Trends and outcomes of non-traumatic major lower extremity amputations in an Irish tertiary referral hospital.

OBJECTIVES: Data on vascular patients following amputation in Ireland is lacking, limiting capability to plan services. This paper seeks to benchmark survival and rehabilitation outcomes among vascular patients in Ireland following lower extremity amputation (LEA), and compare subgroups of those undergoing transfemoral (TFA) or transtibial amputation (TTA). METHODS: A review was conducted of all patients who underwent non-traumatic TFA or TTA from 2000 to 2009 in a tertiary vascular surgery centre. Demographics, surgical data, perioperative outcomes, medium-term functional outcomes, and survival were assessed. RESULTS: One hundred and seventy-two patients (2:1 male: female) underwent 192 non-traumatic LEAs. Median age for TFA was 75 years and TTA 67 (p = 0.002). A percentage of 36.5% had undergone prior attempts at surgical revascularization, 25% had undergone prior distal amputation or debridement. Thirty-three (17%) required stump revision. Twenty-three (13.2%) died in hospital. Median survival for those who died in hospital was 17 days (0-367), versus 17 months (2-106) for those who survived to discharge. CONCLUSION: LEA for vascular pathology has significant morbidity and mortality, with long in-patient stays and short median survival; there is need to focus on improving quality of life in postoperative pathways.

The mobility scale for lower limb amputees: the SIGAM/WAP mobility scale.

PURPOSE: To translate the SIGAM mobility scale into the Dutch language and to test and validate its properties in everyday practice. METHOD: The SIGAM mobility scale as published by Ryall et al. was translated into the Dutch language with the local used verbs for prosthetic use. The translated Dutch text was reviewed by several authors and a panel of professionals. The retranslation by a native speaker was reviewed by the original author who suggested modifications. The Dutch trial version of the mobility scale was presented to a panel of prosthetic users and therapists who advised slight modifications for better understanding of the questionnaire. IN training sessions prosthetic teams across The Netherlands were trained in the use of the translated SIGAM/WAP mobility scale. RESULTS: During the translation there were problems with slang words and the use of specific words in the care of amputee patients. The instruction of team members and the test scoring of the questionnaire and the algorithm showed no difficulties. There was good to perfect agreement between scores in case training sessions with perfect inter observer reliability. CONCLUSIONS: With this instrument we have a specific measurement tool in the English and Dutch language to measure mobility in lower limb amputees.

Prevalence and patterns of back pain and residual limb pain in lower limb amputees at the National Rehabilitation Hospital.

AIMS: To examine the prevalence and impact of back pain (BP) and residual limb pain (RLP) in ambulatory lower limb amputees (LLAs). METHODS: Patients completed questionnaires regarding demographics, their amputation, occurrence of BP and RLP. Visual analogue scales assessed pain severity and effect on activities of daily living (ADLs), recreational, family and social life (RFS), and ability to work. Descriptive statistics were compiled and relationships between pain and details of amputation were examined. RESULTS: A total of 107 patients (88 males, 19 females) participated; mean age 51.1 years. Fifty-one patients (47.7%) suffered BP, mean intensity 5.3, mean interference with ADLs, RFS, ability to work 3.5, 3.8, 3.4, respectively. Sixty (56.1%) suffer from RLP, mean intensity 5.7; mean interference with ADLs, RFS, ability to work 2.9, 2.8, 3.9, respectively. BP intensity increased with age; RLP intensity was greatest among vasculopaths. CONCLUSIONS: Irish LLAs maintain functional capacity despite suffering moderate intensity BP and RLP.

The SIGAM mobility grades: a new population-specific measure for lower limb amputees.

PURPOSE: To develop a valid measure of lower limb amputee mobility suitable for routine clinical use, including monitoring change. METHODS: The Special Interest Group in Amputee Medicine (SIGAM) described a single-item scale comprising six clinical grades (A-F) of amputee mobility. A self-report questionnaire was developed and algorithm designed to facilitate grade assignment. Reproducibility of the questionnaire and grades were assessed in 62 amputees. Concurrent validity and sensitivity to change were investigated using the timed walking test (TWT). The mobility construct was examined in 200 amputees, using item response theory, by co-calibration with the Rivermead Mobility Index (RMI) on the same patients. RESULTS: Patients included 144 males and 66 females, aged 13-90. Intraclass correlation coefficients and reproducibility kappa values were satisfactory. Observers agreed 100% in using the algorithm. TWT improved as SIGAM grade increased. Examination of psychometric properties revealed the SIGAM item fitted within the RMI mobility matrix. Average measures for the six grades were ordered correctly. There was no local dependency or differential item functioning for clinically relevant patient subgroups. The SIGAM scale showed an effect size of 10.66. CONCLUSIONS: The SIGAM mobility grades represent a novel, valid, clinically useful measure of amputee mobility which is also sensitive to change.

Is the Rivermead Mobility Index appropriate to measure mobility in lower limb amputees?

PURPOSE: Measurement of lower limb amputee mobility was investigated using the Rivermead Mobility Index (RMI). METHOD: Reliability and reproducibility were assessed in 62 patients. The timed waking test (TWT) was used to investigate concurrent validity. The RMI construct was examined in 200 established amputees. RESULTS: One hundred and forty-four males and 66 females, aged 13-90 were recruited. Intraclass correlation coefficients and kappa statistics showed good reproducibility. Spearman correlation coefficient between the RMI and TWT -0.58 (p<0.000). Psychometric properties of the RMI were tested using item response theory. Hierachical differences in RMI grades were identified in amputees compared with neurologically impaired patients for which the RMI was developed. The RMI construct was not unidimensional, with redundancy of items and local dependency. At the upper end of the scale there were insufficient items measuring high levels of mobility. Finally, differential item functioning showed items behaving differently for patient subgroups. CONCLUSIONS: Although initial impressions suggest the RMI is a useful measure of lower limb amputee mobility, further analysis shows it is not appropriate for all amputees, with a number of limitations of its psychometric properties. Its use is not recommended in this population.