Abstract
Objective
Summarize the psychometric properties of functional, ambulatory, and quality of life
instruments among adult lower limb amputees, highlighting evidence deemed generalizable
to the United States Medicare population.
Data Sources
Six databases and existing systematic reviews through October 30, 2017. Searches included
terms for lower limb amputation or prostheses and outcome measures in humans, without
language restriction.
Study Selection
We included peer-reviewed studies of at least 20 adults (≥18 years) with lower limb
amputation. Eligible studies reported on psychometric properties of functional, ambulatory,
or quality of life instruments. Fifty-three of 425 retrieved articles (12%) met criteria.
Data Extraction
Study characteristics and psychometric property data (validity, reliability, responsiveness,
minimum detectable change, minimal important difference, or floor or ceiling effect)
were extracted into a customized form based on standardized criteria. All extracted
data were confirmed by 2 experts in systematic review and rehabilitation outcome measurement.
Instruments were categorized regarding having been validated and found reliable. Other
reported psychometric properties were recorded. Studies were also assessed for applicability
to the Medicare population based on age and amputation etiology (dysvascular).
Data Synthesis
Fifty-six studies (in 53 articles) reported psychometric properties of 50 instruments.
There is evidence for both validity and reliability for 30 instruments, 17 of which
have evidence that was deemed generalizable to the Medicare population. Most of the
remaining instruments have evidence of either validity or reliability, but not both.
Twelve instruments have been assessed specifically among lower limb amputees prior
to prosthesis prescription. Thirteen instruments have been assessed regarding their
predictive properties for future outcomes.
Conclusions
Numerous instruments assessing ambulation, function, quality of life, and other patient-centered
outcomes have evidence of validity and reliability for adults with lower limb amputations.
Researchers and clinicians should use validated, reliable instruments when feasible.
Many existing and new instruments require validation for use with lower limb amputees.
Keywords
List of abbreviations:
2MWT (2-minute walk test), AHRQ (Agency for Healthcare Research and Quality), AMPnoPRO (Amputee Mobility Predictor without use of a prosthesis), AMPSIMM (Amputee Single Item Mobility Measure), CMS (Centers for Medicare & Medicaid Services), FAC (Functional Ambulation Categories), FAI (Frenchay Activities Index), FSST (Four Square Step Test), K-level (Medicare Functional Classification Level), LCI (Locomotor Capabilities Index), LCI-4 (LCI with a 4-point ordinal scale), LCI-5 (LCI with a 5-point ordinal scale), LEMOCOT (Lower-Extremity Motor Coordination Test), LLP (lower limb prosthesis), OMT (outcome measurement technique), OPCS (Office of Population Censuses and Surveys Scale), SF (Short Form Health Survey), SF-12 (SF 12 items), TUG (timed Up and Go Test)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 12, 2019
Footnotes
Supported by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract no. 290-20-1500002 I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Agency for Healthcare Research and Quality. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.
Clinical Trial Registration No.: CRD42017058488
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
