1. FUNCTIONAL OUTCOMES IN PROSTHETICS

2. Functional Outcomes Importance of Functional Outcome tools
PT reimbursement: G-Codes required by Medicare currently. Ability to document using a functional outcome measure most objective
Prosthetic industry changes: ability to document patient improvement/potential helps justification with insurance
Justifies treatment/services
Tool to document progression

3. Functional Outcomes
1995- Medicare adopted K-levels to describe “ability of a patient to reach a defined functional state within a reasonable period of time”
Functional level of patient determines componentry- foot and knee
Based on current medical status, comorbidities and desire to ambulate (subjective)

4. Functional Outcomes K-Levels
Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. Level 1: Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator. Level 3: Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. Level 4: Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete. The records must document the beneficiary's current functional capabilities and his/her expected functional potential, including an explanation for the difference, if that is the case. It is recognized, within the functional classification hierarchy, that bilateral amputees often cannot be strictly bound by functional level classifications -Noridian Healthcare Solutions, LCD Lower Limb Prostheses, ID#L11453

5. Functional Outcomes Medicare dictates componentry based on K-Level
Higher K-Level = more advanced technology and materials, increased cost
Example-feet
K0: n/a
K1: SACH foot
K2: multiaxial foot
K3: flex foot
K4: all

6. Functional Outcomes Types of measure Self report Physical performance
Professional report
MDC- minimum amount of change in score to ensure result isn’t due to measurement error

7. Functional Outcomes Self Report Pain/Socket Fit Comfort
Lower Extremity Functional Scale
Other mobility scales

8. Functional Outcomes Physical Performance
Amputee Mobility Predictor(AMP-Pro,-noPro)
Timed Up and Go (TUG)
L Test
6 Minute Walk test

9. Functional Outcomes Amputee Mobility Predictor- AMP
Objective assessment of patient’s ability to ambulate with prosthesis
Assist with K Level determination
AMP Pro…with prosthesis
AMP NoPro…without prosthesis
Same test
Arch Phys Med Rehabil Vol 83, May 2002
Robert S. Gailey, PhD, PT

12. Functional Outcomes AMP- continued 20 functional measurement items
Progress from least to most difficult
Approx minutes
MDC established at 3.4
CPT 97750

13. AMP Scoring K0 K1 K2 K3 K4 AMP Pro n/a 15-26 27-36 37-42 43-47 AMP NoPro 0-8 9-20 21-28 29-36 37-43

14. Timed Up and Go- TUG
MDC 3.6 sec
TT norms 23.1 sec
TF norms 28.3 sec

15. L- Test -Modified version of TUG
-Developed for higher activity patients v. TUG
-Validated against TUG, 2MWT and 10MWT
J. APTA, July 2005, Vol 85, no.7
Minimal detectable change has been established at 3.0

16. 6 Minute Walk Test Ambulate for 6 minutes, record distance
2 MWT highly correlates to 6MWT
Population
Mean +/- SD
Range
Lower limb amputee (K1)*
50 +/- 30 m
4-96
Lower limb amputee (K2)*
190 +/ m
16-480
Lower limb amputee (K3)*
299 +/ m
48-475
Lower limb amputee (K4)*
419 +/- 86 m
Health elderly adults^
417 +/- 95 m
n/a
*Gailey et al, 2002

17. Documentation
Document using language consistent with Medicare’s language.
Mention the patient’s desire to ambulate.
State that the patient can vary their walking cadence (K3)
Document the patient’s ability to traverse low level barriers (K2)
Document specific functional limitations
Document comorbidities thoroughly
Document prior level of function

18. Reasons for denial:
Documentation doesn't support the selected functional level
Inadequate documentation that the patient will reach or maintain a defined functional level within a reasonable time period
No corroborating information in the physician's records
No documentation that the patient is "motivated to ambulate"