Selecting a test for the clinical assessment of balance and walking capacity at the definitive fitting state after unilateral amputation

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p>There is a lack of data and consensus concerning the most appropriate functional evaluation in clinical practice at the definitive prosthetic phase after lower limb amputation.</jats:p></jats:sec><jats:sec><jats:title>Objectives:</jats:title><jats:p>To determine among several selected functional tests the most pertinent to evaluate balance and prosthetic walking.</jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p>Validation of a diagnostic procedure.</jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p>Sixty-four patients were included. Outcome measures: Timed Up and Go test, Functional Reach test (FRT), one-leg balance, tandem test, Modified Houghton Scale, Berg Balance Scale, two-minute walk test (2MW test). Correlations were assessed with the Pearson correlation coefficient and the Principal Component Analysis. Score distribution was analyzed with the Shapiro-Wilk W normality test. Receiver operating characteristic curves were drawn to identify the best predictor for the function.</jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p>The clinical tests correlated highly with each other. Only 2MW test and FRT did not have either a floor/ceiling effect, or a bi-modal distribution. The 2MW test was the best predictor of prosthetic walking limitations (area under the curve 0.93 (0.83–0.97), the best threshold was between 130 and 150 meters), and FRT was best for balance.</jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p>2MW test can be proposed as the first-line clinical test. The FRT can be indicated for the specific assessment of balance disorders.</jats:p></jats:sec><jats:sec><jats:title>Clinical relevance</jats:title><jats:p>This validation of a clinical evaluation of balance and walking capacity after lower limb amputation may be useful in everyday practice to ensure in a simple and standardized way the follow-up of patients and adapt treatments – especially prosthetics – at the definitive prosthetic phase.</jats:p></jats:sec>

Role of balance ability and confidence in prosthetic use for mobility of people with lower-limb loss

“…Others with low ability may have lost confidence after finding their actual function limited. Because the ability to function with a prosthesis requires the actual physical ability to both balance and walk [29], analyzing the roles of balance ability and confidence in prosthetic function was critical.…”

“…BBS 12 (placing alternate foot on step) requires cyclical weight bearing and most closely simulates walking, and it has been repeatedly reported as among the more difficult BBS tasks to perform [4,33]. Walking tasks such as the two-minute walk test have strongly correlated with prosthetic function [9,29] but require time and space to assess, which can prove difficult in a clinic office. BBS 12 may be a useful shortcut to quickly determine prosthetic use for mobility and establish a prognosis that could include referral for additional rehabilitation.…”

Comparison of 6-minute walk test performance between male Active Duty soldiers and servicemembers with and without traumatic lower-limb loss

“…The need to assess fitness, mobility, and function in people with lower-limb loss has required the use of a number of different outcome measures in this population. These measures include many that are typically used in the elderly civilian population with and without limb loss, including the Timed Up and Go, Ltest, 2-minute walk test, 6-minute walk test (6MWT), and Amputee Mobility Predictor [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Many of these measures have also been assessed in a relatively healthy younger population with or without lower-limb loss.…”

Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode

“…Timed walk tests are validated measures of physical performance and overall mobility in the elderly and patients with various medical conditions [17][18][19][20][21], including incomplete spinal cord injury [22][23][24][25][26][27], post-polio syndrome [28][29][30] and lower limb amputations [31][32][33][34]. In subjects with lower limb amputations, the distance walked is well correlated with daily activity and indicative for substantial functional limitations in daily life [33,34].Timed walk tests have not yet been validated specifically for users of KAFOs, but for patients with neurologic conditions that may require fitting of a KAFO such as incomplete SCI, stroke, traumatic brain injury, or multiple sclerosis [35][36][37][38][39][40].…”

“…In subjects with lower limb amputations, the distance walked is well correlated with daily activity and indicative for substantial functional limitations in daily life [33,34].Timed walk tests have not yet been validated specifically for users of KAFOs, but for patients with neurologic conditions that may require fitting of a KAFO such as incomplete SCI, stroke, traumatic brain injury, or multiple sclerosis [35][36][37][38][39][40].…”