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Johansson R, Jensen L, Barnett CT, Rusaw DF. Quantitative methods used to evaluate balance, postural control, and the fear of falling in lower limb prosthesis users: A systematic review. Prosthet Orthot Int 2023; 47:586-598. [PMID: 37318276 DOI: 10.1097/pxr.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Problems with balance, postural control, and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control, and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, AgeLine, Scopus, Web of Science, Proquest, PsycINFO, PsycArticles, and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles used quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, and were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are used to synthesize the results. The search yielded (n = 187) articles assessing balance or postural control (n = 5487 persons in total) and (n = 66) articles assessing fear of falling or balance confidence (n = 7325 persons in total). The most used test to measure balance was the Berg Balance Scale and the most used test to measure fear of falling was the Activities-specific Balance Confidence scale. A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.
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Affiliation(s)
- Robin Johansson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Louise Jensen
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Southern Älvsborg Hospital, Borås, Sweden
| | - Cleveland T Barnett
- School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - David F Rusaw
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Miller TA, Paul R, Forthofer M, Wurdeman SR. Stability and Falls Evaluations in AMPutees (SAFE-AMP 2): Reduced functional mobility is associated with a history of injurious falls in lower limb prosthesis users. Ann Phys Rehabil Med 2022; 66:101679. [PMID: 35667624 DOI: 10.1016/j.rehab.2022.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Injurious falls have a high cost and economic impact on an individual and the health system. Several studies have assessed performance-based functional mobility in lower limb prosthesis (LLP) users and fall risk including fall history. However, limited data exist regarding the relationship between functional mobility and a history of injurious falls in individuals who use a LLP. Such information could inform clinical practice and decision making from prosthesis design to policy. The purpose of this study was to identify factors associated with a history of injurious falls among LLP users using a clinical outcomes database. METHODS Retrospective (2016-2018) observational study. Logistic regression applied. RESULTS A final sample of 12,044 LLP users was included for analysis. Within the sample, 1,529 individuals reported a history of an injurious fall within the previous 6 months. Self-reported functional mobility was stratified into low, middle, and high levels: differences were found between levels for history of an injurious fall. The lowest mobility level was associated with 2.29 higher odds of a history of an injurious fall (95% CI: 1.96-2.69) indicating a potentially greater serious fall risk compared to those with higher mobility levels while controlling for covariates (sex, cause of amputation and level of amputation). CONCLUSION(S) Self-reported functional mobility was associated with a history of injurious falls in LLP users. The Prosthetic Limb Users Survey of Mobility is an accessible tool that prosthetists could use to identify individuals with a high risk of falls; this can inform care planning. Rehabilitation plans and prosthesis designs that target LLP users who report low functional mobility may positively impact health outcomes.
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Affiliation(s)
- Taavy A Miller
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA; Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223 USA
| | - Shane R Wurdeman
- Hanger Institute for Clinical Research and Education, 10910 Domain Dr. #300 Austin, TX, 78758 USA
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Seth M, Pohlig RT, Hicks GE, Sions JM. Clinical mobility metrics estimate and characterize physical activity following lower-limb amputation. BMC Sports Sci Med Rehabil 2022; 14:124. [PMID: 35799260 PMCID: PMC9264684 DOI: 10.1186/s13102-022-00518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
Abstract
Background Regular physical activity following a lower-limb amputation is essential for maintaining health and a high quality of life. Most adults with a lower-limb amputation, however, participate in insufficient daily physical activity, and thus, are predisposed to poor health outcomes. Estimating physical activity after lower-limb amputation via common mobility metrics may aid in clinical decisions regarding treatment prioritization and prosthesis prescription. The objectives of this study were (a) to examine associations between daily physical activity and patient-reported and performance-based mobility metrics among adults with lower-limb amputation, and (b) to determine whether patient-reported and performance-based mobility metrics can distinguish between physical activity status [i.e., sedentary (< 5000 steps/day) or non-sedentary (≥ 5000 steps/day)] of adults with lower-limb amputation. Methods A cross-sectional study involving 35 adults with a unilateral transtibial (N = 23; 63.0 ± 10.4 years) or transfemoral amputation (N = 12; 58.8 ± 9.5 years) was conducted. Participants completed patient-reported (Prosthesis Evaluation Questionnaire-Mobility Subscale) and performance-based mobility metrics (L-Test, 10-m Walk Test, 6-min Walk Test). Physical activity, i.e., average steps/day, was measured with an accelerometer. Results Patient-reported and performance-based mobility metrics were associated with daily physical activity (p < 0.050). Prosthesis Evaluation Questionnaire-Mobility Subscale scores, L-Test time, 10-m Walk Test speed and 6-min Walk Test distance independently explained 11.3%, 31.8%, 37.6% and 30.7% of the total variance in physical activity. Receiver operating characteristic curves revealed patient-reported and performance-based mobility metrics significantly distinguish between physical activity status, i.e., sedentary (< 5000 steps/day) versus non-sedentary (≥ 5000 steps/day). Preliminary cut-points for mobility metrics to classify physical activity status were determined. Conclusions Following a lower-limb amputation, patient-reported and performance-based mobility metrics may estimate daily physical activity, thereby aiding clinical decisions regarding treatment prioritization as well as prosthesis selection.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, 540 South College Avenue, Suite 210JJ, Newark, DE, 19713, USA
| | | | - Gregory Evan Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, 540 South College Avenue, Suite 210JJ, Newark, DE, 19713, USA. .,Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Seth M, Pohlig RT, Beisheim-Ryan EH, Stauffer SJ, Horne JR, Hicks GE, Sions JM. Residual and sound limb hip strength distinguish between sedentary and nonsedentary adults with transtibial amputation. Int J Rehabil Res 2022; 45:137-145. [PMID: 35131977 PMCID: PMC9086098 DOI: 10.1097/mrr.0000000000000520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Following a transtibial amputation (TTA), physical activity has known benefits for health and quality of life. Adults post-TTA, however, demonstrate reduced physical activity, predisposing them to adverse health outcomes. Identifying adults at the risk of sedentarism post-TTA via commonly used, objective clinical measures may enhance clinical decisions, including prosthesis prescription. The study's purpose was to determine whether residual and sound limb hip strength distinguishes between sedentary and nonsedentary adults post-TTA. A secondary analysis of a cross-sectional dataset (n = 44) was conducted. Participant residual and sound limb hip flexion, extension, abduction and adduction strength were assessed via handheld dynamometry. Physical activity was monitored for 7 days and participants were classified as sedentary (<5000 steps/day; n = 13) or nonsedentary (≥5000 steps/day; n = 31). Receiver operating curves revealed that residual and sound limb hip extension, abduction and adduction strength distinguished between sedentary and nonsedentary adults post-TTA (P < 0.050). Preliminary cut-points for hip strength measures to classify adults at the risk of sedentarism were determined. A hip strength composite score (0-6) estimates a 2.2× increased odds of being sedentary with each additional hip strength deficit. Post-TTA, residual and sound limb hip strength can help identify adults at risk of sedentarism to aid clinical decision making, including prosthesis prescription.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
| | - Ryan T Pohlig
- Biostatistics Core, University of Delaware, Newark, DE, USA
| | - Emma H Beisheim-Ryan
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
| | - Samantha J Stauffer
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
- Independence Prosthetics-Orthotics, Inc., Newark, DE, USA
| | - John R Horne
- Independence Prosthetics-Orthotics, Inc., Newark, DE, USA
| | - Gregory E Hicks
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
| | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
- Delaware Spine Studies, Department of Physical Therapy, University of Delaware, Newark DE, USA
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Mellema M, Gjøvaag T. Reported Outcome Measures in Studies of Real-World Ambulation in People with a Lower Limb Amputation: A Scoping Review. SENSORS 2022; 22:s22062243. [PMID: 35336412 PMCID: PMC8955603 DOI: 10.3390/s22062243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022]
Abstract
Background: The rapidly increasing use of wearable technology to monitor free-living ambulatory behavior demands to address to what extent the chosen outcome measures are representative for real-world situations. This scoping review aims to provide an overview of the purpose of use of wearable activity monitors in people with a Lower Limb Amputation (LLA) in the real world, to identify the reported outcome measures, and to evaluate to what extent the reported outcome measures capture essential information from real-world ambulation of people with LLA. Methods: The literature search included a search in three databases (MEDLINE, CINAHL, and EMBASE) for articles published between January 1999 and January 2022, and a hand-search. Results and conclusions: 98 articles met the inclusion criteria. According to the included studies’ main objective, the articles were classified into observational (n = 46), interventional (n = 34), algorithm/method development (n = 12), and validity/feasibility studies (n = 6). Reported outcome measures were grouped into eight categories: step count (reported in 73% of the articles), intensity of activity/fitness (31%), type of activity/body posture (27%), commercial scores (15%), prosthetic use and fit (11%), gait quality (7%), GPS (5%), and accuracy (4%). We argue that researchers should be more careful with choosing reliable outcome measures, in particular, regarding the frequently used category step count. However, the contemporary technology is limited in providing a comprehensive picture of real-world ambulation. The novel knowledge from this review should encourage researchers and developers to engage in debating and defining the framework of ecological validity in rehabilitation sciences, and how this framework can be utilized in the development of wearable technologies and future studies of real-world ambulation in people with LLA.
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Affiliation(s)
- Mirjam Mellema
- Department of Mechanical, Electronic and Chemical Engineering, Faculty of Technology, Art and Design, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
- Correspondence:
| | - Terje Gjøvaag
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130 Oslo, Norway;
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Seth M, Beisheim EH, Pohlig RT, Horne JR, Sarlo FB, Sions JM. Time Since Lower-Limb Amputation: An Important Consideration in Mobility Outcomes. Am J Phys Med Rehabil 2022; 101:32-39. [PMID: 34915544 PMCID: PMC8678402 DOI: 10.1097/phm.0000000000001736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate associations between time since amputation (TSAmp) and mobility outcomes of adults with lower-limb amputation. DESIGN A secondary analysis of a cross-sectional dataset, including 109 community-dwelling adults, 1 yr or more after unilateral transfemoral (n = 39; mean age, 54 ± 15 yrs) or transtibial (n = 70; mean age = 58 ± 14 yrs) amputation, was conducted. Participants attended standardized clinical evaluations and completed mobility-related outcome measures: Prosthesis Evaluation Questionnaire-Mobility Subscale, timed up and go, 10-m walk test, and 6-min walk test. RESULTS After controlling for age, sex, amputation level, and etiology, TSAmp was significantly associated with each mobility outcome. Prosthesis Evaluation Questionnaire-Mobility Subscale and TSAmp were linearly associated, with TSAmp explaining 10.6% of the overall variance. Timed up and go test time and TSAmp were linearly associated, with TSAmp and an interaction term (LevelxTSAmp) explaining 8.4% of the overall variance; 10-m walk test speed and 6-min walk test distance had nonlinear associations with TSAmp, with TSAmp and nonlinear terms (TSAmp2) explaining 12.1% and 13.2% of the overall variance, respectively. CONCLUSIONS Based on the findings, longer TSAmp may be associated with better Prosthesis Evaluation Questionnaire-Mobility Subscale score and timed up and go test time, whereas longer TSAmp may be associated with better or worse 10-m walk test speed and 6-min walk test distance depending upon time elapsed since lower-limb amputation. Estimations of postamputation mobility among adults with lower-limb amputation should consider TSAmp.
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Affiliation(s)
- Mayank Seth
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Emma Haldane Beisheim
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
| | - Ryan Todd Pohlig
- University of Delaware, Biostatistics Core Facility, Newark, Delaware, USA
| | | | | | - Jaclyn Megan Sions
- Delaware Limb Loss Studies, University of Delaware, Department of Physical Therapy, Newark, Delaware, USA
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7
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Physical Activity Among People With Lower Limb Amputation in Brazil. J Phys Act Health 2021; 18:1269-1276. [PMID: 34433702 DOI: 10.1123/jpah.2020-0841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limb loss affects quality of life, well-being, and autonomy. The World Health Organization has launched a global action plan to reduce physical inactivity and presented recommendations of physical activity for people living with disability. Knowledge of the characteristics of people with lower limb amputation regarding physical activity is important. Thus, the aim of this study was to identify the quantity and type of physical activity done by people with lower limb amputation. METHODS The sample (N = 149) included adults aged 53.08 (17.24) years old with lower limb loss. Data collection was performed through the application of a sociodemographic, behavioral, and clinical data sheet and the Brazilian version of the Physical Activity Scale for Individuals with Physical Disabilities. RESULTS The total Physical Activity Scale for Individuals with Physical Disabilities score was between 0 and 65.79 metabolic equivalents of task per hour per day, which suggests low practice of physical activities. The most frequently practiced activities (79.9%) were those that involved stationary behavior. Women carried out more domestic activities, and subjects who used lower limb prosthesis and those with traumatic amputation reported higher practice of physical activity. CONCLUSIONS People living with lower limb amputation, from different regions of Brazil, have low levels of physical activity and mainly carry out activities of stationary behavior.
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Wong CK, Rissland MS, Madagan DM, Jones KN. A Scoping Review of Physical Activity in People With Lower-Limb Loss: 10,000 Steps Per Day? Phys Ther 2021; 101:6254127. [PMID: 33909881 DOI: 10.1093/ptj/pzab115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 02/08/2021] [Accepted: 03/31/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE After amputation, people with lower-limb loss (PLL) face challenges to regain their previous physical activity level. Assessing the scope of evidence regarding physical activity in PLL can identify sources of evidence and gaps within the literature that can influence amputation-related research, outcome assessment choices, and wellness activities. The purpose of this scoping review was to map the evidence regarding steps per day as a physical activity measure for PLL. Specific aims were to (1) identify research designs, (2) catalog population subgroups, (3) document steps per day measurement methods, and (4) provide descriptive data for steps per day in PLL. METHODS The MEDLINE, CINAHL, Embase, Web of Science, and AMED databases; and the Journal of Prosthetics and Orthotics archive were searched without language or time limits. Exclusion criteria included no PLL subjects, not peer-reviewed, and no direct step count measure. Inclusion criteria allowed any sample size, nonprosthetic use, and self-reported step count. As a scoping review, only descriptive statistics were compiled, and no methodologic quality assessment was performed. RESULTS Twenty-one articles using crossover (8), cohort (4), cross-section (8), and case-study (1) designs were included that reported accelerometer (19) or pedometer (2) data. Studies often mixed amputation etiologies (15/21) and most (13/21) excluded transfemoral amputations. Studies primarily examined people with transtibial amputations (81.2%) and people at independent community walking levels (Medicare functional classifications: K3 = 49.2%, K4 = 36.3%). All 21 studies had fewer than 100 participants, and overall included 515 subjects (343, 66.6% male), mean (SD) age 53.2 (22.1) years. Mean (SD) number of pooled steps per day for PLL was 5087 (2998): 5929 (3047) for transtibial amputations and 3553 (2030) for transfemoral amputations. CONCLUSIONS Most PLL have low activity levels compared with the 10,000 steps per day generally recommended or 6000 common in people with diabetes. Research with larger samples, defined subgroups, and data along the recovery continuum would enhance knowledge of physical activity level in PLL. IMPACT This scoping review has identified gaps in the research related to steps per day as a measure of physical activity in people with lower-limb loss to guide future research. LAY SUMMARY People with lower-limb loss take fewer steps per day than suggested for general health. Increasing steps per day may be a useful goal for this population, and this study is a first step in improving knowledge of physical activity levels in people with lower-limb loss.
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Affiliation(s)
- Christopher K Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Maia S Rissland
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deanna M Madagan
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kameron N Jones
- Program in Physical Therapy, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Miller MJ, Morris MA, Magnusson DM, Putnam K, Cook PF, Schenkman ML, Christiansen CL. Psychosocial Factors Influence Physical Activity after Dysvascular Amputation: A Convergent Mixed-Methods Study. PM R 2021; 13:737-745. [PMID: 32936512 PMCID: PMC7873162 DOI: 10.1002/pmrj.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Physical function is a common target of rehabilitation intervention to improve disability and physical activity after dysvascular lower-limb amputation (LLA); yet, the influence of psychosocial factors on physical activity is unclear. OBJECTIVE To identify psychosocial factors with potential to influence clinically relevant measures of physical activity, physical function, and disability in light of participants' narratives. DESIGN Convergent mixed-methods. SETTING General community. PARTICIPANTS Twenty participants with dysvascular LLA were enrolled if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and were between 45 and 88 years old. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Quantitative data included physical activity (activPAL; steps/d), physical function (Timed Up-and-Go; TUG), and disability (World Health Organization Disability Assessment Schedule 2.0; WHODAS 2.0). Qualitative data were collected via semistructured interviews. RESULTS Higher steps/d was moderately correlated with better TUG time (r = -.58, P < .01), but was not correlated with WHODAS 2.0 score (r = -0.18; P > .10). Qualitative analysis of interviews, using an inductive, team-based, phenomenological approach, identified four themes: (1) perceptions of their prosthesis, (2) fear during mobility, (3) influence of LLA on life activities, and (4) positive outlook within social interactions. Mixed-methods analysis used an iterative approach to interpret and describe how psychosocial factors influence physical activity in four exemplar cases. CONCLUSIONS Physical activity in people with dysvascular LLA results from an interaction among perceptions of their prosthesis, fear during mobility, influence of LLA on life activities, and positive outlook within social interactions. The overlapping nature of these themes suggests that interventions targeting psychosocial factors may be associated with improved physical activity, physical function, and subsequent disability after dysvascular LLA.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Megan A Morris
- Adult and Child Consortium of Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Dawn M Magnusson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Kelly Putnam
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, CO, USA
| | - Margaret L Schenkman
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, CO, USA
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Burger H, Bavec A, Giordano A, Franchignoni F. A new valid Walking Aid Scale better predicts distance walked by prosthesis users than Prosthetic Mobility Questionnaire 2.0 and Activities-Specific Balance Confidence Scale. Int J Rehabil Res 2021; 44:99-103. [PMID: 33395143 DOI: 10.1097/mrr.0000000000000452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The availability of psychometrically-sound and parsimonious outcome measures is key for optimizing decision-making about prosthetic fitting and rehabilitation in lower limb prosthesis users. Despite the increasing clinical use of observational and self-reported scales for assessing mobility and balance, there is currently no scale that accounts for the use of assistive devices while walking under conditions of increasing difficulty. Therefore, the purpose of this study was to develop and validate a Walking Aid Scale (WAS) in a cross-sectional sample of 144 prosthesis users. Specifically, we examined internal consistency and concurrent validity of WAS against two commonly used self-report measures of prosthetic mobility and balance confidence - the Prosthetic Mobility Questionnaire 2.0 (PMQ 2.0) and Activities-Specific Balance Confidence Scale (ABC-5). The predictive value of WAS, in comparison to PMQ 2.0 and ABC-5, was assessed using a 6-Minute Walk Test (6MWT) and participants' characteristics. The WAS showed significant moderate-to-good correlations with PMQ 2.0 and ABC-5, and all scales correlated well with age and 6MWT. Participants who relied less on walking aids reported higher mobility levels, greater balance confidence, and walked longer distances. Age was associated with greater use of walking aids and lower mobility and balance confidence. In the stepwise linear regression analysis, age, amputation level, time since amputation, and WAS predicted about two-thirds of the variability in 6MWT with no significant contribution of PMQ 2.0 and ABC-5. These findings indicate that WAS is a valid instrument and a better predictor of walking distance than PMQ 2.0 and ABC-5 in the lower limb prosthesis users.
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Affiliation(s)
- Helena Burger
- Ward for rehabilitation of people after amputation, University Rehabilitation Institute, Ljubljana
- Head for Physical and rehabilitation medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Andrej Bavec
- Ward for rehabilitation of people after amputation, University Rehabilitation Institute, Ljubljana
| | - Andrea Giordano
- Istituti Clinici Scientifici Maugeri, IRCCS, Bioengineering Unit of Veruno Institute
| | - Franco Franchignoni
- Istituti Clinici Scientifici Maugeri, IRCCS, Physical and Rehabilitation Medicine Department of Tradate Institute, Italy
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11
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Miller MJ, Blankenship JM, Kline PW, Melanson EL, Christiansen CL. Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation. Phys Ther 2020; 101:6039323. [PMID: 33336706 PMCID: PMC7921296 DOI: 10.1093/ptj/pzaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA. METHODS Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30-60, 60-90, and >90 minutes), standing (0-1, 1-5, and >5 minutes), and stepping (0-1, 1-5, and >5 minutes) was also calculated. RESULTS Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}-quartile 3 {Q3} = 67%-84%]), followed by standing (median = 16% [Q1-Q3 = 12%-27%]) and stepping (median = 6% [Q1-Q3 = 4%-9%]). One-quarter (median = 25% [Q1-Q3 = 16%-38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1-Q3 = 34%-54%]; stepping: median = 98% [Q1-Q3 = 95%-99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1-Q3 = 59%-78%]; dysvascular: median = 79% [Q1-Q3 = 73%-86%]) and standing (traumatic: median = 23% [Q1-Q3 = 16%-32%]; dysvascular: median = 15% [Q1-Q3 = 11%-20%]). CONCLUSION Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute. IMPACT High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA.
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Affiliation(s)
| | - Jennifer M Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Edward L Melanson
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
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12
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Christiansen CL, Miller MJ, Kline PW, Fields TT, Sullivan WJ, Blatchford PJ, Stevens-Lapsley JE. Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial. PM R 2020; 12:957-966. [PMID: 32248638 PMCID: PMC8229675 DOI: 10.1002/pmrj.12374] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. OBJECTIVE To test the feasibility of a biobehavioral intervention designed to promote physical activity. DESIGN A randomized, single-blind feasibility trial with a crossover design. SETTING Veterans Administration Medical Center. PARTICIPANTS Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). INTERVENTIONS Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. MAIN OUTCOME MEASURES Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index - Disability Scale [LLFDI-DS]). RESULTS Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = -0.15) or LLFDI-DS (d = -0.22 and 0.17 for frequency and limitations scales, respectively). CONCLUSIONS Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.
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Affiliation(s)
- Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA
| | - Paul W Kline
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Thomas T Fields
- Department of Physical Medicine and Rehabilitation, Rocky Mountain Regional Medical Center, Aurora, CO
| | - William J Sullivan
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Patrick J Blatchford
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
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13
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Miller MJ, Cook PF, Magnusson DM, Morris MA, Blatchford PJ, Schenkman ML, Christiansen CL. Self-Efficacy and Social Support are Associated with Disability for Ambulatory Prosthesis Users After Lower-Limb Amputation. PM R 2020; 13:453-460. [PMID: 32926546 DOI: 10.1002/pmrj.12464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower-limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. OBJECTIVE To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. DESIGN Cross-sectional study. SETTING General community. PARTICIPANTS Participants with LLA (N = 122) were included in this cross-sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self-efficacy, social support, and motivation, measured using the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self-efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. RESULTS The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P = .10), with self-efficacy (P < .001) and social support (P = .002) variables remaining in the final model. The final model fit was statistically improved (P < .001) and explained an additional 6.1% of disability variability when compared to the covariate model. CONCLUSIONS Greater self-efficacy and social support are related to lower disability after LLA. Findings suggest there may be a role for interventions targeting increased physical function, self-efficacy, and social support for ambulatory prosthesis users after LLA in middle age or later, especially when complicated by multiple chronic conditions.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, CO, USA
| | - Dawn M Magnusson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Consortium of Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Patrick J Blatchford
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, CO, USA.,Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Margaret L Schenkman
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, CO, USA
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14
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Chadwell A, Diment L, Micó-Amigo M, Morgado Ramírez DZ, Dickinson A, Granat M, Kenney L, Kheng S, Sobuh M, Ssekitoleko R, Worsley P. Technology for monitoring everyday prosthesis use: a systematic review. J Neuroeng Rehabil 2020; 17:93. [PMID: 32665020 PMCID: PMC7362458 DOI: 10.1186/s12984-020-00711-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring, with particular focus on low-resource settings. METHODS A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis users during daily-living. RESULTS Sixty lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. CONCLUSIONS Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user's requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.
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Affiliation(s)
| | - Laura Diment
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
| | - M Micó-Amigo
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
| | | | - Alex Dickinson
- People Powered Prosthetics Group, University of Southampton, Southampton, UK.
- Exceed Research Network, Exceed Worldwide, Lisburn, UK.
| | - Malcolm Granat
- University of Salford, Salford, UK
- Exceed Research Network, Exceed Worldwide, Lisburn, UK
| | - Laurence Kenney
- University of Salford, Salford, UK
- Exceed Research Network, Exceed Worldwide, Lisburn, UK
| | - Sisary Kheng
- University of Salford, Salford, UK
- Exceed Worldwide, Phnom Penh, Cambodia
| | | | | | - Peter Worsley
- People Powered Prosthetics Group, University of Southampton, Southampton, UK
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15
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Kim J, Colabianchi N, Wensman J, Gates DH. Wearable Sensors Quantify Mobility in People With Lower Limb Amputation During Daily Life. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1282-1291. [PMID: 32356753 DOI: 10.1109/tnsre.2020.2990824] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is necessary to effectively assess functional mobility for appropriate prosthetic prescription and post-amputation rehabilitation. As part of this process, patients' ability for variable cadence and community ambulation are assessed in-clinic, often through visual assessments and without objective standards. The purpose of this study was to explore the clinical viability of using wearable sensors to characterize the functional mobility of people with lower limb amputation. We collected inertial measurement unit (IMU) and global positioning system (GPS) data over two weeks, from 17 individuals with lower limb amputation and 14 healthy non-amputee controls. We calculated stride-by-stride cadence, walking speed and stride lengths, along with whether they occurred in or out of the home. Self-selected walking speed was also assessed in the lab. Compared to the lab, both groups walked slower and with a lower cadence during their daily lives. There were no differences in cadence variability between groups or between strides taken in and out of the home. Both groups walked faster and with greater stride lengths away from the homes. The results suggest that functional capacity measured in the lab was not necessarily reflected in routine walking during daily life. The walking measures derived in this approach can be used to aid in the prosthetic prescription process or in the assessment of different interventions.
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16
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Wong CK, Chihuri ST, Santo EG, White RA. Relevance 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. Physiotherapy 2020; 107:133-141. [PMID: 32026813 DOI: 10.1016/j.physio.2020.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Various modifiable and non-modifiable factors affect functional mobility, but subjective patient-reported and objective performance-based measures are rarely combined in explanatory analyses of functional mobility in people with limb loss. This study determined separate explanatory models for patient-reported function using the Prosthetic Evaluation Questionnaire Mobility Subscale (PEQ-MS), and performance-based 2-Minute Walk Test (2MWT). DESIGN Retrospective cross-sectional observational analysis. SETTING Wellness-walking program. PARTICIPANTS Three hundred five volunteers with lower limb loss participated. Sixty nine percent were men, mean age 56 (15) years. Fifty two percent had vascular amputation causes, 42% had surgical levels above the knee, and 82% had medical comorbidities. Walking levels included limited-household (21%), limited-community (30%), and independent-community (49%). Outcome measures included patient-reported PEQ-MS, Activities-specific Balance Confidence (ABC) and Houghton scales; and performance-based balance and walking. MAIN OUTCOMES Separate PEQ-MS and 2MWT multiple regression models fit using backward deletion. RESULTS Modifiable (balance ability, ABC, Houghton score; P<0.05) and non-modifiable factors (sex, amputation cause, surgical level; P<0.05) explained the variance in 2MWT (adjusted R2=0.685). Patient-reported and performance-based modifiable factors (Houghton score, 2MWT; P<0.001) explained PEQ-MS variance (adjusted R2=0.660). Integumentary (P=0.022) and cardiopulmonary (P<0.001) comorbidities explained an additional 4% of PEQ-MS variance, while surgical level was insignificant. CONCLUSIONS Both modifiable and non-modifiable factors explained prosthetic functional mobility. Performance-based walking was explained by modifiable factors including balance ability and confidence, prosthesis and walking aid use. Patient-reported function was also explained by prosthesis and walking aid use, walking speed and medical comorbidities. Modifiable factors for objective and subjective prosthetic mobility may provide a clinical roadmap for rehabilitation.
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Affiliation(s)
- Christopher K Wong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, 617 West 168th Street, Georgian #311, New York, 10032 NY, USA.
| | - Stanford T Chihuri
- Center for Injury Epidemiology and Prevention, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth G Santo
- Program in Physical Therapy, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ryan A White
- Program in Physical Therapy, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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17
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Miller MJ, Cook PF, Kline PW, Anderson CB, Stevens-Lapsley JE, Christiansen CL. Physical Function and Pre-Amputation Characteristics Explain Daily Step Count after Dysvascular Amputation. PM R 2019; 11:1050-1058. [PMID: 30729727 DOI: 10.1002/pmrj.12121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/21/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with dysvascular lower limb amputation (LLA) achieve one-third of the recommended steps per day and experience severe disability. Although physical function improves with rehabilitation after dysvascular LLA, physical activity remains largely unchanged, and factors contributing to limited daily step count are unknown. OBJECTIVES To identify factors that contribute to daily step count after dysvascular LLA. DESIGN Cross-sectional, secondary data analysis. SETTING Outpatient rehabilitation facilities. PARTICIPANTS Fifty-eight patients with dysvascular major LLA (age: 64 ± 9 years, body mass index: 30 ± 8 kg/m2 , male: 95%, transtibial LLA: 95%). METHODS Data were collected by a blinded assessor after dysvascular LLA. Candidate explanatory variables included (1) demographics, (2) LLA characteristics, (3) comorbidities and health behaviors, and (4) physical function. Variables with univariate associations with log steps/day (transformed due to non-normality) were included in a multiple linear regression model using backward elimination to identify factors that explained significant variability in log steps/day. PRIMARY OUTCOME MEASURE The primary outcome, daily step count, was measured with accelerometer-based activity monitors worn by participants for 10 days. RESULTS Participants took an average (± SD) of 1450 ± 1309 steps/day. After backward elimination, the final model included four variables explaining 62% of the overall daily step count (P < .0001): 2-minute walk distance (32%), assistive device use (11%), cardiovascular disease (10%), and pre-amputation walking time (11%). CONCLUSIONS Average daily step count of 1450 steps/day reflects the lowest category of sedentary behavior. Physical function, cardiovascular disease, and pre-amputation walking time explain 62% of daily step count after dysvascular LLA. Although physical rehabilitation commonly focuses on improving physical function, interventions to increase daily step count after dysvascular LLA should also consider chronic disease and health behaviors that predate LLA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthew J Miller
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, CO
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO
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