Predicting Prosthetic Mobility at Discharge From Rehabilitation Following Major Amputation in Vascular Surgery

Area of Science:

• Rehabilitation Medicine
• Prosthetics and Orthotics
• Clinical Decision Support

Background:

• Limb loss due to advanced ischemia or diabetic foot disease (DFD) necessitates effective rehabilitation strategies.
• Estimating the likelihood of prosthetic independence is crucial for patient outcomes and resource allocation.

Purpose of the Study:

• To develop a decision aid for predicting independent prosthetic mobility (IPM) after major amputation.
• To investigate if IPM serves as a surrogate marker for long-term survival in this patient population.

Main Methods:

• Retrospective cohort study of unilateral amputations (2007-2020) due to ischemia or DFD.
• Construction and validation of an IPM prediction model using predictors of functional mobility (e.g., Timed Up and Go, 2-minute walk test).
• Kaplan-Meier and Cox regression analyses to assess survival outcomes.

Main Results:

• Nearly 50% of amputees achieved IPM; predictors of poorer outcomes included advanced age, female sex, higher amputation level, and comorbidities.
• The IPM prediction model demonstrated high discrimination (C-statistic 0.778) and criterion validity.
• Patients achieving IPM had significantly longer median survival (93.7 months) compared to non-IPM patients (56.6 months).

Conclusions:

• An internally validated decision aid for estimating prosthetic independence after major amputation was successfully developed.
• Prosthetic function, indicated by IPM, is a significant surrogate marker for long-term survival.
• Further external validation is recommended to confirm the generalizability of the decision aid in clinical practice.