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

Abstract

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.

Development and initial validation of the Orthotic Patient-Reported Outcomes—Mobility (OPRO-M): An item bank for evaluating mobility of people who use lower-limb orthoses

“…By addressing many of the barriers to use of PROMs (e.g., lack of perceived clinical value, challenges with interpretation, and excessive administrative burden), we expect that OPRO-M will be readily implemented into routine orthotic patient care. The Prosthetic Limb Users Survey of Mobility (PLUS-M) [ 63 ], a population-specific item bank that is similar to OPRO-M but developed for lower limb prosthesis users, is increasingly used in clinical practice to assess mobility outcomes in patients with lower limb amputation. Although PLUS-M is one of the more recent PROMs developed for prosthesis users, it has been translated into more than 20 languages [ 64 ], integrated into electronic health record software, and adopted as a primary clinical outcome measure by orthotic providers across the United States.…”

Cortical activation during imagined walking for people with lower limb loss: a pilot study

“…For the next analysis, the primary motor cortex (M1) was selected as the brain region of interest (ROI) for this study to allow comparison to the existing fMRI literature in lower extremity amputees (Hanspal et al, 2003;Malouin et al, 2009;Haffner et al, 2017). The left M1 ROI, right M1 ROI, and the whole-brain M1 ROI were obtained from the probabilistic Harvard-Oxford cortical structural atlas (as distributed with FSL v6.0) for all participants.…”

“…The following information was collected for the people with LLA: etiology of amputation, duration of prosthesis use (years), prosthesis use (days per week), Socket Comfort Score (Hanspal et al, 2003) [visual analog scale with anchors of 0 (most uncomfortable) and 10 (most comfortable)] and Prosthetic Limb Users Survey of Mobility (PLUS-M) -12 item short form (Haffner et al, 2017). The PLUS-M evaluates the perceived ability of people with LLA to carry out 12 activities that require use of both lower limbs while using their prosthesis (Haffner et al, 2017). Scores can range from 12 to 60 with higher scores representing better perceived mobility.…”

Towards a holistic assessment of walking with lower limb prostheses in realistic conditions

“…Typically, domains such as satisfaction, function, health perception and quality of live are assessed. Patient-reported outcomes include: Amputee activity survey (AAS) [66], Prosthesis evaluation questionnaire (PEQ) [67], Prosthetic profile of the amputee (PPA) [68], Locomotor capabilities index (LCI) [69], rthotic prosthetic user's survey (OPUS) [70], Trinity amputation and prosthesis experience scales (TAPES) [71], and Prosthetic limb users survey (PLUS) [72]. The AAS is asking for details about prosthesis use, employment status, social activity and walking habits, as well as use of other assistive devices [66].…”

“…The TAPES takes into consideration physical and psychosocial aspects of adjusting to a prosthetic device and is also used to track changes in quality of life during the rehabilitation process [71]. Lastly, the PLUS is a collection of outcome measurements with different subsets, such as the PLUS-M which focuses on mobility with a prosthetic leg [72].…”