Roffman Caroline E, Buchanan John, Allison Garry T
C.E. Roffman, BScPT, School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia, and Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia 6847, Australia.
J. Buchanan, GDipPT, School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, and Physiotherapy Department, Royal Perth Hospital.
Phys Ther. 2016 Jul;96(7):985-94. doi: 10.2522/ptj.20140164. Epub 2015 Dec 4.
It is recognized that multifactorial assessments are needed to evaluate balance and locomotor function in people with lower limb amputation. There is no consensus on whether a single screening tool could be used to identify future issues with locomotion or prosthetic use.
The purpose of this study was to determine whether different tests of locomotor performance during rehabilitation were associated with significantly greater risk of prosthetic abandonment at 12 months postdischarge.
This was a retrospective cohort study.
Data for descriptive variables and locomotor tests (ie, 10-Meter Walk Test [10MWT], Timed "Up & Go" Test [TUGT], Six-Minute Walk Test [6MWT], and Four Square Step Test [FSST]) were abstracted from the medical records of 201 consecutive participants with lower limb amputation. Participants were interviewed and classified as prosthetic users or nonusers at 12 months postdischarge. The Mann-Whitney U test was used to analyze whether there were differences in locomotor performance. Receiver operating characteristic curves were generated to determine performance thresholds, and relative risk (RR) was calculated for nonuse.
At 12 months postdischarge, 18% (n=36) of the participants had become prosthetic nonusers. Performance thresholds, area under the curve (AUC), and RR of nonuse (95% confidence intervals [CI]) were: for the 10MWT, if walking speed was ≤0.44 ms(-1) (AUC=0.743), RR of nonuse=2.76 (95% CI=1.83, 3.79; P<.0001); for the TUGT, if time was ≥21.4 seconds (AUC=0.796), RR of nonuse=3.17 (95% CI=2.17, 4.14; P<.0001); for the 6MWT, if distance was ≤191 m (AUC=0.788), RR of nonuse=2.84, (95% CI=2.05, 3.48; P<.0001); and for the FSST, if time was ≥36.6 seconds (AUC=0.762), RR of nonuse=2.76 (95% CI=1.99, 3.39; P<.0001).
Missing data, potential recall bias, and assessment times that varied were limitations of the study.
Locomotor performance during rehabilitation may predict future risk of prosthetic nonuse. It may be implied that the 10MWT has the greatest clinical utility as a single screening tool for prosthetic nonuse, given the highest proportion of participants were able to perform this test early in rehabilitation. However, as locomotor skills improve, other tests (in particular, the 6MWT) have specific clinical utility. To fully enable implementation of these locomotor criteria for prosthetic nonuse into clinical practice, validation is warranted.
人们认识到，需要进行多因素评估来评价下肢截肢患者的平衡和运动功能。对于是否可以使用单一筛查工具来识别未来的运动或假肢使用问题，目前尚无共识。
本研究的目的是确定康复期间不同的运动表现测试是否与出院后12个月时更高的假肢弃用风险显著相关。
这是一项回顾性队列研究。
从201例连续的下肢截肢患者的病历中提取描述性变量和运动测试（即10米步行测试[10MWT]、定时起立行走测试[TUGT]、6分钟步行测试[6MWT]和四方步测试[FSST]）的数据。在出院后12个月对参与者进行访谈，并将其分类为假肢使用者或非使用者。采用曼-惠特尼U检验分析运动表现是否存在差异。生成受试者工作特征曲线以确定表现阈值，并计算非使用的相对风险（RR）。
出院后12个月时，18%（n = 36）的参与者成为假肢非使用者。非使用的表现阈值、曲线下面积（AUC）和RR（95%置信区间[CI]）分别为：对于10MWT，如果步行速度≤0.44米/秒（AUC = 0.743），非使用的RR = 2.76（95%CI = 1.83, 3.79；P <.0001）；对于TUGT，如果时间≥21.4秒（AUC = 0.796），非使用的RR = 3.17（95%CI = 2.17, 4.14；P <.0001）；对于6MWT，如果距离≤191米（AUC = 0.788），非使用的RR = 2.84（95%CI = 2.05, 3.48；P <.0001）；对于FSST，如果时间≥36.6秒（AUC = 0.762），非使用的RR = 2.76（95%CI = 1.99, 3.39；P <.0001）。
数据缺失、潜在的回忆偏差以及评估时间的变化是本研究的局限性。
康复期间的运动表现可能预测未来假肢弃用的风险。这可能意味着，鉴于最高比例的参与者能够在康复早期进行该测试，10MWT作为假肢弃用的单一筛查工具具有最大的临床效用。然而，随着运动技能的提高，其他测试（特别是6MWT）具有特定的临床效用。为了使这些假肢弃用的运动标准能够完全应用于临床实践，有必要进行验证。
