Community ambulation in people with lower limb amputation

Abstract

Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited. To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA. An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient's autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome. The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = –0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4–6). These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.

Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? A secondary analysis retrospective cohort study

“…According to the WHO statement, 'Rehabilitation addresses the impact of a health condition on a person's everyday life, by optimizing their functioning and reducing their experience of disability', regardless of the reason for its need, and 'is a priority health strategy for the 21 st century that uniquely contributes to optimizing the functioning of the population' [1][2][3][4]. Many studies investigated the possibility of predicting the results of the rehabilitation of disability secondary to different pathologies [5][6][7][8][9], rarely facing the recovery of autonomy activities of daily life (ADLs) [10][11][12][13]. Among different assessment tools, the Barthel Index (BI) is a well-established patient-centered outcome measure and one of the most administrated instruments in rehabilitation settings to evaluate the functional status of patients at admission and discharge.…”

Rehabilitation of a Patient after a Transtibial Amputation: A Case Report

“…Lower limb amputation rates have been dropping in recent years, but it should remain a therapeutic option of major clinical and often life-saving value if adequate advice is provided. Even in developed nations, lower limb amputation (LLA) remains a health concern that needs rehabilitation and long-term care [ 3 ].…”

Key Modifiable Factors in Community Participation Among Adults With Lower Limb Amputation

“…Individuals who regularly use a prosthesis are 440 times more likely to walk than peers who do not use a prosthesis 4 ; thus, prosthesis use, determined, in part, by socket comfort, may be a significant factor in community reintegration. In fact, greater prosthesis use, as well as younger age, lower amputation From the Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark, Delaware (JMS, MS, SJS); University of Delaware, Biostatistics Core, Newark, Delaware (RTP); Independence Prosthetics-Orthotics, Inc, Newark, Delaware (SJS, JRH); and Christiana Spine Center, Newark, Delaware (FBS).…”

“…Older age, less time since amputation, and transfemoral-level amputation (TFA) versus transtibial-level amputation (TTA) are associated with a reduced odds of work return 2 . Greater work reintegration rates among those with lower amputation levels may be explained, in part, by walking capacity, as individuals with TTA are 3.2 times more likely to walk than their peers with TFA 4 . In addition to reduced mobility, Burger and Marinček 3 suggest persistent residual limb issues, poor prosthesis comfort, and comorbidity as additional negative prognostic factors for return to work after LLA.…”

“…Individuals who regularly use a prosthesis are 440 times more likely to walk than peers who do not use a prosthesis 4 ; thus, prosthesis use, determined, in part, by socket comfort, may be a significant factor in community reintegration. In fact, greater prosthesis use, as well as younger age, lower amputation level, and phantom limb pain (PLP) absence, has been associated with being employed 5 …”