Article

BACKGROUND: It is recognized that multifactorial assessments are needed to
evaluate balance and locomotor function in people with lower limb amputation.
There is no consensus on whether a single screening tool could be used to
identify future issues with locomotion or prosthetic use. OBJECTIVE: The purpose
of this study was to determine whether different tests of locomotor performance
during rehabilitation were associated with significantly greater risk of
prosthetic abandonment at 12 months postdischarge.
DESIGN: This was a
retrospective cohort study. METHOD: Data for descriptive variables and locomotor
tests (ie, 10-Meter Walk Test [10MWT], Timed "Up & Go" Test [TUGT], Six-Minute
Walk Test [6MWT], and Four Square Step Test [FSST]) were abstracted from the
medical records of 201 consecutive participants with lower limb amputation.
Participants were interviewed and classified as prosthetic users or nonusers at
12 months postdischarge. The Mann-Whitney U test was used to analyze whether
there were differences in locomotor performance. Receiver operating
characteristic curves were generated to determine performance thresholds, and
relative risk (RR) was calculated for nonuse. RESULTS: At 12 months
postdischarge, 18% (n=36) of the participants had become prosthetic nonusers.
Performance thresholds, area under the curve (AUC), and RR of nonuse (95%
confidence intervals [CI]) were: for the 10MWT, if walking speed was </=0.44
ms(-1) (AUC=0.743), RR of nonuse=2.76 (95% CI=1.83, 3.79; P<.0001); for the TUGT,
if time was >/=21.4 seconds (AUC=0.796), RR of nonuse=3.17 (95% CI=2.17, 4.14;
P<.0001); for the 6MWT, if distance was </=191 m (AUC=0.788), RR of nonuse=2.84,
(95% CI=2.05, 3.48; P<.0001); and for the FSST, if time was >/=36.6 seconds
(AUC=0.762), RR of nonuse=2.76 (95% CI=1.99, 3.39; P<.0001). LIMITATIONS: Missing
data, potential recall bias, and assessment times that varied were limitations of
the study. CONCLUSIONS: Locomotor performance during rehabilitation may predict
future risk of prosthetic nonuse. It may be implied that the 10MWT has the
greatest clinical utility as a single screening tool for prosthetic nonuse, given
the highest proportion of participants were able to perform this test early in
rehabilitation. However, as locomotor skills improve, other tests (in particular,
the 6MWT) have specific clinical utility. To fully enable implementation of these
locomotor criteria for prosthetic nonuse into clinical practice, validation is
warranted.
CI - (c) 2016 American Physical Therapy Association.

Langue : ANGLAIS