Czerniecki et al evaluate patients undergoing dysvascular lower limb amputations. They identified risk factors affecting mobility 1 year after the amputation. The authors are from the VA Puget Sound Health Care System, University of Washington, Oregon Health and Science University, and Spectrum Research, Inc.
Outcome: mobility 1-year later. Mobility was classified as iBASIC and iADVANCED based on the ability to perform various tasks with or without mobility aid.
(1) iBASIC tasks: get up from chair, walk in the house, walk outside on even ground, go upstairs with handrail, step up from sidewalk curb, step down from sidewalk curb
(2) iADVANCED: pick up an object from the floor when standing up with prosthesis, get up from the floor, walk outside on uneven ground, go down a few steps without using handrail, go up a few steps without using handrail, walk while carrying an object
Parameter
Better iBASIC Mobility
Better iADVANCED Mobility
level of amputation
tramsmetatarsal > below knee > above knee
tramsmetatarsal > below knee > above knee
age
decreasing
decreasing
body mass index (BMI)
increasing BMI to 30 kg per sq m, then decreases
decreasing
race
White
White
living status
married or partnered
married or partnered
education
high school diploma or higher
NA
diabetes
no
NA
current dialysis
no
no
COPD
no
NA
history of therapy for anxiety or depression
no
no
self-rated health
good to very good
good to very good
The chances of achieving a mobility level increases with the number of favorable factors.
Parameter
Coefficient for iBASIC Mobility
Coefficient for iADVANCED Mobility
level of amputation
tramsmetatarsal 0;
below knee -1.12;
above knee -2.80
tramsmetatarsal 0;
below knee 0.016;
above knee -1.30
age (centered at 60 years)
-0.125
-0.138
body mass index (BMI, centered at 30)
NA
-0.064
BMI squared
-0.008
NA
race White
1.10
2.01
living status married or partnered
0.995
1.16
education high school or above
1.28
NA
diabetes
-1.76
NA
current dialysis
-1.19
-1.02
COPD
-1.74
NA
history of therapy for anxiety or depression
-0.796
-1.56
self-rated health fair to very poor
-0.713
-1.19
intercept
2.57
-1.34
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