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Vol. 22. Num. 3.01 May 2018
Pages 175-254
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Vol. 22. Num. 3.01 May 2018
Pages 175-254
Original Research
DOI: 10.1016/j.bjpt.2017.08.002
Predicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study
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Inés Fajardo-Martosa, Olga Rodab, Ramón Zambudio-Periagoa, Aurora Bueno-Cavanillasc, Fidel Hita-Contrerasd,
Corresponding author
fhita@ujaen.es

Corresponding author at: Department of Health Science, Faculty of Health Sciences, University of Jaén, E-23071 Jaén, Spain.
, Indalecio Sánchez-Montesinosb
a Service of Physical Medicine and Rehabilitation, Prosthetics and Orthotics Unit, University Hospital Virgen de las Nieves, Granada, Spain
b Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain
c Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Granada, Granada, Spain
d Department of Health Sciences, Human Anatomy and Embryology, Faculty of Health Sciences, University of Jaén, Jaén, Spain
Highlights

  • Walking ability with a prosthetic limb is basic for major lower-limb amputees.

  • Walking capacity is indicative of successful prosthetic rehabilitation.

  • Male gender is an independent predictor of failure regardless of walking aid.

  • Transtibial amputation is independently related to success irrespective of aid.

  • Older age and multimorbidity can predict failure if walking aid is considered.

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Tables (5)
Table 1. Analysis of comorbidity and lower-limb characteristics according to cause of amputation.
Table 2. Characteristics of the population under study regarding successful prosthetic use as assessed through their ability to walk regardless of the use of assistive devices after the rehabilitation program.
Table 3. Logistic regression model predicting successful or failed prosthetic rehabilitation regarding criterion 1.a
Table 4. Characteristics of the population under study regarding successful prosthetic use after the rehabilitation program.
Table 5. Logistic regression model predicting successful or failed prosthetic rehabilitation regarding criterion 2.a
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Abstract
Objective

To determine and compare specific factors that could be associated and predictive with successful prosthetic rehabilitation in major lower-limb amputations.

Methods

A 15-year long (2000–2014) retrospective observational cohort study was conducted. Two different criteria were used to define successful prosthetic rehabilitation: (1) the ability to walk at least 45m, regardless of assistive devices; and (2) walking >45m without other ambulatory aids than one cane (if required). Age, gender, comorbidities, cause and level of amputation, stump characteristics, ulcers in the preserved limb, and time between surgery and physical therapy were examined as predictors of successful prosthetic rehabilitation.

Results

A total of 169 patients (61.60±15.9 years) were included. Regarding walking ability with or without walking aids, the presence of ulcers in the preserved limb was individually associated with failed prosthetic rehabilitation (p<0.001), while being male (OR=0.21; 95%CI=0.06–0.80) and transtibial level of amputation (OR=6.73; 95%CI=1.92–23.64) were identified as independent predictors of failure and success, respectively. Regarding the criterion of successful rehabilitation, a shorter time until rehabilitation was individually associated with improved walking ability (p<0.013), while failure could be predicted by comorbidities (OR=0.48; 95%CI=0.29–0.78) and age groups of 65–75 years old (OR=0.19; 95%CI=0.05–0.78) and over 75 years old (OR=0.19; 95%CI=0.04–0.91).

Conclusions

Regarding walking ability with or without walking aids, male gender and transtibial level of amputation are independently associated with failure and success respectively, whereas older age and comorbidities can predict failed prosthetic rehabilitation when assistive walking devices are considered. Future prospective cohort studies are needed to confirm these findings.

Keywords:
Successful rehabilitation
Predictive
Walking ability
Lower-limb
Amputees

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