Mobility outcomes for those with primary lower limb amputation attending a regional outpatient prosthetic rehabilitation service

Background: There is an age-related increase in lower limb amputation (LLA) secondary to dysvascular disease, however, the effectiveness of Multi-Disciplinary Team (MDT) is unknown. Purpose: The aims of the study were to investigate if a) individuals with primary lower limb amputation (IPLLAs) attending a regional outpatient prosthetic rehabilitation service achieve successful mobility outcomes, b) to examine the multi-disciplinary team's ability to accurately predict mobility outcome in this cohort and c) to evaluate how pre-amputation mobility levels affect mobility outcomes of IPPLAs attending an outpatient rehabilitation service. Methods: This retrospective observational cohort study included 93 primary, unilateral and bilateral IPPLAs at or proximal to the transtibial level. Pre-rehabilitation (baseline) data was collected between one and six weeks after amputation when clients attended for their pre-rehabilitation MDT Assessment. This data (including Specialist Interest in Amputee Medicine (SIGAM) Score and Pre-Amputation Mobility Status) was gathered to establish their rehabilitation needs. Pre-amputation mobility was characterised as 1) Ambulatory (independent ambulation out of house); 2) Ambulatory/homebound (ambulatory in the home only), 3) Nonambulatory/transfer, 4) Nonambulatory/bedridden. Peri- and post-rehabilitation data (Timed Walking Test (TWT), Locomotor Capabilities Index 5 (LCI-5) and SIGAM Score) was collected at six weeks, six months and twelve months after delivery of prosthesis to the client. Results: Fifty-six percent of participants who completed the 12 month post rehabilitation assessment (n = 68) achieved mobility success. (success was defined as returning to or exceeding baseline mobility scores on the SIGAM for those scoring C-F, and for those who scored A or B at baseline, moving up one category (i.e. going from A to B, or B to C). The pre-rehabilitation SIGAM score was used as a predictor of the IPLLAs expected mobility outcome. There was a highly significant correlation between pre-rehabilitation and 12 month post-rehabilitation SIGAM scores, (r = 0.89, n = 68, p < 0.001) demonstrating that the MDT's predictions significantly correlated to the post-rehabilitation SIGAM scores. There was a highly significant association between pre-amputation mobility levels and mobility success post-rehabilitation at 12 month follow-up (χ² (3) = 26.43, p < 0.001), such that those who were ambulatory independently pre-amputation were significantly more likely to achieve mobility success post-rehabilitation. Conclusion: IPLLAs attending an outpatient rehabilitation service can achieve successful mobility outcomes. The MDT was found to be accurate in its predictions of mobility outcome in this cohort. Greater pre-amputation mobility was significantly associated with successful mobility outcomes.