PROGNOSTIC INDICATORS FOR SUCCESSFUL PROSTHETIC REHABILITATION IN OLDER UNILATERAL TRANSFEMORAL AMPUTEES
Jane Cumming 1, 2, Keith Rome 3, Vicki Whittaker 2
1 The James Cook University Hospital, Middlesbrough, England; 2 The University of Teesside, Middlesbrough, England. 3 The University of Auckland, New Zealand
The aim was to develop profiles of older (60 +) transfemoral prosthetic limb users to inform prosthetic provision. Older unilateral transfemoral amputees (OTFAs) do not achieve a high level of prosthetic mobility or function (Cumming, et al 2006). However, success rates published are very variable. OTFAs (n=206) referred to the Prosthetic Centre between 2000 and 2005 were included in this mixed history retrospective cohort study. Relationships between clinical, social and demographic variables and outcomes including level of mobility and use of prosthesis were explored. The primary measure of success was based on mobility outcomes and usage at 6 months. Data was abstracted from case notes. Analysis (SPSS) was mainly descriptive and comparative. Regression analysis was applied. 53/206 were relatively successful in independent mobility. Many (n=38) stopped limb wearing by 6 months; significant variables (p<0.05) were particular co-morbidities; >8 medications, low pre-amputation mobility, low Barthel index (<12), delayed casting and dysvascular aetiology. Full time limb wearing at 6 months correlated to fewer co morbidities, higher previous mobility. Mobility and use of prosthesis in OTFAs is generally poor and very few achieve useful ambulation. The author was able to formulate prognostic indicators for likely success applicable to assessment and practice. OTFAs have a low success rate in useful walking ability. Good pre-amputation mobility, fewer co-morbidities, low dependence and recovery of independence post amputation are major positive indicators. Alternative modes of mobility such as powered chairs may offer greater independence and re-integration into community life.
Support
Health Foundation Award: Leading practice through research
References
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