Ambulation and functional outcome after major lower extremity amputation

Chopra, Atish; Azarbal, Amir F.; Jung, Enjae; Abraham, Cherrie Z.; Liem, Timothy K.; Landry, Gregory J.; Moneta, Gregory L.; Mitchell, Erica L.

doi:10.1016/j.jvs.2017.10.051

Cited by 65 publications

(59 citation statements)

References 25 publications

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“…Impairment variables of THES, SLB, hip extension, RoM restriction, and waist circumference comprised modifiable variables that can be directly influenced by rehabilitation intervention. Nonmodifiable personal factors of age and number of comorbidities were included in the regression analyses, since both variables have been associated with a decline in mobility in people with LLA …”

Section: Discussionmentioning

confidence: 99%

“…Lower limb amputation (LLA) affects over 623 000 Americans, with a prevalence that is anticipated to double globally by 2050 . Impairing strength and balance, amputation burdens patients and can markedly inhibit their ability to traverse common environmental barriers . Although prostheses mitigate some barriers to ambulation, the problem is multifactorial and often different patients with similar amputations demonstrate varying prosthetic mobility.…”

Section: Introductionmentioning

confidence: 99%

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Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

Gailey

Clemens

Sorensen

et al. 2019

PM&R

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Background There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. Objective To determine the influence of modifiable and non‐modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self‐reported balance and mobility are predictive of Component timed‐up‐and‐go (cTUG) performance. Design Cross‐sectional study of a convenience sample. Setting National conference. Participants People (N=68) with non‐vascular causes of unilateral LLA. Methods Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. Main Outcome Measure Timed performance of the cTUG. Results The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities‐specific Balance Confidence scale score, all variables easily collected in a waiting room. Conclusion Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. Level of Evidence II.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

Gailey

Clemens

Sorensen

et al. 2019

PM&R

View full text Add to dashboard Cite

show abstract

“…112 Of a cohort of 256 major amputees, 90% of whom were below-knee, Chopra et al reported 46% ambulatory at one-year postoperative ambulation rate. 113 Large longitudinal analysis of diabetic amputees failed to identify an additional risk factor in amputees versus controls, suggesting the amputation and its impact on function is a risk factor itself (26203063). Even with early prosthetic fitting followed by aggressive rehabilitation, this population are often requiring near-max (80%) cardiorespiratory capacity to ambulate before additional energy costs (rates of oxygen uptake divided by maximum aerobic capacity) are incurred from biomechanical adaptation to prosthetic ambulation.…”

Section: Amputation Versus Reconstructionmentioning

confidence: 99%

Amputations versus Salvage: Reconciling the Differences

Black

Ormiston

Fan

et al. 2019

J Reconstr Microsurg

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Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

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“…When compared to age-matched counterparts, it is well established that individuals with lower limb loss exhibited significantly reduced physical function. 23,24 This loss of function has been generally attributed to the bodily structural changes inherent to amputation, but a number of studies showed that non-physical stressors disproportionately affected individuals with limb loss. For example, a prognostic study by Melcer et al 25 showed that patients with limb loss exhibited significantly greater odds of mental health disorders even when compared to those with severe lower extremity trauma but not amputation at comparable disability levels.…”

Section: Discussionmentioning

confidence: 99%

Financial difficulty in community-dwelling persons with lower limb loss is associated with reduced self-perceived health and wellbeing

Lee

Chien

Chin

et al. 2020

Prosthetics &Amp; Orthotics International

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Background: Socioeconomic status has been shown to be an important factor in the disparate prevalence and selected treatment of limb loss, but how personal financial difficulty affects patients’ health outcomes is currently unclear. Objective: Examining how presence and experience of personal financial difficulty affects perceived health and wellbeing in individuals with lower limb loss. Study Design: Cross-sectional study. Methods: A total of 90 participants (68 males, mean age 58.7 ± 16.7 years) were recruited from local physical therapy and prosthetic and orthotic clinics, rehabilitation hospitals, and a regional amputee patient support group. All participants were community-dwelling, non-military adults with amputation involving at least one major lower limb joint. Participants were interviewed, and each completed a survey that included basic demographic/medical information, self-reported health and wellbeing (Short-Form Health Survey, SF-36v2), and a question to determine their financial situation after limb loss. Multiple regression analyses were used to examine the effect of financial difficulty on the eight subscales of SF-36v2 while accounting for age, gender, and amputation level. Results: Experiencing financial difficulty significantly and negatively affected Role-Physical and Role-Emotional subscale scores ( p < 0.01 and p = 0.02, respectively). Individuals with financial difficulty scored approximately 60% lower in these two specific subscales. Conclusion: Experiencing financial difficulty is a significant predictor for diminished work or daily activity participation due to physical and emotional stresses. Clinicians and health policy makers need to understand how socioeconomic factors may prevent individuals with lower limb loss from achieving higher levels of functional recovery and community re-integration after amputation. Clinical relevance Our findings showed that presence or experience of financial difficulty was significantly associated with diminished community re-integration in community-dwelling, non-military adults with lower limb loss. It affects both physical and emotional aspects of wellbeing. Clinicians should be aware how socioeconomic factors may affect social re-integration after amputation.

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Ambulation and functional outcome after major lower extremity amputation

Cited by 65 publications

References 25 publications

Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

Amputations versus Salvage: Reconciling the Differences

Financial difficulty in community-dwelling persons with lower limb loss is associated with reduced self-perceived health and wellbeing

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