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Published on: May 8, 2014
Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees
Tanneke Schoppen1, Annemarijke Boonstra, Johan W Groothoff
1Department of Rehabilitation Medicine, University Hospital Groningen, The Netherlands. T.Schoppen@rev.azg.nl
Objective:
To study the value of physical, mental, and social characteristics as predictors of functional outcome of elderly amputees.
Design:
Prospective, inception cohort study; comparisons with reference populations.
Setting:
Main hospitals, rehabilitation centers, nursing homes, patients' own residence settings in 1 of the 3 northern provinces in the Netherlands.
Participants:
Forty-six patients older than 60 years, with unilateral transtibial or transfemoral amputation or knee disarticulation because of vascular disease.
Interventions:
Measurement of physical, mental, and social predictors 2 and 6 weeks postamputation.
Main Outcome Measures:
The Sickness Impact Profile (SIP-68), Groningen Activity Restriction Scale (GARS), Timed up and go (TUG) test, and prosthetic use.
Results:
A total of 15% of amputees died within the first year after amputation. Seventy percent lived independently at home 1 year postamputation. The functional level of the patients was low, as shown by high scores on the SIP-68 (mean, 23.6), GARS (mean, 41.2), and TUG test (mean, 23.9s). Functionally effective prosthetic use, as measured with the classification of Narang and Pohjolainen, was reached by 49%. For the SIP-68 scores, age, comorbidity, 1-leg balance, and the 15-word test predicted functional outcome in 69% of amputees. For the GARS score, age, 1-leg balance, and the 15-word test predicted functional outcome in 64%. For the TUG test, age and 1-leg balance predicted functional outcome in 42% of amputees. After correction for age, the only significant predictor for prosthetic use was 1-leg balance.
Conclusions:
Elderly patients with a leg amputation had a low functional level 1-year postamputation. An important part of functional outcome could be predicted 2 weeks after amputation by age at amputation, 1-leg balance on the unaffected limb, and cognitive impairment. Severe comorbidity probably also played a role. The results may be used in the general policy concerning leg amputees.
