Predicting the use of prostheses by vascular amputees.

OBJECTIVE

To evaluate our accuracy in predicting the use of prostheses by patients undergoing major lower limb amputation.

DESIGN

Prospective study, with multiple assessors, "blind" to the predictions made by each other.

MATERIALS

Sixty-one patients (35 male: age 51-91, median 79) having their first major lower limb amputation.

METHODS

Five members of the rehabilitation team (surgeon, specialist in prosthetics, nurse, physiotherapist and occupational therapist) each recorded predictions of prosthetic use and mobility before amputation and during the first 2 weeks thereafter. Patients were followed up 6-24 months later.

RESULTS

At follow-up 17 patients had died. Of the remaining 44 (25 below-knee and 19 above-knee amputees), 23 of 27 (85%) who had been predicted as using prostheses were doing so, while only 11 of 17 (65%) had been correctly predicted as non-users. Nevertheless, only two of the patients not using prostheses contrary to prediction had ever had prostheses made for them, and both had developed problems with the other leg at a later date. Different members of the rehabilitation team were similar in their ability to predict outcome.

CONCLUSIONS

Inappropriate fitting of prostheses can be kept to a minimum by a team approach to rehabilitation, but amputees may defy careful prediction by the development of new medical problems.