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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
June 1, 2020
Christopher K Wong et al. (4 authors)
Journal ArticleObservational StudyHuman StudyClinical
Study Details

Study Goal

The researchers aimed to determine how modifiable and non-modifiable factors influence prosthetic functional mobility, using both patient-reported and performance-based measures.

Results Summary

The study found that both modifiable (balance ability, confidence, prosthesis use) and non-modifiable factors (sex, amputation cause, surgical level) explained variance in functional mobility. Performance-based walking was linked to balance and confidence, while patient-reported function was influenced by prosthesis use, walking speed, and comorbidities.

Population

305 volunteers with lower limb loss (69% men, mean age 56 years; 52% vascular amputation causes, 42% above-knee surgical levels, 82% with comorbidities).

Effective Dosage

Not available

Duration

Not specified

Interactions

None mentioned

Extracted Claims (14)
InterventionDirectionEndpointPopulationDosageImpactClaim #
balance ability
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#1
Activities-specific Balance Confidence (ABC)
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#2
Houghton score
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#3
sex
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#4
amputation cause
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#5
surgical level
neutral
2-Minute Walk Test (2MWT)
volunteers with lower limb loss
-
explained the variance
#6
balance ability
neutral
performance-based walking
people with limb loss
-
explained
#7
confidence
neutral
performance-based walking
people with limb loss
-
explained
#8
prosthesis use
neutral
performance-based walking
people with limb loss
-
explained
#9
walking aid use
neutral
performance-based walking
people with limb loss
-
explained
#10
prosthesis use
neutral
patient-reported function
people with limb loss
-
explained
#11
walking aid use
neutral
patient-reported function
people with limb loss
-
explained
#12
walking speed
neutral
patient-reported function
people with limb loss
-
explained
#13
medical comorbidities
neutral
patient-reported function
people with limb loss
-
explained
#14
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 R 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.

Medical Subject Headings (MeSH)
AdultAgedAmputeesArtificial LimbsComorbidityCross-Sectional StudiesDisability EvaluationFemaleGaitHumansLower ExtremityMaleMiddle AgedPatient Reported Outcome MeasuresPostural BalanceRetrospective StudiesSurveys and QuestionnairesWalk TestWalking
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality70/10
Citation Metrics
Total Citations8
Citations/Year1.6
Relative Citation Ratio1.34
NIH Percentile61%
Research Impact Scores
APT Score0.50
Weight Score2.10
Normalized Score0.64
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