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

Abstract

Objective To describe physical function outcomes and modes of physical therapy intervention for a cohort of patients with dysvascular lower extremity amputation (LEA) during the prosthetic training phase of rehabilitation. Design A retrospective cohort study. Setting Physical rehabilitation clinics at a Veterans Affairs Medical Center and a University Hospital. Patients Forty-two patients (38 men, 4 women, age 60.2±8.4 years) who completed outpatient physical therapy rehabilitation with prosthetic training after dysvascular LEA. Methods All patients underwent a prosthetic training phase of rehabilitation, with standardized outcome measures performed at initiation and discharge. Main Outcome Measures Performance-based physical function measures included: Two-Minute Walk (2MW), Timed-Up and Go (TUG), and 5-meter gait speed. Self-report physical function measures included: the Prosthesis Evaluation Questionnaire – Mobility Section (PEQ-MS) and the Patient-Specific Functional Scale (PSFS). Rehabilitation dose was tracked as total number of clinic visits, rehabilitation duration, and specific intervention modes. Results There were significant improvements in 2MW (mean±SD) [67.5±29.9 m (initial) and 103.3±45.8 m (discharge) (p<0.001)], gait speed [0.58±0.27 m/s (initial) and 0.88±0.39 m/s (discharge) (p<0.001)], TUG [34.8±21.3 s (initial) and 18.6±13.9 s (discharge) (p<0.001)], PEQ-MS [2.2±0.9 (initial) and 2.8±0.8 (discharge) (p<0.001)], and PSFS [3.2±2.0 (initial) and 5.9±2.3 (discharge) (p<0.001)]. Performance-based (TUG) and self-report (PEQ-MS) changes in functional mobility from initial exam to discharge had low or no correlations with rehabilitation dose measures. Number of clinic visits was 12.7±13.1 and rehabilitation duration was 13.7±16.8 weeks. Conclusions Significant improvements in performance-based and self-report measures of physical function occurred during the prosthetic training phase of physical rehabilitation following dysvascular major LEA. Despite improvements in function, gait speed and TUG outcomes remained below clinically important thresholds, indicating patients were limited in community ambulation and at risk for falls. Lack of moderate or higher correlation between rehabilitation dose and outcome measures may indicate need for more specific rehabilitation dose measures.

Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes

“…Evidence suggests that each of these variables can serve to characterize motor performance and would influence a user’s self-organization or ability to benefit from a device intervention. For example, increasing age is known to influence muscle coordination, strength and response time characteristics of lower-extremity movements 99–103 , and individuals with dysvascular-related amputation may suffer from reduced sensory feedback compared to those with trauma-related amputation that could affect general mobility 104, 105 . Although these simple measures of characterization can be readily collected or assigned in clinical and research environments, their shortcomings include: 1) assuming that a given patient follows generalized trends, and 2) limited resolution and accuracy.…”

“…Prior studies have proposed general training recommendations to allow the user to explore and engage the functional capabilities of themselves and the prosthesis 105, 131–134 . A review on therapeutic interventions to improve prosthetic gait performance identified five categories: supervised walking, specific muscle strengthening, balance training, (part-to-whole) gait training, and functional mobility training 132 .…”

Physical Function and Pre‐Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation

“…Rehabilitation has a historic focus on remediation of physical function and activity limitations in an effort to minimize disability. Conventional interventions are effective for improving 2MWT distance, gait speed, and L‐test after dysvascular LLA, yet physical function after dysvascular LLA continues to be below clinically meaningful cutoffs upon discharge . For example, a TUG time of 19 seconds or greater is associated with higher risk for multiple falls within 6 months of discharge from inpatient rehabilitation after unilateral transtibial amputation, yet participants in our study who are less than 5 years after LLA had an average TUG time of 20.4 seconds .…”

Physical activity behavior change for older veterans after dysvascular amputation

“…While physical function improves across the course of rehabilitation, 63, 64 long-term functional outcomes after LLA are poor. 3, 8, 65, 66 Traditional physical rehabilitation focuses narrowly on care immediately following LLA, emphasizing prosthetic function, mobility/gait training, and targeted remediation of physical impairments.…”