The impact of gender, level of amputation and diabetes on prosthetic fit rates following major lower extremity amputation

Abstract

Background:Diabetes mellitus is a leading cause of major lower extremity amputation.Objective:To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease.Study design:Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset.Results:Within the cohort with peripheral arterial disease (n = 1735), 64% were men (n = 1112) and 48% (n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively (p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation (p = 0.001) and trans-femoral amputation (p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb (p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level (p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level.Conclusion:Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus.Clinical relevanceThis is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.

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

“…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. While Davie-Smith et al [29] analyzed age effects separately for transfemoral and transtibial amputations, Resnik et al [33] reported only a combined age coefficient.…”

“…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. While Davie-Smith et al [29] analyzed age effects separately for transfemoral and transtibial amputations, Resnik et al [33] reported only a combined age coefficient. Hence, we applied data from Davie-Smith et al [29].…”

“…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.…”

“…While Davie-Smith et al [29] analyzed age effects separately for transfemoral and transtibial amputations, Resnik et al [33] reported only a combined age coefficient. Hence, we applied data from Davie-Smith et al [29]. Estimated age effects of both studies were comparable though (0.97 vs. 0.98) [29,33].…”

“…Hence, we applied data from Davie-Smith et al [29]. Estimated age effects of both studies were comparable though (0.97 vs. 0.98) [29,33].…”