A recent retrospective chart review supports the use of the Prosthesis Evaluation Questionnaire–Mobility Subscale score and the Amputee Mobility Predictor in patients with a prosthesis in the assessment of mobility and assignment of K-levels in patients with lower limb loss.
“The purpose behind the study was to learn a little bit about our specific patient population at Ability, but also to delve into the differences between K2 and K3 amputees,” Brian Kaluf, BSE, CP, clinical outcome and research director at Ability Prosthetics and Orthotics Inc., told O&P Business News. “[This study would also] help to support the outcome measure tools that we started to administer, to understand how they can differentiate between different K-levels and to study the difference between patients’ perceived mobility and their functional capability.”
Use of AMP, PEQ-MS
After the adoption of the Amputee Mobility Predictor (AMP) and Prosthesis Evaluation Questionnaire–Mobility Subscale (PEQ-MS) by Ability Prosthetics and Orthotics, Kaluf reviewed 120 patient charts to investigate the effects of amputation level and assigned activity level on patient-perceived potential for mobility and functional ambulatory potential. AMP and PEQ-MS scores were compared between transtibial and transfemoral patients and stratified by K-level.
Overall, there were more K3 patients than any other K-level patients, while transtibial amputation was more frequent among all K-levels then transfemoral amputation in the population studied. Researchers found a significant variation for amputation K-levels in an analysis of variance of AMP and PEQ-MS scores. According to a Fisher protected least significant difference post hoc test, K3 and K4 groups showed significantly higher AMP and PEQ-MS scores compared with the K2 group. However, study results showed no difference in AMP and PEQ-MS scores among transtibial and transfemoral amputation levels.
“We were able to differentiate K2 and K3 and also K2 and K4 activity level groups through patient-reported outcome measures and the functional test,” Kaluf said. “It supports our decision to use these measures to guide our clinical decision making, but it also helps inform the field as well that these outcome measures are relevant to routine clinical practice.”
The fact that AMP and PEQ-MS scores did not differentiate between transfemoral and transtibial amputee groups was at first surprising to Kaluf, he said. However, after reviewing previously published data on other outcome measures, Kaluf found the other results showed no difference between how functional transtibial and transfemoral amputees are.
“As a clinician, I tend to have the perception that the patients who have intact anatomical knees can be more functional and would be more mobile in the community, but the populations we fit and that were included in the study showed no significant difference between patient perceived mobility and how well they did on the AMP test,” Kaluf said.
Benefits of outcome measures
According to Kaluf, this study is just the beginning of research on differences in K-levels in transtibial and transfemoral amputees and future research should include more transfemoral amputees, as well as more lower functioning patients.
With the current results, Kaluf said it will be beneficial to compare different components and technologies to find trends where patients may have a better clinical outcome, allowing practitioners to become more informed and make better decisions for their patients.
“I always say that it is hard to manage what we don’t measure, so for our organization [these results are] going to allow us to continue to record these outcome measures in our documentation and also include them in medical necessity justification and treatment plans,” Kaluf said. “It supports the idea that learning a little bit more about our patients’ functional capabilities and also their perceived mobility can help us pinpoint any community barriers or any weaknesses that need to be focused on to help them get the most positive clinical outcome.” — by Casey Tingle
Disclosure: Kaluf is employed by Ability Prosthetics and Orthotics Inc.