Predicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study

Abstract

ObjectiveTo determine and compare specific factors that could be associated and predictive with successful prosthetic rehabilitation in major lower-limb amputations. MethodsA 15-year long (2000–2014) retrospective observational cohort study was conducted. Two different criteria were used to define successful prosthetic rehabilitation: (1) the ability to walk at least 45m, regardless of assistive devices; and (2) walking >45m without other ambulatory aids than one cane (if required). Age, gender, comorbidities, cause and level of amputation, stump characteristics, ulcers in the preserved limb, and time between surgery and physical therapy were examined as predictors of successful prosthetic rehabilitation. ResultsA total of 169 patients (61.60±15.9 years) were included. Regarding walking ability with or without walking aids, the presence of ulcers in the preserved limb was individually associated with failed prosthetic rehabilitation (p<0.001), while being male (OR=0.21; 95%CI=0.06–0.80) and transtibial level of amputation (OR=6.73; 95%CI=1.92–23.64) were identified as independent predictors of failure and success, respectively. Regarding the criterion of successful rehabilitation, a shorter time until rehabilitation was individually associated with improved walking ability (p<0.013), while failure could be predicted by comorbidities (OR=0.48; 95%CI=0.29–0.78) and age groups of 65–75 years old (OR=0.19; 95%CI=0.05–0.78) and over 75 years old (OR=0.19; 95%CI=0.04–0.91). ConclusionsRegarding walking ability with or without walking aids, male gender and transtibial level of amputation are independently associated with failure and success respectively, whereas older age and comorbidities can predict failed prosthetic rehabilitation when assistive walking devices are considered. Future prospective cohort studies are needed to confirm these findings.