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Mobility Analysis of AmpuTees (MAAT 6): Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users—Results of a Cross-Sectional Analysis JPO033-3B
Journal of Prosthetics and Orthotics: Volume 33, Issue 3
Keyword(s)
JPO033-3B
Objective: The aim of this study was to establish the mobility, satisfaction, and quality of life (QoL) among prosthesis users with dysvascular/diabetic amputation at both acute and long-term phases of prosthetic rehabilitation.
Methods: This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0–3 months [n = 24], 4–6 months [n = 72]) and chronic phases (24–36 months [n = 91], 37–48 months [n = 53], 49–60 months [n = 47], and 60–84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire–Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared.
Results: The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F5,330 = 1.52, P = 0.18), QoL (F5,333 = 0.78, P = 0.57), or PEQ-WB (F5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0–3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009).
Conclusions: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.
Methods: This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0–3 months [n = 24], 4–6 months [n = 72]) and chronic phases (24–36 months [n = 91], 37–48 months [n = 53], 49–60 months [n = 47], and 60–84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire–Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared.
Results: The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F5,330 = 1.52, P = 0.18), QoL (F5,333 = 0.78, P = 0.57), or PEQ-WB (F5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0–3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009).
Conclusions: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.
Credit Information
2.0 Credits (Scientific)
Author(s)
Shane R. Wurdeman, PhD, CP, FAAOP(D); Phillip M. Stevens, MEd, CPO, FAAOP; James H. Campbell, PhD, CO, FAAOP
Description
Irrespective of the cause, amputation brings a dramatic change in the life situation of an individual in almost all aspects of daily living and functioning. Although major lower-limb amputation may result from traumatic injury or acute disease processes such as cancer or septic infection, the most common cause in the United States is vascular disease typically with associated diabetes.
Recent articles on the long-term prognosis of those individuals who undergo major lower-limb amputation due to vascular disease and diabetes have emphasized mortality rates. A recent meta-analysis observed aggregated mortality rates of 47.9%, 61.3%, 70.6%, and 62.6% at 1-, 2-, 3-, and 5-year follow-up, respectively. A separate systematic review among the same target population reported comparable 5-year mortality rates of 52% to 80%. In addition, postamputation surgical revisions, including revisions to more proximal amputations, are frequently indicated.7 Finally, return to ambulation rates are equally concerning with reports varying between 23% and 55% approximately 1 year postamputation. Yet, clinical experience of prosthetists supports the premise that many individuals with amputations of dysvascular etiology continue to ambulate successfully with a prosthesis for many years, an observation subjectively echoed in the vascular literature.