Abstract
Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. Mobility changes in
individuals with dysvascular amputation from the presurgical period to 12 months postamputation.
Objectives
To describe changes in ambulation among individuals with lower-extremity amputation
secondary to peripheral artery disease and/or diabetes prior to surgery through 12
months after surgery. To compare differences in ambulation by amputation level and
to examine risk factors for change in ambulation over time.
Design
Prospective cohort study.
Setting
Two Veterans Affairs medical centers, 1 university hospital, and a level I trauma
center.
Participants
Patients with peripheral artery disease or diabetes (N=239) undergoing a first unilateral
major amputation were screened for participation between September 2005 and December
2008. Among these, 57% (n=136) met study criteria, and of these, 64% (n=87) participated.
Interventions
Standard of care at each facility.
Main Outcome Measures
Ambulatory function measured using the Locomotor Capability Index-5.
Results
Seventy-five of the 87 (86%) subjects enrolled finished their 12-month follow-up interview.
Ambulatory mobility declined during the period immediately prior to surgery (premorbid)
and remained low at 6 weeks postsurgery. On average, ambulation improved after surgery
but did not return to premorbid levels. In the final multivariate model, age and history
of lower-extremity arterial reconstruction were significantly associated with a poorer
ambulatory trajectory over time, while other factors, such as amputation level, prior
alcohol use, and length of disability prior to amputation, were not.
Conclusions
The findings highlight the importance of considering premorbid ambulatory function.
Informing providers and patients about the trajectory and time course of changes in
ambulation can enhance patient education, patient expectations, and treatment planning.
Key Words
List of Abbreviations:
ANCOVA (analysis of covariance), LCI-5 (Locomotor Capability Index (5 responses)), LEA (lower-extremity amputation), PAD (peripheral artery disease), TF (transfemoral), TM (transmetatarsal), TT (transtibial)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 26, 2012
Footnotes
Supported by the US Department of Veterans Affairs, Office of Research and Development, Rehabilitation Research and Development (Merit Review A41241 and Career Development Award B4927W).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on May 25, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
