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

Abstract

Background People with dysvascular lower limb amputation (LLA) achieve one‐third of the recommended steps per day and experience severe disability. Although physical function improves with rehabilitation after dysvascular LLA, physical activity remains largely unchanged, and factors contributing to limited daily step count are unknown. Objectives To identify factors that contribute to daily step count after dysvascular LLA. Design Cross‐sectional, secondary data analysis. Setting Outpatient rehabilitation facilities. Participants Fifty‐eight patients with dysvascular major LLA (age: 64 ± 9 years, body mass index: 30 ± 8 kg/m2, male: 95%, transtibial LLA: 95%). Methods Data were collected by a blinded assessor after dysvascular LLA. Candidate explanatory variables included (1) demographics, (2) LLA characteristics, (3) comorbidities and health behaviors, and (4) physical function. Variables with univariate associations with log steps/day (transformed due to non‐normality) were included in a multiple linear regression model using backward elimination to identify factors that explained significant variability in log steps/day. Primary Outcome Measure The primary outcome, daily step count, was measured with accelerometer‐based activity monitors worn by participants for 10 days. Results Participants took an average (± SD) of 1450 ± 1309 steps/day. After backward elimination, the final model included four variables explaining 62% of the overall daily step count (P < .0001): 2‐minute walk distance (32%), assistive device use (11%), cardiovascular disease (10%), and pre‐amputation walking time (11%). Conclusions Average daily step count of 1450 steps/day reflects the lowest category of sedentary behavior. Physical function, cardiovascular disease, and pre‐amputation walking time explain 62% of daily step count after dysvascular LLA. Although physical rehabilitation commonly focuses on improving physical function, interventions to increase daily step count after dysvascular LLA should also consider chronic disease and health behaviors that predate LLA. Level of Evidence III.

Self‐Efficacy and Social Support are Associated with Disability for Ambulatory Prosthesis Users After Lower‐Limb Amputation

“…Historically, psychosocial concerns have had limited focus during rehabilitation, with physical function as the primary target of conventional rehabilitation following both traumatic and dysvascular LLA 2‐4 . Findings from the final regression model in this study reinforce prior evidence of association between perceived physical function and rehabilitation outcome 11,15 . Specifically, for every one‐point increase in perceived functional capacity (PEQ‐MS; 0: unable to 4: no difficulty), the disability score (WHODAS 2.0) was 5 points lower, indicating lower disability.…”

“…Further, a longstanding bias towards research focused on young and relatively healthy people with LLA has limited the generalizability of findings towards older people with LLA with multiple comorbid conditions, 8 including those who use a prosthesis for locomotion. Although there is a growing body of evidence highlighting the significance of complicating factors (eg, multiple comorbid conditions), there continues to be a lack of clarity about etiology‐specific influences (eg, traumatic, dysvascular) on rehabilitation outcomes for people of similar age and time since LLA who use a prosthesis beyond 1 year post‐LLA 9‐15 . Theoretical underpinnings suggest factors ranging from age, chronic disease, adjustment, and social functioning may influence etiology‐specific differences in rehabilitation outcomes within the first year of LLA, regardless of prosthesis use for locomotion 14 .…”

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

“…62,63 The time course of physical activity recovery for patients with nontraumatic LLA is unique, as they require extended recovery times compared to patients with LLA from other etiologies, due to vascular and medical comorbidity. 64 Previous studies in nontraumatic LLA have found accelerometer-based average daily step counts to be very low, 9,11 equating to less than one-third of the recommended daily steps for people with disabilities. 59 For example, average daily steps for people within the first 6 months after LLA have been measured at 1721 (1524) steps/d [mean(SD)].…”

“…10 It is possible that such low physical activity and high disability are associated with chronic behaviors that predate the need for amputation. 11 Current clinical practice guidelines for rehabilitation describe a comprehensive approach, including mobility training and community reintegration after LLA. 12 Conventional LLA rehabilitation guidelines encourage increasing free-living physical activity through resistance exercise, mobility training, cardiovascular exercise, and other specific functional exercises.…”

“…The loss of lower limb due to vascular‐related etiologies is characterized by extremely low levels of physical activity and high disability . It is possible that such low physical activity and high disability are associated with chronic behaviors that predate the need for amputation . Current clinical practice guidelines for rehabilitation describe a comprehensive approach, including mobility training and community reintegration after LLA .…”