Department of Physiotherapy, Federal University of Bahia, Salvador, Brazil.
State Center for the Prevention and Rehabilitation of Persons with Disabilities, Salvador, Brazil.
Disabil Rehabil Assist Technol. 2021 Jul;16(5):556-560. doi: 10.1080/17483107.2019.1684581. Epub 2019 Nov 5.
Elderly amputees are a specific clientele because of the interaction of this disease with the ageing process. The objective of this study was to determine the impact of prosthesis rehabilitation on the functional capacity of elderly with lower-limb amputation (LLA) in short and long time.
A quasi-experimental study was developed. The sample consisted of 29 elderly with LLA who finished the prosthesis rehabilitation programme. Gait capacity was evaluated by Functional Ambulation Classification Scale (FAC), ability to perform basic activities of daily living (ADL) was evaluated by Barthel Index (BI) and Pfeffer Questionnaire was used to evaluate the capacity to execute instrumental ADL. Statistical inference was done by -test, -student test and chi-squared test. The significance level was fixed at 5% ( < 0.05).
In the transtibial group ( = 15) no difference ( = 0.108) was found between BI score before amputation and after 3 months of follow up. The transfemoral group ( = 14) improved significantly ( = 0.045) the FAC before starting and after 3 months of discharge from ambulatory rehabilitation. Both groups increased the time of prosthesis use during the day after 3 months of follow up. However, no group has achieved FAC and Pfeffer Questionnaire pre-amputation performance.
Although elderly with LLA improved functional capacity after 3 months of a prosthesis rehabilitation programme, they did not achieve their pre-amputation functionality.Implications for rehabilitationLower-limb amputation causes a significant socioeconomic impact and decreases functional capacity, autonomy and quality of life. Elderly people with a lower-limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. The specific presentation of elderly persons with lower-limb amputation, with multiple physical, psychological, cognitive, and social comorbidities, imposes unique challenges to ongoing care. The potential bias from the inclusion of younger patients into a study with an elderly population with lower-limb amputation supports the need for independent investigation.In our study we verified that although elderly with transfemoral or transtibial amputation have improved their functional independence after lower-limb prosthesis rehabilitation, they could not achieve their functional capacity before amputation. This improvement especially occurred for the basic activities of daily living, however elderly patients with transfemoral amputations presented greater difficulty in improving functional capacity.These results support that being able to better select elderly by their mobility potential and environmental barriers, is an important goal for future research to aim toward those who will achieve and maintain prosthetic walking or those who could better focus on regaining nonprosthetic mobility.
老年人截肢患者是一个特殊的群体，因为该疾病与衰老过程相互作用。本研究的目的是确定下肢截肢（LLA）老年人在短期和长期内假肢康复对其功能能力的影响。
进行了一项准实验研究。该样本包括 29 名完成假肢康复计划的下肢截肢老年人。通过功能性步行分类量表（FAC）评估步态能力，通过巴氏指数（BI）评估日常生活活动（ADL）基本能力，通过 Pfeffer 问卷评估执行工具性 ADL 的能力。统计推断采用 t 检验、t 检验和卡方检验。显著性水平固定为 5%（p<0.05）。
在经胫骨组（n=15）中，截肢前和 3 个月随访后的 BI 评分无差异（p=0.108）。股骨组（n=14）在开始和从步态康复出院后 3 个月时，FAC 显著改善（p=0.045）。两组在 3 个月随访后白天使用假肢的时间都有所增加。然而，两组均未达到截肢前的 FAC 和 Pfeffer 问卷表现。
尽管下肢截肢的老年人在接受 3 个月的假肢康复计划后改善了功能能力，但他们并未恢复到截肢前的功能水平。
下肢截肢会对社会经济造成重大影响，并降低功能能力、自主性和生活质量。下肢截肢的老年人给卫生资源带来沉重负担，需要进行广泛的康复和长期护理。下肢截肢老年人的特殊表现，伴有多种身体、心理、认知和社会合并症，对持续护理提出了独特的挑战。将年轻患者纳入一项针对下肢截肢老年人群的研究中可能存在潜在偏倚，这支持了进行独立研究的必要性。
在我们的研究中，我们发现，尽管经股骨或经胫骨截肢的老年人在接受下肢假体康复后提高了日常生活活动的独立性，但他们无法恢复到截肢前的功能水平。这种改善尤其体现在日常生活活动中，但股骨截肢的老年患者在提高功能能力方面存在更大困难。
这些结果支持，能够更好地根据老年人的活动能力和环境障碍来选择他们，是未来研究的一个重要目标，以针对那些能够实现并维持假肢行走的人，或者那些能够更好地恢复非假肢行走的人。
