Prognostic factors in prosthetic rehabilitation of bilateral dysvascular above-knee amputee: is the stump condition an influencing factor?
OBJECTIVE
The aim of this study was to evaluate the prognostic factors for rehabilitation outcome in bilateral dysvascular lower limb amputees, specifically to ascertain how the stump condition can influence the mobility outcome.


METHODS
A retrospective study of 30 selected bilateral above-knee amputees for vascular disease was carried out. Barthel Index (BI) was given and stump condition was assessed at admission and at discharge. Influence of age, comorbidities and stump condition on effectiveness of BI was evaluated. Locomotor Capability Index (LCI) was performed at discharge. Influence of stump problems (pain, flexion, pain with flexion) on LCI was evaluated.


RESULTS
At discharge, 25 patients were able to ambulate. Age and pathological conditions of stumps correlated negatively with BI effectiveness. LCI values were higher for patients with ideal stumps and lower for patients with combined stump pain and flexion deformities. Post hoc analysis showed that the principal factor negatively influencing the LCI score was the presence of stump flexion deformities.


CONCLUSIONS
In our homogeneous group of bilateral amputees, age reduced the possibility of improving the level of autonomy. Good stump quality is one of the major determinants of mobility outcome. Efforts should be made to minimize stump complications. In particular, incorrect positioning of the stump, which is responsible for hip flexor retraction, should be avoided after surgery.
Traballesi
M
M
Operative Unit D, Santa Lucia Foundation, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy. m.traballesi@hsantalucia.it
Porcacchia
P
P
Averna
T
T
Angioni
C
C
Lubich
S
S
Di Meo
F
F
Brunelli
S
S
D000203:Activities of Daily Living; D000368:Aged; D000672:Amputation Stumps / Q000503:physiopathology*; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs / Q000706:statistics & numerical data*; D050197:Atherosclerosis / Q000150:complications; D003925:Diabetic Angiopathies / Q000150:complications; D005260:Female; D006801:Humans; D007558:Italy; D007866:Leg / Q000098:blood supply / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016138:Walking / Q000502:physiology