. 28 Our findings are consistent with Sions et al 18 who also evaluated balance confidence using the ABC but inquired on physical performance using other tests. Importantly, Sions et al 18 recruited people with transtibial and transfemoral amputations, whereas our study only included those with transtibial amputations.…”

Section: Discussionsupporting

confidence: 90%

Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study

Omaña

Frengopoulos

Montero‐Odasso

et al. 2023

Prosthetics &Amp; Orthotics International

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Introduction: Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis. Methods: Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test. Results: Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST (P < 0.001, R2 = 0.56) and DT (P = 0.008, R2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35–0.14) and 0.23 (95% confidence interval, 0.39–0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed. Conclusions: Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.

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Section: Discussionsupporting

confidence: 90%

Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study

Omaña

Frengopoulos

Montero‐Odasso

et al. 2023

Prosthetics &Amp; Orthotics International

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“…14,15 This is an important consideration for individuals with LLA, as levels of balance self-efficacy tend to be low. 12, 31 The results from the current study highlights the relationship between walking ability and self-efficacy of balance at a single point in the rehabilitation journey. Further research is needed to fully understand the longitudinal relationship between selfefficacy, goal setting and walking ability for those with LLAs.…”

Section: Discussionmentioning

confidence: 59%

Association Between Balance Self-Efficacy and Walking Ability in Those With New Lower Limb Amputations

Frengopoulos

Zia

Payne

et al. 2022

Can. Prosthet. Orthot. J.

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BACKGROUND: A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). OBJECTIVE(S): To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. METHODOLOGY: Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). FINDINGS: Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. CONCLUSION: Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA. Layman's Abstract Self-efficacy is a person’s belief in their ability to do a certain task well. Improving self-efficacy can be done by watching others complete a task, by getting praise from experts, or by doing the task yourself. There is a link between how well some people walk and their confidence with walking, however this has not been studied in people learning to use a lower limb prosthesis. The goal of this paper was to study the link between balance self-efficacy, scores on walking tests and self-reported walking ability in those with lower limb amputations (LLA) when they leave rehabilitation. To do this, two walking tests were done (straight path and complex path) in two settings (walking only and walking with distraction). A survey about walking ability and a questionnaire on balance self-efficacy were also done. Results showed that self-efficacy of balance was related to the straight path walking test under both settings and the complex walking test during walking alone. A person’s satisfaction with walking ability was also linked. The only test not related was the complex walking test under distracting conditions. It might be that more time is needed for people with LLA to confidently do this task. This shows the link between physical and mental factors during rehabilitation. More research is needed to find other factors that might impact self-efficacy and walking ability in people with LLA when they leave rehabilitation. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36695/28904 How To Cite: Frengopoulos C, Zia Z, Payne M.W.C, Viana R, Hunter S.W. Association between balance self-efficacy and walking ability in those with new lower limb amputations. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.4. https://doi.org/10.33137/cpoj.v5i1.36695 Corresponding Author: Courtney Frengopoulos,University of Western Ontario, Room 1408, Elborn College, London, Ontario, Canada, N6G 1H1.E-Mail: cfrengop@uwo.caORCID ID: https://orcid.org/0000-0002-4131-2727

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“…PROMs therefore appear well suited to measuring constructs, like prosthetic mobility, that may be challenging to measure comprehensively in a clinic or laboratory setting 19 . Information gained from PROMs is increasingly recognized as important, as it is often distinct from that obtained with performance tests 20 . PROMs are also well suited to clinical and research applications as they are often brief, easy to complete, and can be administered electronically, 21 thereby allowing data to be collected efficiently either in‐person or remotely.…”

Section: Introductionmentioning

confidence: 99%

Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS‐M)

Hafner

Amtmann

Morgan

et al. 2023

PM&R

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Background Achieving mobility with a prosthesis is a common post‐amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient‐reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research. Objective To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility. Design A cross‐sectional study was conducted to administer previously developed candidate items to a national sample of lower limb prosthesis users. Items were calibrated to an item response theory model and two fixed‐length short forms were created. Instruments were assessed for readability, effective range of measurement, agreement with the full item bank, ceiling and floor effects, convergent validity, and known groups validity. Setting Participants were recruited using flyers posted in hospitals and prosthetics clinics across the United States, magazine advertisements, notices posted to consumer websites, and direct mailings. Participants Adult prosthesis users (N = 1091) with unilateral lower limb amputation due to traumatic or dysvascular causes. Interventions Not applicable. Main Outcome Measures Candidate items (N = 105) were administered along with the Patient Reported Outcome Measurement Information System Brief Profile, Prosthesis Evaluation Questionnaire – Mobility Subscale, and Activities‐Specific Balance Confidence Scale, and questions created to characterize respondents. Results A bank of 44 calibrated self‐report items, termed the Prosthetic Limb Users Survey of Mobility (PLUS‐M), was produced. Clinical and statistical criteria were used to select items for 7‐ and 12‐item short forms. PLUS‐M instruments had an 8th grade reading level, measured with precision across a wide range of respondents, exhibited little‐to‐no ceiling or floor effects, correlated expectedly with scores from existing PROMs, and differentiated between groups of respondents expected to have different levels of mobility. Conclusion The PLUS‐M appears to be well suited to measuring prosthetic mobility in people with lower limb amputation. PLUS‐M instruments are recommended for use in clinical and research settings.

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Association Between Changes in Subjective and Objective Measures of Mobility in People With Lower Limb Amputations After Inpatient Rehabilitation

Cited by 9 publications

References 23 publications

Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study

Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study

Association Between Balance Self-Efficacy and Walking Ability in Those With New Lower Limb Amputations

Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS‐M)

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