Mobility Changes in Individuals With Dysvascular Amputation From the Presurgical Period to 12 Months Postamputation

Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. Mobility changes in individuals with dysvascular amputation from the presurgical period to 12 months postamputation. Arch Phys Med Rehabil 2012;93:1766-73. Objectives: To describe changes in ambulation among individuals with lower-extremity amputation secondary to peripheral artery disease and/or diabetes prior to surgery through 12 months after surgery. To compare differences in ambulation by amputation level and to examine risk factors for change in ambulation over time. Design: Prospective cohort study. Setting: Two Veterans Affairs medical centers, 1 university hospital, and a level 1 trauma center. Participants: Patients with peripheral artery disease or diabetes (N = 239) undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 57% (n = 136) met study criteria, and of these, 64% (n = 87) participated. Interventions: Standard of care at each facility. Main Outcome Measures: Ambulatory function measured using the Locomotor Capability Index-5. Results: Seventy-five of the 87 (86%) subjects enrolled finished their 12-month follow-up interview. Ambulatory mobility declined during the period immediately prior to surgery (premorbid) and remained low at 6 weeks postsurgery. On average, ambulation improved after surgery but did not return to premorbid levels. In the final multivariate model, age and history of lower-extremity arterial reconstruction were significantly associated with a poorer ambulatory trajectory over time, while other factors, such as amputation level, prior alcohol use, and length of disability prior to amputation, were not. Conclusions: The findings highlight the importance of considering premorbid ambulatory function. Informing providers and patients about the trajectory and time course of changes in ambulation can enhance patient education, patient expectations, and treatment planning.