Predictors of Receiving a Prosthesis for Adults With Above‐Knee Amputations in a Well‐Defined Population

Abstract

Background Prior studies have identified age as a factor in determining an individual’s likelihood of receiving a prosthesis following a lower limb amputation. These studies are limited to specific subsets of the general population and are unable to account for pre-amputation characteristics within their study populations. Our study seeks to determine the effect of pre-amputation characteristics on the probability of receiving a prosthesis for the general population in the United States. Objective Identify pre-amputation characteristics that predict of the likelihood of receiving a prosthesis following an above-knee amputation (AKA). Design A retrospective, population-based cohort study. Setting Olmsted County, Minnesota (2010 population: 144,248) Participants Individuals (n=93) over the age of 18 years who underwent an AKA i.e. knee disarticulation or trans-femoral amputation while residing in Olmsted County, MN between 1987 and 2013. Methods Characteristics affecting the receipt of a prosthesis were analyzed using a logistic regression and a random forest algorithm for classification trees. Pre-amputation characteristics include age, sex, amputation etiology, year of amputation, mobility, cognitive ability, comorbidities, and time between surgery and the prosthesis decision. Main Outcome Measures The association of pre-amputation characteristics with the receipt of a prosthesis following an AKA. Results Twenty Four of the participants received a prosthesis. The odds of receiving a prosthesis were almost 30 times higher in those able to walk independently prior to an amputation relative to those who could not walk independently. A 10-year increase in age was associated with a 53.8% decrease in the likelihood of being fit for a prosthesis (odds ratio=0.462, p-value =.030). Time elapsed between surgery and the prosthesis decision was associated with a rise in probability of receiving a prosthesis for the first three months in the random forest algorithm. No other observed characteristics were associated with receipt of a prosthesis. Conclusions The association of pre-amputation mobility and age with the likelihood of being fit for a prosthesis is well-understood. The effect of age, after controlling for confounders, still persists and is associated with the likelihood of being fit for a prosthesis.

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

“…Several studies investigated prosthesis use and prosthesis fitting rates in lower limb amputees [29][30][31][32][33][34][35][36]. However, most studies [30][31][32][34][35][36] had a small sample size and/or did not report outcomes for different amputation levels. Davie-Smith et al [29] as well as Resnik et al [33] found fit rates in transfemoral amputees of 21.6% and 19.2%, respectively.…”

Low Back Pain in Adults With Transfemoral Amputation: A Retrospective Population‐Based Study

“…Individuals with prosthesis were 84% less likely to die within the first 2.5 years of the index date compared with those who did not receive a prosthesis (Table ). As reported previously, all individuals who received a prescription for prosthesis received one within the first 7 months of amputation (prosthesis fitting occurred an average of 105 days postamputation) . In a sensitivity analysis, we eliminated the individuals who died within the first 7 months of index date (N = 41) and the protective effect of prosthesis on death hazard rate disappeared.…”

“…As reported previously, all individuals who received a prescription for prosthesis received one within the first 7 months of amputation (prosthesis fitting occurred an average of 105 days postamputation). 28 In a sensitivity analysis, we eliminated the individuals who died within the first 7 months of index date (N = 41) and the protective effect of prosthesis on death hazard rate disappeared. This indicates that the effect of prosthesis is likely confounded by indication for amputation and illness severity, and we are unable to explain the relationship with our current construct given that patients needed to be healthy enough to qualify for prosthesis receipt.…”

Suitability of ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ for the Eastern Cape, South Africa: A qualitative study

“…Findings showed instances of prosthetic prescription where the cause of amputation, comorbidities, age and general physical condition were seemingly not taken into consideration. Evidence on the negative effect of these variables on a person’s ability to function with a prosthesis is clear from these studies (Davie-Smith et al 2017 ; Mundell et al 2016 ; Resnik & Borgia 2015 ; Roffman et al 2014 ; Schoppen et al 2003 ; Yilmaz et al 2016 ). The tool, which takes these factors into consideration, might provide valuable guidance in this regard.…”

“…The AMP assesses sitting, standing, balance and locomotion. The ability to balance on the remaining leg has a strong correlation with prosthetic ability and use (Raya et al 2010 ; Schoppen et al 2003 ), whereas the use of mobility-assistive devices before the amputation correlates with decreased prosthetic provision (Mundell et al 2016 ) and function (Roffman, Buchanan & Allison 2014 ). However, aspects such as age (Davie-Smith et al 2017 ; Mundell et al 2016 ; Resnik & Borgia 2015 ; Schoppen et al 2003 ; Yilmaz et al 2016 ), cause of amputation (Mundell et al 2016 ), comorbidities (Resnik & Borgia 2015 ), cognition (Mundell et al 2016 ) as well as the condition of the remaining and residual limbs (Raya et al 2010 ; Roberts et al 2006 ) also influence prosthetic functioning.…”