Pousett B M, Harasym C C, Rapaport M S, Richardson T, Spellen J, Moe D W, Miller W C
Barber Prosthetics Clinic, Vancouver, Canada.
Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Can Prosthet Orthot J. 2024 Oct 25;7(1):43890. doi: 10.33137/cpoj.v7i1.43890. eCollection 2024.
Functional mobility, comfort and the absence of pain are key goals of prosthetic treatment. Outcome measures (OMs) evaluate the impact of treatment and normative and minimal detectable change (MDC) values are key to interpreting these scores and measuring treatment outcomes.
This study seeks to 1) present practice-based normative values of four commonly used OMs at four prosthetic milestones and 2) explore the MDC of the measures over the treatment period.
A chart review was conducted of OMs collected with individuals with lower limb loss between January 1, 2015, and December 31, 2023. This included data for individuals with unilateral transtibial (TT), transfemoral (TF) and rotationplasty (RP) amputations and bilateral transtibial amputation (BTT). OMs included the Socket Comfort Score (SCS), Pain Scale (PS), 2 Minute Walk Test (2MWT), and Prosthetic Limb Users Survey of Mobility (PLUS-M). Data were collected at four milestone time points: (1) Baseline and (2) Discharge from Rehabilitation for those in initial prosthetic rehabilitation, and (3) Initial Evaluation and (4) Definitive Delivery for those receiving a replacement socket. Normative values and MDC values were calculated.
Data from 30 individuals undergoing in-patient rehabilitation and 74 individuals receiving a replacement socket were included. Practice-based normative data were different for each level of amputation and milestone and had the following ranges: SCS: 5.7 - 9.1, PS: 0.8 - 3.7, 2MWT: 68.4 - 146.3 m and PLUS-M: 38.9 - 57.3. MDC values also varied based on time in treatment (Rehabilitation: SCS = 2.5, PS = 1.6, 2MWT = 32.6, PLUS-M = 8.8; Replacement Socket: SCS = 3.1, PS = 2.6, 2MWT = 38.9, PLUS-M = 4.0). All measures had a statistically significant change over the intervention, however, no average scores changed by greater than the MDC.
The normative data and MDC scores demonstrate the PS & PLUS-M are useful measures of pain and mobility at all points within treatment. The 2MWT is indicated for individuals in rehabilitation, while the SCS is indicated for those receiving a replacement socket, as both effectively measure treatment goals that are particularly important for each phase of rehabilitation. This provides clinicians with practice-based evidence that enables them to interpret OM scores, a critical part of the decision-making process along the treatment journey.
功能活动能力、舒适度和无疼痛是假肢治疗的关键目标。结局指标（OMs）评估治疗效果，而规范值和最小可检测变化（MDC）值是解释这些分数和衡量治疗结果的关键。
本研究旨在1）呈现四个假肢治疗关键节点上四种常用结局指标基于实践的规范值，以及2）探讨治疗期间这些指标的最小可检测变化。
对2015年1月1日至2023年12月31日期间下肢缺失患者收集的结局指标进行图表回顾。这包括单侧胫骨（TT）、股骨（TF）和旋转成形术（RP）截肢以及双侧胫骨截肢（BTT）患者的数据。结局指标包括接受腔舒适度评分（SCS）、疼痛量表（PS）、2分钟步行测试（2MWT）和假肢使用者活动能力调查（PLUS - M）。在四个关键时间点收集数据：（1）基线，以及（2）初始假肢康复患者的康复出院时，还有（3）初始评估，以及（4）接受更换接受腔患者的最终交付时。计算规范值和最小可检测变化值。
纳入了30名接受住院康复治疗的患者和74名接受更换接受腔的患者的数据。基于实践的规范数据在每个截肢水平和关键节点各不相同，范围如下：SCS：5.7 - 9.1，PS：0.8 - 3.7，2MWT：68.4 - 146.3米，PLUS - M：38.9 - 57.3。最小可检测变化值也因治疗时间而异（康复阶段：SCS = 2.5，PS = 1.6，2MWT = 32.6，PLUS - M = 8.8；更换接受腔阶段：SCS = 3.1，PS = 2.6，2MWT = 38.9，PLUS - M = 4.0）。所有指标在干预期间均有统计学上的显著变化，然而，平均得分变化均未超过最小可检测变化值。
规范数据和最小可检测变化评分表明，PS和PLUS - M在治疗的各个阶段都是评估疼痛和活动能力的有用指标。2MWT适用于康复期患者，而SCS适用于接受更换接受腔的患者，因为两者都能有效衡量对康复各阶段尤为重要的治疗目标。这为临床医生提供了基于实践的证据，使他们能够解释结局指标分数，这是治疗过程中决策的关键部分。
