Study: Non-use of lower-limb prosthesis can be predicted

In a study of people with lower-limb amputations after discharge from rehabilitation, researchers found non-use of the prosthesis can be predicted at 4 months, 8 months and 12 months after discharge.

Researchers audited patient medical records for potential predictor variables. They interviewed 135 retrospective participants at a median 1.9 years after discharge and 66 prospective participants at a mean of 1.3 years after discharge.

The researchers identified variables allowing them to predict the percentage of participants who would stop using their prostheses at three time frames. Amputation level above transtibial level and mobility aid use were common predictors at each stage.

At 4 months post-rehabilitation, an additional 15 patients had stopped using their prostheses. Variables found to be predictive of non-use included amputation level above transtibial level, mobility aid use, dependence walking outdoors on concrete, a very high number of comorbidities and not having a diagnosis of type 2 diabetes. The likelihood of participants experiencing four out of five variables to stop using their prostheses increased from 12% to 86%, according to the researchers.

At 8 months, 20 patients were no longer using their prostheses. The three variables predictive of non-use at this stage included amputation level above transtibial level, mobility aid use and dependence walking outdoors on concrete. The probably of non-use for participants experiencing all three predictors increased from 15% to 86% at this time.

At 12 months, 25 patients had stopped using their prostheses. The three predictive variables of non-use included amputation level above transtibial level, mobility aid use and delay to prosthesis. Delay to prosthesis was caused by wound complications, comorbidities, orthopedic injuries and/or deconditioning. If two out of three predictors were present for participants at 12 months, their likelihood of stopping prosthesis use increased from 17% to 36%, according to the researchers.

“These findings call for development of a model of care that optimizes outcome for these individuals,” the researchers wrote. “Rehabilitation may focus on optimizing transfers, wheelchair mobility, physical fitness and mental wellbeing rather than prosthetic gait.”

For more information: 

Roffman CE. Aust J Physiother. 2014. doi:10.1016/j.jphys.2014.09.003.

Disclosure: The authors have no relevant financial disclosures.

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