Differences in Physical Performance Measures Among Patients With Unilateral Lower-Limb Amputations Classified as Functional Level K3 Versus K4

Sions, Jaclyn Megan; Beisheim, Emma Haldane; Manal, Tara Jo; Smith, S.; Horne, John Robert; Sarlo, Frank Bernard

doi:10.1016/j.apmr.2017.12.033

Cited by 34 publications

(33 citation statements)

References 54 publications

(97 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is consistent with a recent study that noted functional tests such as the 6MWT and AMPPro were able to distinguish between K3 and K4 groups but self-report measures, including the LCI-5, did not. 22 The Houghton, LCI-5, and ABC scales are known to be of lesser value for higher performing individuals because of significant ceiling effects. 1,8 In a conservative approach, floor or ceiling effects are present when 15% or more of a group’s scores are at either extreme.…”

Section: Discussionmentioning

confidence: 99%

Validity of the Comprehensive High-Level Activity Mobility Predictor in a heterogeneous population with lower extremity amputations

Anton

Legault

Dudek

2020

Prosthetics &Amp; Orthotics International

View full text Add to dashboard Cite

Background and objective: Lower extremity amputee outcome measures assess basic mobility. The Comprehensive High-Level Activity Mobility Predictor was developed to assess high-level mobility. Validity evidence was collected in military men with traumatic lower extremity amputations. This study examines its validity in a broader population. Study design: Cross-sectional. Methods: Forty-five lower extremity amputees (Medicare Functional Classification Level K3 or K4) completed the 2-min walk test, Amputee Mobility Predictor with Prosthesis, and Comprehensive High-Level Activity Mobility Predictor. Results: The Comprehensive High-Level Activity Mobility Predictor correlated with the Amputee Mobility Predictor with Prosthesis ( r = 0.77, p < 0.01) and the 2-min walk test ( r = 0.65, p < 0.01). The Comprehensive High-Level Activity Mobility Predictor differentiated between K-levels, age groups, etiology of amputation, and amputation level ( p < 0.005). No ceiling effect was observed (range: 2.5–29/40). Conclusion: This study provides convergent and discriminative validity evidence for Comprehensive High-Level Activity Mobility Predictor use in a more heterogeneous population than previously published, suggesting that clinicians should feel confident to use it as an outcome measure for individuals with amputations who are capable of more than level-ground walking. Clinical relevance Clinically, the Comprehensive High-Level Activity Mobility Predictor has validity evidence for use in a more heterogeneous population than originally demonstrated, including civilians, women, people over age 40 years, and non-traumatic etiologies. The Comprehensive High-Level Activity Mobility Predictor may be more useful than standard outcome measures for high-level mobility.

show abstract

Section: Discussionmentioning

confidence: 99%

Validity of the Comprehensive High-Level Activity Mobility Predictor in a heterogeneous population with lower extremity amputations

Anton

Legault

Dudek

2020

Prosthetics &Amp; Orthotics International

View full text Add to dashboard Cite

show abstract

“…The outcome metrics for assessment were chosen based on prosthetic literature as comprehensive assessments for performance-based clinical outcomes [21][22][23][24] as well as participant-reported outcomes [25].…”

Section: Outcome Metricsmentioning

confidence: 99%

Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial

Jayaraman

Mummidisetty

Albert

et al. 2021

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

Background Individuals with transfemoral amputations who are considered to be limited community ambulators are classified as Medicare functional classification (MFCL) level K2. These individuals are usually prescribed a non-microprocessor controlled knee (NMPK) with an appropriate foot for simple walking functions. However, existing research suggests that these individuals can benefit from using a microprocessor controlled knee (MPK) and appropriate foot for their ambulation, but cannot obtain one due to insurance policy restrictions. With a steady increase in older adults with amputations due to vascular conditions, it is critical to evaluate whether advanced prostheses can provide better safety and performance capabilities to maintain and improve quality of life in individuals who are predominantly designated MFCL level K2. To decipher this we conducted a 13 month longitudinal clinical trial to determine the benefits of using a C-Leg and 1M10 foot in individuals at K2 level with transfemoral amputation due to vascular disease. This longitudinal clinical trial incorporated recommendations prescribed by the lower limb prosthesis workgroup to design a study that can add evidence to improve reimbursement policy through clinical outcomes using an MPK in K2 level individuals with transfemoral amputation who were using an NMPK for everyday use. Methods Ten individuals (mean age: 63 ± 9 years) with unilateral transfemoral amputation due to vascular conditions designated as MFCL K2 participated in this longitudinal crossover randomized clinical trial. Baseline outcomes were collected with their current prosthesis. Participants were then randomized to one of two groups, either an intervention with the MPK with a standardized 1M10 foot or their predicate NMPK with a standardized 1M10 foot. On completion of the first intervention, participants crossed over to the next group to complete the study. Each intervention lasted for 6 months (3 months of acclimation and 3 months of take-home trial to monitor home use). At the end of each intervention, clinical outcomes and self-reported outcomes were collected to compare with their baseline performance. A generalized linear model ANOVA was used to compare the performance of each intervention with respect to their own baseline. Results Statistically significant and clinically meaningful improvements were observed in gait performance, safety, and participant-reported measures when using the MPK C-Leg + 1M10 foot. Most participants were able to achieve higher clinical scores in gait speed, balance, self-reported mobility, and fall safety, while using the MPK + 1M10 combination. The improvement in scores were within range of scores achieved by individuals with K3 functional level as reported in previous studies. Conclusions Individuals with transfemoral amputation from dysvascular conditions designated MFCL level K2 benefited from using an MPK + appropriate foot. The inference and evidence from this longitudinal clinical trial will add to the knowledgebase related to reimbursement policy-making. Trial registration This study is registered on clinical trials.gov with the study title “Functional outcomes in dysvascular transfemoral amputees” and the associated ClinicalTrials.gov Identifier: NCT01537211. The trial was retroactively registered on February 7, 2012 after the first participant was enrolled.

show abstract

“…In order to assess walking speed, we performed the 10MWT, 15,17 which is a simple method of measuring walking speed in meters per second over a short duration. Subjects were instructed to walk a 10 m straight path distance at their preferred walking pace.…”

Section: Methodsmentioning

confidence: 99%

“…6,13,14 The Falls Efficacy Scale (FES) and the 10-meter walk test (10MWT) are two instruments used to characterise the functionality of lower limb amputees. [15][16][17] FES measures fear of falls and 10MWT assesses walking speed over short distances. The level of functional performance is relevant to detect fall risk.…”

Section: Introductionmentioning

confidence: 99%

Falls in unilateral lower limb amputees living in the community. A Portuguese study.

et al. 2020

View full text Add to dashboard Cite

Introduction: Lower limb amputees present a high risk of falling. This study aims to characterise fall history in unilateral lower limb amputees that are autonomous in the community, identifying differences between transfemoral and transtibial amputees and assessing fear of falling between fallers and non-fallers.Material and Methods: Descriptive, cross-sectional study of consecutive community-dwelling unilateral lower limb adult amputees of any aetiology, attending outpatient consultation in a Portuguese Physical and Rehabilitation Medicine central and university hospital department. Inclusion criteria: a prior 12 week individualised rehabilitation program for prosthesis training; regular prosthesis use for more than one year with autonomous gait; and a Functional Independence Measure® score equal to or greater than 100. Injury severity was classified according to the National Database of Nursing Quality Indicators® injury falls measure. In order to assess walking performance over short distances and fear of falling we used the 10-meter walk test and the Falls Efficacy Scale, respectively.Results: In a sample of 52 lower limb amputees, mainly men (80.8%) and of traumatic aetiology (63.5%), with a mean age of 57.21 ± 11.55 years, 36.5% reported at least one fall in the previous 12 months, all classified as minor injuries. Transfemoral amputees (n = 23) presented a higher number of falls (2.22 ± 3.23, p = 0.025) and lower gait velocity (0.77 ± 0.26 m per second, p < 0.001). Regarding fear of falling, we found no significant differences between fallers and non-fallers.Discussion: The prevalence of falls was low and of minor severity. Transfemoral amputees fell more often and were slower. There were no reported differences in fear of falling between groups.Conclusion: This paper contributes information about Portuguese lower limb amputees, whose studies are scarce and are rarely dedicated to falling.

show abstract

Differences in Physical Performance Measures Among Patients With Unilateral Lower-Limb Amputations Classified as Functional Level K3 Versus K4

Cited by 34 publications

References 54 publications

Validity of the Comprehensive High-Level Activity Mobility Predictor in a heterogeneous population with lower extremity amputations

Validity of the Comprehensive High-Level Activity Mobility Predictor in a heterogeneous population with lower extremity amputations

Using a microprocessor knee (C-Leg) with appropriate foot transitioned individuals with dysvascular transfemoral amputations to higher performance levels: a longitudinal randomized clinical trial

Falls in unilateral lower limb amputees living in the community. A Portuguese study.

Contact Info

Product

Resources

About