1. Amputee Mobility Predictor
Louise Whitehead
Physiotherapy Team Leader
27th October 2011

2. Introduction
In 1995, Medicare adopted a 5 level functional classification system for amputees
K levels developed K0 - K4
Bob Gailey developed the Amputee Mobility Predictor (AMP) to help to determine which K levels amputees fit into
AMP PRO / AMPnoPRO

3. K levels
K0 – Patient does not have the ability or potential to walk or transfer with or without assistance and a prosthesis does not enhance their QOL or mobility
K1 – Patient has the ability to use a prosthesis for transfers or walking on level surface at fixed cadence (indoor)
K2 – Patient has the ability to walk indoors and outdoors including negotiating kerbs, stairs and uneven surfaces (community)
K3 - Patient is able to walk with variable cadence and may require prosthetic consideration for work, hobbies or sport
K4 – Patient requires a prosthesis which allows high impact, stress or energy levels, typical of a child, active adult or athlete

4. AMP PRO
Designed to assess an amputee’s existing mobility or potential to mobilise with a prosthesis
Items taken from Tinetti’s Performance-Orientated Assessment of Mobility Problems (POMA) & Duke Mobility Skills Profile (DMSP)
No cost, easy & quick to administer
Equipment = stopwatch, ruler, pencil, 2 chairs, set of 3 steps and a 4” obstacle (step)
21 tasks - scored out of 47
Guidance notes for scoring

5. Tasks Achievement of tasks corresponds to K levels K0 = 1, 2
Sitting balance
Sitting reach (12”)
Chair to chair transfer
Sit to stand
Attempt to stand
Immediate standing balance
Standing balance 30 secs
Single limb stance
Standing reach (12”)
Nudge test
Eyes closed
Pick up object from floor
Sit down (arms across chest)

6. Tasks 14. Initiation of gait K3 + K4 relate to tasks 14 - 21
Foot advancement
Foot clearance
Step continuity
degree turn
Variable cadence
Step over 4” obstacle
Stairs
+ Walking aids used
K3 + K4 relate to tasks
5 points available for walking aids:
1 = WC; 2 = frame;
3 = crutches; 4 = sticks
5 = none

7. Methodology 191 lower limb amputees in study
Subjectively put into K0-K4 categories
24 subjects in reliability study – average time since amputation > 5 years
167 in validity study
Predictive validity & concurrent validity
K0 + K1 – average time from amp 2 yrs
K3 + K4 – over 10 years

8. Results Inter rater reliability (0.99)
Test-retest reliability ( )
Predictive validity – significantly predicted patient’s level of function with prosthesis
Concurrent validity – correlated well with 6 min walk test & Amputee Activity Survey (AAS)
AMP PRO distinguished between K0 – K4 but not validated (Gailey 2006)

9. Dundee experience
17 patients tested at IP discharge 3 week follow up
Transtibial = 14
Tranfemoral = 2
Bilateral = 1
Average scores for transtibial patients
IP D/C = 36/47
3 week follow up = 40/47

10. Dundee experience Average increase in score (all levels) = 4
Patients whose scores did not improve had difficulties preventing prosthetic use during 3 week period (N=3)
Quick & easy to administer
Minimal training required
No ceiling effect with our 3 weeks (most still using walking aids)

11. CHAMPS Developed to address ceiling effect @ K4 level
5 point test as adjunct to AMP PRO
Single limb stance (aim 30 secs)
Medicine ball putt (sit on floor + throw)
Edgren side step test (4m course – no. of cones passed in 10 secs)
T-test (run forwards, left, right & backwards)
Illinois agility test (start & finish on floor – run different directions, turning & figure of 8)

12. References
Gailey RS, Roach KE, Brooks Applegate E, Cho B, Cunnliffe B, Licht S, Maguire M, Nash MS (2002) The Amputee Mobility Predictor: An instrument to assess determinants of the lower limb amputee’s ability to ambulate. Arch of Phys Med & Rehabil 83:
Gailey RS (2006) Predictive outcome measures versus functional outcome measures in the lower limb amputee. Journal of Prosthetics & Orthotics 18:1S;51-60
BACPAR toolbox of outcome measures BACPAR version 1 Feb 2010