Age and pre-amputation mobility affected the likelihood of a transfemoral amputee being fitted for a prosthesis, with older patients being less likely to receive a device, according to results from a patient-based study recently published in the Physical Medicine and Rehabilitation: The Journal of Injury, Function and Rehabilitation.
Kenton R. Kaufman, PhD, PE, research scientist in the Department of Orthopedic Surgery at the Mayo Clinic in Rochester, Minn., and colleagues aimed to identify pre-amputation factors associated with an amputee’s likelihood of receiving a prosthesis after an amputation.
Patient medical records
Kaufman and colleagues retrospectively identified 93 patients with the Rochester Epidemiology Project, from Olmstead County, Minn., who underwent transfemoral amputations between 1987 and 2013.
The Rochester Epidemiology Project was created 50 years ago through the combination of medical records from the Mayo Clinic and Olmstead Medical Center, also in Rochester, Minn.
“We went back 25 years in the database to conduct this study because this is a retrospective study, but it also is a population-based study and O&P care is population-based health care because you are taking care of all the individuals with limb loss,” Kaufman told O&P News. “The amputee is a consumer for life.”
The researchers evaluated patients’ medical records to determine the etiology of amputation, side of limb amputated, whether it was a bilateral amputation, pre-amputation mobility level, pre-amputation living situation and cognitive ability.
The primary outcome was whether the patient was fitted for and received a prosthesis following the amputation. Associations between the pre-amputation factors and receipt of prosthesis were determined with multivariate logistic regressions and a random forest algorithm for classification trees.
Mobility and morbidity
Kaufman and colleagues found the chance of receiving a prosthesis decreased by 54% for every decade increase in age. The odds of getting a prosthesis were 30-times higher for individuals who were able to walk independently before the amputation.
The researchers noted 24 patients were provided with prosthetic fittings after the amputation, within an average of 105 days.
“Not everybody who has an amputation is going to receive a prosthesis,” he said. “So it is important to have a conversation prior to [the] amputation so people are aware they may or may not be getting a prosthesis, and there are factors that contribute to that medical decision.”
According to Kaufman, the following three main factors could affect the likelihood of an amputee receiving a prosthesis: the physician’s decision, difficulty with prosthetic fitting; and insurance denial.
“We do not have information to know which [of the] three reasons [caused them to] not receive a prosthesis,” he said. “All we know is they had an amputation, and they did or did not have a prosthesis. This is where we can dive down on the data a little bit more.”
The two main influences on the physician’s decision to prescribe a prosthesis were mobility and morbidity. According to Kaufman, if patients showed limited mobility prior to the amputation, they were less likely to get a prosthesis after the amputation. In approximately 10% of the study population, researchers observed morbidity as another reason for individuals not receiving a prosthesis.
The researchers suggested further study should focus on improving mobility for elderly adults with transfemoral amputation. Kaufman plans to focus his next study on quantifying the cost of falls in transfemoral amputees.
Kaufman said the study results point to a need for a national registry on prostheses starting at the time of amputation.
“We need to understand what conditions patients might have that would preclude them from receiving a prosthesis or [whether there are] things that we can do to intervene so that we can increase their likelihood of receiving a prosthesis,” he said. – by Monica Jaramillo
Mundell B, et al. PMR. 2015; doi: 10.1016/j.pmrj.2015.11.012.
Disclosure: Kaufman reports the study was partially funded by the American Orthotic and Prosthetic Association.