Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures

Abstract

Background:Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care.Methods:Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made.Results:The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire—Residual Limb Health, Prosthetic Evaluation Questionnaire—Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System—29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs.Conclusion:The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.

How Comprehensive and Efficient Are Patient-Reported Outcome Measures for Individuals with Lower Extremity Amputation Undergoing Implantation of Osseointegrated Bone Anchored Limbs?

“…Because this study examined existing literature, no ethics approval was required. We conducted a comprehensive search for existing systematic review articles of PROMs [6][7][8] and reviewed the recent recommendations from the International Society of Prosthetics and Orthotics lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services 9 to identify the available measures in the context of LEA and BALs. Expert opinions were used to include additional instruments deemed important.…”

Validierte deutschsprachige PROMs für Menschen mit Majoramputation der unteren Extremität – Ein narrativer Review anhand des Abschlussreports der LEAD- und COMPASS-Initiative der ISPO

“…Allerdings müssen dafür diese Scores auch in der jeweiligen Landessprache zur Verfügung stehen [7]. Hier zeigen sich Lücken in Deutschland und den Ländern mit deutschsprachiger Bevölkerung.…”

“…In einem umfassenden systematischen internationalen Prozess wurden Empfehlungen zu standarisierten Erhebungen von geeigneten PROMs für Menschen mit Majoramputation der unteren Extremität erarbeitet und in einem umfassenden Abschlussbericht vorgestellt [6]. In der daraus ausgekoppelten Publikation [7], wer-den zudem Empfehlungen für den weiteren Umgang mit den Ergebnissen diskutiert. Unter anderem wird explizit die standardisierte Übersetzung in andere Sprachen mit anschließender Überprüfung der psychometrischen Eigenschaften sowie eine freie Verfügbarkeit der validierten Fragebögen auf einer unabhängigen Plattform gefordert.…”

“…Die ISPO Initiativen LEAD und COMPASS sind geschätzte und wichtige Initiativen. Die Tatsache, dass viele PROMs international kursieren, teilweise mit nationalen Bevorzugungen einzelner Scores, macht eine internationale Vergleichbarkeit unmöglich [6,7]. Bereits seit Jahren ist im Rahmen der International Classification of functioning, disability and health (ICF) ein Core-Set für Amputa tion in Planung [32].…”

3d Printing in Prosthetics, Orthotics and Assistive Technology: Myth and Reality

“…Much changed in the subsequent four decades. There was the development and expansion of evidence-based measures in the clinical setting in particular for lower limb prosthetics 5 which set the stage for objective consideration of prosthetic components design. At the same time the patents on 3D printers began expiring, expanding availability and lowering costs making 3D printers available in the home and classroom.…”