Introduction: Mobility tests are increasingly used in prosthetic rehabilitation to evaluate patient outcomes. Knowledge of the space, equipment, and time resources available to clinicians who work in different settings can guide recommendations for which tests are most clinically feasible and promote coordination of mobility testing among members of the rehabilitation team. The primary aim of this study was to characterize the different resources available to clinicians for measuring mobility of people with lower-limb amputation. A secondary aim was to identify performance tasks that clinicians use to evaluate prosthetic mobility.
Materials and Methods: Semistructured interviews were conducted with prosthetists, physical therapists, and physiatrists who treat people with lower-limb amputation. Researchers used convenience and snowball sampling to identify participants. Interviews included questions about the resources available for conducting mobility tests, as well as questions about which tasks clinicians deemed valuable to assessing mobility of patients with lower-limb amputation. Interviews were audio recorded and transcribed. Summary and frequency statistics were calculated for quantitative data; explanatory comments were summarized.
Results: Interviews were conducted with 25 clinicians (eight prosthetists, nine physical therapists, and eight physiatrists). Participants had access to multiple spaces and basic measurement equipment. The maximum time participants were willing to spend on performance tests varied. Physiatrists reported less time available (median, 10 minutes; range, 5–30 minutes) than prosthetists and physical therapists (median, 30 minutes; range, 5–60 minutes for both professions). Mobility tasks commonly used to evaluate patients with lower-limb amputation included sit-to-stand, standing balance, walking, and varying speed. Participant comments suggested that mobility tests need to be quick, simple, and add value; existing mobility tests are beneficial but challenging to incorporate into practice; mobility tests should reflect real-world activities; and technological advancements could improve mobility testing.
Conclusions: Clinicians generally had small-to-medium spaces, basic measurement equipment, and sufficient training to administer mobility tests in their clinics. A limiting factor was time, which can be addressed through selection of efficient measures and collaboration within the rehabilitation team. (J Prosthet Orthot. 2022;34:69–78)
Rehabilitation clinicians often perform physical evaluations of mobility to assess patient status, guide the rehabilitation care plan, and inform details of the prosthetic prescription. For people with lower-limb amputation, mobility with a prosthesis is a primary determinant of key outcomes, including functional independence, community reintegration, employment, and quality of life. Mobility is also a criterion by which third-party payers determine individuals' eligibility for prosthetic components and physical therapy. Although a patient's mobility classification can be based on observational clinical evaluation, some payers require justification of this determination using validated outcome measures. Further, standardized mobility assessment facilitates prescription of prosthetic or therapeutic intervention, evaluation of patient progress, communication between care providers, and documentation of intervention effectiveness. Therefore, use of standardized outcome measures to assess and document mobility in people with lower-limb amputation is increasingly critical to the provision of rehabilitation care.
Clinical assessments used to evaluate patients' mobility include both patient-reported and performance-based outcome measures. Patient-reported outcome measures are surveys or questionnaires intended to evaluate health from the patient's perspective. Performance-based outcome measures are tests of patient ability, typically administered and scored by a trained clinician or researcher. Performance-based tests require a patient to perform one or more tasks, such as walking a short distance or standing up from a chair. Both patient-reported surveys and performance-based tests provide distinct, valuable, and complementary information about patients' health. Despite the recognized importance of outcomes measurement to prosthetic care, only 38% of prosthetists and 48% of physical therapists previously reported routine use of standardized outcome measures in clinical practice. Rehabilitation professionals describe a number of barriers to outcomes measurement, including lack of time and training. Further, some clinicians may not perceive the value of using standardized outcome measures for patient evaluation, which leads to prioritization of other activities.
In addition to these recognized barriers, many performance-based tests of mobility have spatial, equipment, and organizational requirements. Spatial requirements for measurement include environmental resources, such as large, open spaces, or long corridors. Equipment requirements for measurement include physical resources, such as stairs, chairs, stopwatches, and tape measures. Organizational requirements for measurement include the administrative support and culture of the clinic. Although some rehabilitation clinics are designed to accommodate performance-based outcomes measurement, others may be limited by small spaces, insufficient equipment, and a lack of organizational support.
Knowledge of resources available to clinicians who work in different types of rehabilitation settings will help organizations to identify standardized performance-based mobility tests that can be administered in most clinical environments. Such knowledge may also help to inform space and design decisions for new rehabilitation clinics that wish to include performance-based mobility testing as part of routine care. Lastly, information about resource constraints in clinics and perceived value of performance tasks could facilitate design of new performance-based tests for lower-limb prosthesis users. Therefore, the aim of this study was to collect descriptive information about the space, equipment, and time available to clinicians who regularly work with people who have lower-limb amputation. Information about the perceived clinical value of tasks and measures was also collected to identify outcomes that clinicians believe provide meaningful information about a patient's mobility.