Functional outcome of lower limb amputees with peripheral vascular disease

Abstract

A series of 40 patients accepted for prosthetic rehabilitation after lower limb amputations for peripheral vascular disease were reviewed nine to 27 months later. Two have since died, one has not been traced, and 37 have been assessed. Fourteen were successful full-time limb users ('walkers'), 10 were partial users ('partial walkers') and 13 were wheelchair-dependent ('none walkers' or 'wheelchair users'). Of the walkers, 85% completed a 10-metre walk in under 30 seconds (mean 20s), whereas 90% of the partial walkers took over 30 seconds (mean 79s). The Barthel Activities of Daily Living (ADL) Index, a measure of independence in self-care, correlated closely with outcome status and walking speed. Other items that correlated well with outcome included grip strength, assessed using a simple hand-held dynanometer, and cardiovascular fitness, the measure being time taken for the pulse to return to resting baselme after exercise. This was less than two minutes in 85% of the walkers (mean 94s) and two minutes or more in 100% of the partial walkers (mean 240s). Age did not indicate whether prosthetic training would be successful, but in those who were walking it correlated closely with speed. The partial walkers had lower kitchen and domestic activity scores, which were due to lack of environmental modification for wheelchair use, it being assessed that their walking status conferred ability to do tasks whilst standing. These patients can easily be identified by measuring their walking speed and Barthel ADL Index.

Functional Outcomes After the Prosthetic Training Phase of Rehabilitation After Dysvascular Lower Extremity Amputation

“…For example, Schoppen et al [12] examined patients with LEA resulting from peripheral vascular disease and found that, at a mean of 3.7 years after amputation, patients with TTAs and TFAs had mean TUG times of 23.8 seconds and 28.3 seconds, respectively. In terms of gait speed, the discharge speed of 0.88 m/s observed in our study is similar to cross‐sectional studies, ranging from 0.50 [38] to 1.04 m/s [28] seen at various time points for patients after LEA.…”

Rehabilitation of the older vascular amputee: A review of the literature

“…Age alone is not an absolute contraindication to gait retraining, with studies reporting success in patients aged 90 years and older . However, increasing age does reduce the likelihood of being fitted with a prosthetic limb, of successfully mastering prosthesis use and returning to independent living post‐amputation .…”

“…Therefore, amputees need to be taught how to monitor their remaining limb for any signs of ulceration or infection and act on these promptly. Bilateral amputees have much poorer functional outcomes than unilateral amputees; therefore every effort must be made to preserve the remaining limb . It is more appropriate to aim for wheelchair mobility than attempt gait retraining in the older dysvascular bilateral amputee .…”

Better practical evaluation for lower limb amputees

“…It has been observed that improved mobility and independence are seen following prosthetic rehabilitation, irrespective of previous medical problem. 9,10 Successful prosthetic rehabilitation for elderly amputees, above the age of 90 years, was also reported. 11 Anticipation of patient success in relation to limb wearing can be difficult, even for experienced doctors.…”