ORIGINAL RESEARCH| Volume 103, ISSUE 9, P1723-1729, September 2022

Postamputation Cognitive Impairment Is Related to Worse Perceived Physical Function Among Middle-Aged and Older Prosthesis Users

  • Matthew J. Miller
    Corresponding author Matthew J. Miller, PT, DPT, PhD, 1500 Owens St, Suite 400, San Francisco, CA 94158-2332.
    Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California

    Division of Geriatrics, University of California, San Francisco, San Francisco, California
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  • Rashelle M. Hoffman
    Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado

    VA Eastern Colorado Geriatric Research, Education, and Clinical Center, university of colorado. Aurora, Colorado
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  • Laura A. Swink
    Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado

    VA Eastern Colorado Geriatric Research, Education, and Clinical Center, university of colorado. Aurora, Colorado
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  • Deborah E. Barnes
    San Francisco VA Health Care System, San Francisco, California

    Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California

    Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States
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  • Cory L. Christiansen
    Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado

    VA Eastern Colorado Geriatric Research, Education, and Clinical Center, university of colorado. Aurora, Colorado
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Published:February 02, 2022DOI:


      • Nearly 25% of middle-aged and older prosthesis users may have cognitive impairment.
      • Even after adjustment, cognitive impairment is related to worse physical function.
      • Ongoing cognitive screening of middle-aged and older prosthesis users is warranted.



      To compare characteristics between middle-aged and older prosthesis users with and without cognitive impairment and determine whether cognitive impairment contributes to variability in perceived physical function.


      Cross-sectional, observational study


      General community.


      Adults 45 years or older, at least 1-year post lower limb amputation (LLA) who were walking independently with a prosthesis (N=119).


      Not applicable.

      Main Outcome Measures

      We identified cognitive impairment using an education-adjusted Telephone Interview for Cognitive Status-modified score. Perceived physical function was measured using the Prosthesis Mobility Questionnaire.


      Of 119 participants (mean age, 62.6±8.2 years; male: 89.1%; vascular etiology: 82.4%; years since amputation: 4.9±4.7 years), 28 (23.5%) had cognitive impairment. Compared with participants without cognitive impairment, those with cognitive impairment were more likely to use an assistive device (60.7% vs 25.3%, P=.002); were older (66.3±7.3 vs 61.5±8.1 years, P=.006) and had more chronic conditions (7.1±3.4 vs 5.4±2.5, P=.004), more depressive symptoms (6.6±5.1 vs 4.2±3.8, P=.008), and worse perceived physical function (2.0±0.6 vs 2.6±0.7, P<.001). Using backward stepwise linear regression, we found that participants with cognitive impairment had worse perceived physical function (standardized parameter estimate [β]=−0.15, P=.02), even after adjusting for depressive symptoms (β=−0.31, P<.001), prosthesis satisfaction (β=0.34, P<.001), number of chronic conditions (β=−0.19, P=.006), and assistive device use (βcane=0.01, P=.93; βother=−0.20, P=.003). Together, these variables explained 59% of perceived physical function variability.


      Cognitive impairment is common and associated with worse perceived physical function post LLA, even after controlling for physical and mental health differences. Tailored rehabilitation interventions may be needed to improve perceived physical function in prosthesis users with cognitive impairment.


      List of abbreviations:

      BMI (body mass index), FCI (Functional Comorbidity Index), HADS (Hospital Anxiety and Depression Scale), LLA (lower limb amputation), PMQ (Prosthesis Mobility Questionnaire), TICS-m (Telephone Interview for Cognitive Status-modified)
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