Self-Reported Functional Mobility, Balance Confidence, and Prosthetic Use Are Associated With Daily Step Counts Among Individuals With a Unilateral Transtibial Amputation

Sions, Jaclyn Megan; Arch, Elisa S.; Horne, John Robert

doi:10.1123/jpah.2017-0196

Cited by 21 publications

(41 citation statements)

References 47 publications

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“…The significance of pre‐amputation characteristics (ie, presence of cardiovascular disease, low walking time) in daily step count after dysvascular LLA is a novel finding. Prior research has identified that vascular etiology, greater age, and comorbidity burden are associated with lower levels of physical activity after LLA . The broad scope of characteristics that define dysvascular LLA and clinical practice guidelines for rehabilitation after LLA provide little guidance for what pre‐amputation factors should be considered when targeting improved daily step count .…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidity burden may be associated with daily step counts after LLA . The Functional Comorbidity Index (FCI) is a self‐report questionnaire of the presence of symptomatic chronic conditions known to influence physical function for older adults and people with disabilities .…”

Section: Methodsmentioning

confidence: 99%

“…Level of major LLA and time since amputation were selected as candidate variables because evidence suggested that higher levels of amputation, bilateral involvement, and shorter time since amputation were associated with more severe disability. 17,33,34 Level of major LLA was dichotomized as transtibial LLA or other (ie, transfemoral LLA, knee disarticulation, bilateral involvement). Residual limb quality and the presence of a wound were explored in this analysis due to the potential influence of prosthesis fit on walking activity.…”

Section: Lla Characteristicsmentioning

confidence: 99%

“…Unchanged daily step count after rehabilitation indicates that factors beyond physical function should be intentionally targeted to improve physical activity after dysvascular LLA. Separate studies have demonstrated that greater age, shorter time since amputation, higher comorbidity burden, and dysvascular etiology are associated with lower levels of physical activity after LLA . Unfortunately, people with dysvascular LLA are broadly characterized by advanced age, high number of medical conditions, and poor physical function .…”

Section: Introductionmentioning

confidence: 99%

“…Separate studies have demonstrated that greater age, shorter time since amputation, higher comorbidity burden, and dysvascular etiology are associated with lower levels of physical activity after LLA. 16,17 Unfortunately, people with dysvascular LLA are broadly characterized by advanced age, high number of medical conditions, and poor physical function. 18,19 These broad characteristics lack specificity for what conditions and/or factors should be considered when targeting improved physical activity after dysvascular LLA.…”

Section: Introductionmentioning

confidence: 99%

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

Miller¹,

Cook

Kline³

et al. 2019

PM&R

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Lla Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Miller¹,

Cook

Kline³

et al. 2019

PM&R

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

Christiansen

Miller

Kline

et al. 2020

PM&R

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Background: Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. Objective: To test the feasibility of a biobehavioral intervention designed to promote physical activity. Design: A randomized, single-blind feasibility trial with a crossover design. Setting: Veterans Administration Medical Center. Participants: Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). Interventions: Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. Main Outcome Measures: Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index-Disability Scale [LLFDI-DS]). Results: Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = −0.15) or LLFDI-DS (d = −0.22 and 0.17 for frequency and limitations scales, respectively). Conclusions: Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.

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

Miller

Cook

Magnusson

et al. 2020

PM&R

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Background Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower‐limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. Objective To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. Design Cross‐sectional study. Setting General community. Participants Participants with LLA (N = 122) were included in this cross‐sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Interventions Not applicable. Main Outcome Measures Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self‐efficacy, social support, and motivation, measured using the Self‐Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self‐efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. Results The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P = .10), with self‐efficacy (P < .001) and social support (P = .002) variables remaining in the final model. The final model fit was statistically improved (P < .001) and explained an additional 6.1% of disability variability when compared to the covariate model. Conclusions Greater self‐efficacy and social support are related to lower disability after LLA. Findings suggest there may be a role for interventions targeting increased physical function, self‐efficacy, and social support for ambulatory prosthesis users after LLA in middle age or later, especially when complicated by multiple chronic conditions.

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Self-Reported Functional Mobility, Balance Confidence, and Prosthetic Use Are Associated With Daily Step Counts Among Individuals With a Unilateral Transtibial Amputation

Abstract: Self-reported functional mobility, balance confidence, and prosthetic use predict short-term average daily step counts as determined from research-grade accelerometers.

Cited by 21 publications

References 47 publications

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

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

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

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

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