Original ResearchPredicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study
Introduction
Major lower-extremity amputations have a great impact on the psychological and physical well-being, the mobility and the social life of individuals. Close monitoring of lower-limb amputee patients in multidisciplinary rehabilitation units plays an important role in the recovery or maintenance of function, as well as in the return to daily work, social, and sports activities.1
The ability to walk with a prosthetic limb is of paramount importance for major lower-limb amputees. From a physical health perspective, being unable to walk after a lower limb amputation can lead to physical deterioration and comorbidities, and be detrimental to overall health.2, 3 As far as psychological and social aspects are concerned, the inability to walk may have a negative impact on the individual's participation in daily life activities, on their body image perception, and on their degree of social reintegration, seriously affecting their quality of life.4, 5 Furthermore, prosthetic rehabilitation and the identification of prognostic factors are of great interest not only from a social and sanitary point of view, but also from the financial perspective of the cost of prostheses and rehabilitation processes.6
It is therefore essential, for patients and health-care teams alike, to be able to predict a patient's ability to walk with a prosthesis, since any incorrect estimation may lead to supplying patients with prostheses they will not be able to use, an undesirable situation for both patients and health services.7 So far, studies on rehabilitation outcomes after lower-limb amputation have been performed on either relatively young patients or on the elderly. In other cases, research has been centered on specific causes or levels of amputation.6, 8, 9 An important limitation affecting previous studies is the lack of a standard definition for successful prosthetic rehabilitation, which has led many authors to set their own criteria.10, 11, 12, 13
The objective of this study was to analyze prosthetic rehabilitation and its effect on walking ability (according to two different definitions) in major lower-limb amputee patients treated in the outpatient service of a Prosthetics and Orthotics Rehabilitation Unit, and to determine and compare which specific factors are associated with walking ability and which are able to predict successful or failed prosthetic rehabilitation.
Section snippets
Design and participants
In this retrospective study we reviewed medical records from 335 major lower-limb amputees who took part in an outpatient rehabilitation program at the Prosthetics and Orthotics Rehabilitation Unit of the Virgen de las Nieves University Hospital of Granada (Spain), from January 1st 2000 to December 31st 2014. Prostheses for transfemoral amputations, in the case of patients between 60 and 65 years of age, were endoskeletal, with a resin- and carbon-fiber-laminated square socket, and fitted with
Results
A total of 169 patients met the inclusion criteria and were included in the study. The average age was 61.60 ± 15.9 years, ranging from 15 to 91 years, and 82.84% were male. The most frequent causes of amputation were vascular (70.41%), followed by traumatological, infective, and tumoral etiologies (18.93%, 4.73%, and 5.33%, respectively). Comorbidities and lower-limb characteristics by cause of amputation are displayed in Table 1. Patients with amputations of vascular etiology were significantly
Discussion
The present study examined and compared the independent association between a number of critical factors and successful prosthetic rehabilitation by examining walking ability at the time of discharge (for two definitions of walking ability). Our results indicate that gender and level of amputation were independently associated with walking ability with or without walking aids, whereas older age and comorbidities were able to predict failed prosthetic rehabilitation when the use of assistive
Conclusions
In summary, the results of this study showed that if walking ability is used as the only definition for successful prosthetic rehabilitation, the presence of ulcers in the preserved limb was individually related to failure, while male gender and transtibial level were independent predictors of failure and success respectively. However, when the use of assistive devices was taken into consideration, a shorter time to rehabilitation was individually associated with improved walking potential,
Conflicts of interest
The authors declare no conflicts of interest.
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2020, Archives of Rehabilitation Research and Clinical TranslationRelevance of medical comorbidities for functional mobility in people with limb loss: retrospective explanatory models for a clinical walking measure and a patient-reported functional outcome
2020, Physiotherapy (United Kingdom)Citation Excerpt :However, in the seminal systematic review of factors associated with prosthetic function by Sansam et al. [11] and an updated review from 2016 using the same search criteria [12], only four of the 78 combined articles analyzed both patient-reported and performance-based measures [13–16]. The same search criteria identified another six papers published from January 2016 through December 2018 [17–22]. Balance impairment has been the most consistent factor associated with prosthetic function [23].