Cardiopulmonary, neuropsychiatric comorbidities tied to lower limb amputations


Megan Sions

J. Megan Sions

LAS VEGAS — Cardiopulmonary and neuropsychiatric comorbidities should be considered in interpreting outcome measures in patients with lower limb amputations, according to research presented at the American Orthotic & Prosthetic Association World Congress.

J. Megan Sions, PhD, DPT, PT, assistant professor in physical therapy and an orthopedic certified specialist at the University of Delaware and director of the Delaware Limb Loss Studies, and colleagues sought to determine the relationships between body system comorbidities and physical performance and activity among 50 adults with lower limb amputations.

“In terms of research gap, when we looked at adults with lower limb loss, there has been little research exploring comorbidities that impact performance-based function as well as physical activity,” Sions said.

Inclusion criteria included prosthetic use for at least 8 hours per day and use inside and outside the home. A cumulative illness rating scale and performance based activity tests, including a 10-meter walk test and amputee mobility predictor, were conducted. The researchers studied cardiovascular respiratory, musculoskeletal-integumentary and neuropsychiatric subscales. The most common initial amputation causes were infection and trauma. Results were available for 47 patients, with a mean age of 58.5 years.

The patients had a mean average daily step count of 5,491.7 steps, which was at an upper end of what is typically seen in patients with unilateral limb loss, Sions said. The researchers found statistical significance in the neuropsychiatric comorbidity index. They also reported a correlation between gait speed and worse cardiopulmonary comorbidity.

“Our cross-sectional study results are the first to link concurrent neuropsychiatric comorbidity to less daily physical activity,” Sions said.

The researchers reported that a study limitation was its cross-sectional nature and the study was primarily limited to unilateral transitbiial amputees who were longer term prosthetic users.

“Consider these cardiopulmonary and neuropsychiatric comorbidities when you’re interpreting outcome measures obtained in patients with a lower limb loss,” Sions said. “Don’t forget to conclude this as part of your physical exam.” – by Bruce Thiel



Sions, JM. Comorbidities, physical function and daily step counts among adults with unilateral transtibial amputation who are using a prosthetic. Presented at: American Orthotic & Prosthetic Association World Congress; Sept. 6-9, 2017; Las Vegas.


Disclosure: Sions reports grant or research support from The Orthotic and Prosthetic Education and Research Foundation Inc., NIH: 1R03HD088668-01A1, Independence Prosthetics-Orthotics Inc. and Postdoctoral Researchers Fund: Post-Amputation Clinical Care and Outcomes; and she is a consultant for Independence Prosthetics-Orthotics Inc.

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