Highlights
- •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.
Abstract
Objective
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.
Design
Cross-sectional, observational study
Setting
General community.
Participants
Adults 45 years or older, at least 1-year post lower limb amputation (LLA) who were
walking independently with a prosthesis (N=119).
Intervention
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.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 02, 2022
Accepted:
December 24,
2021
Received in revised form:
December 14,
2021
Received:
August 25,
2021
Footnotes
Supported by the National Institutes of Health (5T32 AG000212-27, UL1-TR001082) and the Foundation for Physical Therapy Research (Promotion of Doctoral Studies: Level I and II). This material is the result of work supported with resources and facilities of the VA Eastern Colorado Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.
Disclosures: none
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
