Original article| Volume 93, ISSUE 10, P1766-1773, October 2012

Mobility Changes in Individuals With Dysvascular Amputation From the Presurgical Period to 12 Months Postamputation

Published:April 26, 2012DOI:


      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.


      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.


      Prospective cohort study.


      Two Veterans Affairs medical centers, 1 university hospital, and a level I trauma center.


      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.


      Standard of care at each facility.

      Main Outcome Measures

      Ambulatory function measured using the Locomotor Capability Index-5.


      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.


      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)
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        • Cruz C.P.
        • Eidt J.F.
        • Capps C.
        • Kirtley L.
        • Moursi M.M.
        Major lower extremity amputations at a Veterans Affairs hospital.
        Am J Surg. 2003; 186: 449-454
        • van Velzen J.M.
        • van Bennekom C.A.
        • Polomski W.
        • Slootman J.R.
        • van der Woude L.H.
        • Houdijk H.
        Physical capacity and walking ability after lower limb amputation: a systematic review.
        Clin Rehabil. 2006; 20: 999-1016
        • Taylor S.M.
        • Kalbaugh C.A.
        • Blackhurst D.W.
        • et al.
        Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients.
        J Vasc Surg. 2005; 42: 227-235
        • Johnson V.J.
        • Kondziela S.
        • Gottschalk F.
        Pre and post-amputation mobility of trans-tibial amputees: correlation to medical problems, age and mortality.
        Prosthet Orthot Int. 1995; 19: 159-164
        • Schoppen T.
        • Boonstra A.
        • Groothoff J.W.
        • de Vries J.
        • Goeken L.N.
        • Eisma W.H.
        Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees.
        Arch Phys Med Rehabil. 2003; 84: 803-811
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Bradley K.A.
        • Bush K.R.
        • Epler A.J.
        • et al.
        Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population.
        Arch Intern Med. 2003; 163: 821-829
        • Bradley K.A.
        • DeBenedetti A.F.
        • Volk R.J.
        • Williams E.C.
        • Frank D.
        • Kivlahan D.R.
        AUDIT-C as a brief screen for alcohol misuse in primary care.
        Alcohol Clin Exp Res. 2007; 31: 1208-1217
        • Bush K.
        • Kivlahan D.R.
        • McDonell M.B.
        • Fihn S.D.
        • Bradley K.A.
        The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking.
        Arch Intern Med. 1998; 158: 1789-1795
        • Brunelli S.
        • Averna T.
        • Porcacchia P.
        • Paolucci S.
        • Di Meo F.
        • Traballesi M.
        Functional status and factors influencing the rehabilitation outcome of people affected by above-knee amputation and hemiparesis.
        Arch Phys Med Rehabil. 2006; 87: 995-1000
        • Franchignoni F.
        • Giordano A.
        • Ferriero G.
        • Orlandini D.
        • Amoresano A.
        • Perucca L.
        Measuring mobility in people with lower limb amputation: Rasch analysis of the mobility section of the prosthesis evaluation questionnaire.
        J Rehabil Med. 2007; 39: 138-144
        • Fulton J.
        • Wertheim D.
        • Hanspal R.
        • Geake T.
        Graphical representation of the five point Locomotor Capability Index.
        Prosthet Orthot Int. 2009; 33: 295-298
        • Geake T.
        • Hanspal R.
        • Wertheim D.
        • Fulton J.
        The Locomotor Capability Index in diagram form: the Stanmore-Kingston Splat.
        Prosthet Orthot Int. 2006; 30: 300-304
        • Larsson B.
        • Johannesson A.
        • Andersson I.H.
        • Atroshi I.
        The Locomotor Capabilities Index: validity and reliability of the Swedish version in adults with lower limb amputation.
        Health Qual Life Outcomes. 2009; 7: 44
        • Salavati M.
        • Mazaheri M.
        • Khosrozadeh F.
        • Mousavi S.M.
        • Negahban H.
        • Shojaei H.
        The Persian version of Locomotor Capabilities Index: translation, reliability and validity in individuals with lower limb amputation.
        Qual Life Res. 2010; 3: 3
        • Traballesi M.
        • Porcacchia P.
        • Averna T.
        • et al.
        Prognostic factors in prosthetic rehabilitation of bilateral dysvascular above-knee amputee: is the stump condition an influencing factor?.
        Eura Medicophys. 2007; 43: 1-6
        • Franchignoni F.
        • Orlandini D.
        • Ferriero G.
        • Moscato T.A.
        Reliability, validity, and responsiveness of the Locomotor Capabilities Index in adults with lower-limb amputation undergoing prosthetic training.
        Arch Phys Med Rehabil. 2004; 85: 743-748
        • Ribu L.
        • Hanestad B.R.
        • Moum T.
        • Birkeland K.
        • Rustoen T.
        A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population.
        Qual Life Res. 2007; 16: 179-189
        • Razmjou H.
        • Yee A.
        • Ford M.
        • Finkelstein J.A.
        Response shift in outcome assessment in patients undergoing total knee arthroplasty.
        J Bone Joint Surg Am. 2006; 88: 2590-2595
        • Balain B.
        • Ennis O.
        • Kanes G.
        • et al.
        Response shift in self-reported functional scores after knee microfracture for full thickness cartilage lesions.
        Osteoarthritis Cartilage. 2009; 17: 1009-1013
        • Johannesson A.
        • Larsson G.U.
        • Oberg T.
        • Atroshi I.
        Comparison of vacuum-formed removable rigid dressing with conventional rigid dressing after transtibial amputation: similar outcome in a randomized controlled trial involving 27 patients.
        Acta Orthop. 2008; 79: 361-369
        • Mizelle C.
        • Rodgers M.
        • Forrester L.
        Bilateral foot center of pressure measures predict hemiparetic gait velocity.
        Gait Posture. 2006; 24: 356-363
        • O'Neill B.F.
        • Evans J.J.
        Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation.
        Disabil Rehabil. 2009; 31: 1083-1091