Outcome Measures Locomotor Capabilities Index Barthel Index Functional Independence Measure Office of Population Consensus and Surveys Scale Amputee Activity Score Functional Measure for Amputees Houghton Scale Prosthetic Profile of the Amputee Frenchay Activities Index Patient Generated Index Short Form 36 Short Form 12 Sickness Impact Profile Attitude to Artificial Limb Questionnaire Amputation Related Body Image Scale Body Image Questionnaire Prosthesis Evaluation Questionnaire Perceived Social Stigma Scale Questionnaire for Persons with Transfemoral Amputation Trinity Amputation and Prosthesis Experience Scale Russek’s Code Special Interest Group in Amputee Medicine Rivermead Mobility Index Orthotics and Prosthetics National Outcome Tool Amputee Mobility Predictor Timed-Up-and-Go Test L-Test 2-Minute Walk Test 6-Minute Walk Test 10-Metre Walk Test Energy Expenditure Temporospatial Data Kinematics Kinetics
Outcome Measures Functional Certain TS data e.g. walking speed Functional measures e.g. TUG test, TWT Time, money, clinical impracticality Perception Self-report measures e.g. questionnaires Gait Analysis Kinematics Kinetics Energy Expenditure TUG, timed-up-and-go; TWT, timed walk test
Hypothesis Relationships exist between self-report data, functional outcome measures and quantitative gait analysis. Complex gait parameters can be predicted using simpler, cheaper and faster outcome measures such as questionnaires and functional ability assessments.
Aims To develop a clinical tool that enables perceptive and functional outcome measures to provide insights into quantitative gait parameters. To use self-report questionnaires to obtain quality-of-life related information from a well represented proportion of lower limb amputees. To conduct biomechanical analysis on a number of lower limb amputees. To explore relationships between perception, functional outcome measures and quantitative gait analysis.
Experimental Design Visit UNSW? Yes Ethics Approval (HREC 07247) Subject recruitment Mail-out questionnaire studyAnalysis Subject participation complete No Physical testingAnalysis Subject participation complete Analysis of relationships between questionnaires and physical testing
Short-Form 36 PF, physical functioning; RP, role limitations due to physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role limitations due to emotional; MH, mental health; PCS, physical components scale; MCS, mental components scale
Short-Form 36 – Influence of Pain Pain TypePFRPBPGHVTSFREMHPCSMCS Phantom sensations* Diff. in median 95% CI (median) p-value 10 -5-20 0.15 6 -6-19 0.35 10 -2-20 0.23 3 -5-12 0.51 9 0-19 0.06 7 0-13 0.57 4 0-8 0.52 -3 -10-5 0.99 4 -1-8 0.08 1 -3-5 0.53 Phantom pain Diff. in median 95% CI (median) p-value 8 -5-20 0.22 13 0-25 0.04 12 0-23 0.02 5 -5-15 0.26 10 0-19 0.04 13 0-25 0.03 9 0-17 0.02 2 -5-9 0.63 4 0-8 0.04 4 1-8 0.02 Residual limb pain Diff. in median 95% CI (median) p-value 8 -4-20 0.14 13 0-25 0.04 19 10-38 0.00 13 5-22 0.01 9 0-19 0.03 7 0-13 0.06 9 0-17 0.04 5 0-10 0.07 5 2-9 0.01 4 0-7 0.03 Intact limb pain Diff. in median 95% CI (median) p-value 10 0-20 0.13 13 0-25 0.02 10 0-21 0.09 13 5-20 0.01 9 0-19 0.01 7 0-13 0.04 8 0-17 0.09 5 0-10 0.04 4 0-9 0.03 4 0-8 0.04 Back pain Diff. in median 95% CI (median) p-value 13 0-25 0.02 13 0-25 0.1 21 10-31 0.00 6 -3-15 0.20 9 0-19 0.01 7 0-13 0.13 8 0-17 0.06 5 0-10 0.07 5 2-9 0.01 3 -1-7 0.10 * Defined as an awareness of pressure and proprioception in the phantom limb (Legro et al, 1998)
Locomotor Capabilities Index NOYES if someone helps me YES if someone is near me YES alone with a walking aid YES alone without a walking aid a. Get up from a chair? b. Pick up an object from the floor when you are standing up with your artificial leg? c. Get up from the floor? (for example: if you had fallen) d. Walk in the house? e. Walk outside on EVEN ground? f. Walk outside on UNEVEN ground? (for example: grass, gravel, slope) g. Walk outside in bad weather? (for example: rain or snow) h. Go upstairs holding a banister? NOYES if someone helps me YES if someone is near me YES alone with a walking aid YES alone without a walking aid i. Go downstairs holding a banister? j. Step up onto the pavement? k. Step down from the pavement? l. Go up a few steps without a handrail? m. Walk down a few steps without a handrail? n. Walk while carrying an object? (for example: cup of tea, newspaper)
Comparison to Published Results Short-Form 36 Similar to Legro et al. (1999), Pezzin et al. (2000), Smith et al. (1995) and Hagberg et al. (2001) Locomotor Capabilities Index Higher than other published results Prosthesis Evaluation Questionnaire Mixed results Frustration and social burden lower
Multivariate Analysis – Regression Analysis 90 80 70 60 50 40 30 20 10 0 One Type of PredictorTwo Types of PredictorsAll ABCA-BA-CB-C A-B-C Predictor Types A DemographicsB Questionnaire Scales (PEQ)C Functional Outcome Measures
Multivariate Analysis t stand AM_C t stand AM_C UT_G AM_C: Rate your ability to walk in close spaces when using your prosthesis UT_G: Rate how much energy it took to use your prosthesis for as long as you needed it.
2. The Role of Gait Deviation in Patient Satisfaction Kark and Simmons, Patient satisfaction following lower-limb amputation: the role of gait deviation. Prosthetics and Orthotics International, 2011. 35(2): 225 - 233
Satisfaction in the Prosthesis Evaluation Questionnaire AbbreviationQuestion SA hapypros Over the past four weeks, rate how happy you have been with your current prosthesis. SA satpros Over the past four weeks, rate how satisfied you have been with your current prosthesis. SA satwalk Over the past four weeks, rate how satisfied you have been with how you are walking. WB sincamp Over the past four weeks, rate how satisfied you have been with how things have worked out since your amputation. WB qol Over the past four weeks, how would you rate your quality of life? PC prostist How satisfied have you been with the person who fit your current prosthesis? PC curtrain How satisfied are you with the training you have received on using your current prosthesis? PC alltrain Overall, how satisfied are you with the gait and prosthetic training you have received since your amputation?
Patient Satisfaction Satisfaction Measures MinQ1MedianQ3Maxp SA hapypros 7.747.882.190.81000.85 SA satpros 3.948.780.195.81000.16 SA satwalk 1.348.785.397.81000.05 WB sincamp 18.048.784.095.81000.22 WB qol 18.040.782.797.11000.17 PC prostist 14.151.991.798.71000.49 PC curtrain and PC alltrain were omitted from further analysis because 25% of respondents reported that they had not received gait training.
Correlates of Satisfaction Participant demographics did not correlate significantly with any of the satisfaction measures Level of amputation showed small correlation with satisfaction with walking Self-report measures showed the strongest correlation Ambulation with: walking, well-being and quality of life Frustration with: happiness with prosthesis and satisfaction with prosthetist Perceived response with: quality of life Social burden with: walking, well-being, and quality of life Performance-based and gait deviation did not correlate significantly with any of the satisfaction measures
Summary In this cohort, gait deviation was relatively unimportant to the amputee Self-reported functional ability in a variety of areas (including physical, mental and social domains) had the greatest influence on patient satisfaction Further advocates for multidisciplinary rehabilitation
Future Work Development of a standardised set of outcome measures, which will facilitate comparison between rehabilitation facilities, and ultimately result in improved outcomes for individuals with lower-limb amputation.