title: Functional Outcomes After the Prosthetic Training Phase of Rehabilitation After Dysvascular Lower Extremity Amputation.
abstract: OBJECTIVE
  To describe physical function outcomes and modes of physical therapy intervention for a cohort of patients with dysvascular lower extremity amputation (LEA) during the prosthetic training phase of rehabilitation.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  Physical rehabilitation clinics at a Veterans Affairs medical center and a university hospital.
  
  
  METHODS
  Forty-two patients (38 men, 4 women, age 60.2 ± 8.4 years) who completed outpatient physical therapy rehabilitation with prosthetic training after dysvascular LEA.
  
  
  METHODS
  All patients underwent a prosthetic training phase of rehabilitation, with standardized outcome measures performed at initiation and discharge.
  
  
  METHODS
  Performance-based physical function measures included Two-Minute Walk (2 MW), Timed-Up and Go (TUG), and 5-meter gait speed. Self-report physical function measures included the Prosthesis Evaluation Questionnaire-Mobility Section (PEQ-MS) and the Patient-Specific Functional Scale. Rehabilitation dose was tracked as total number of clinic visits, rehabilitation duration, and specific intervention modes.
  
  
  RESULTS
  There were significant improvements between initial and discharge values (mean ± SD) for the Two-Minute Walk (67.5 ± 29.9 m and 103.3 ± 45.8 m, respectively, P < .001), gait speed (0.58 ± 0.27 m/s and 0.88 ± 0.39 m/s, respectively, P < .001), TUG (34.8 ± 21.3 seconds and 18.6 ± 13.9 seconds, respectively, P < .001), PEQ-MS (2.2 ± 0.9 and 2.8 ± 0.8, respectively, P < .001), and Patient-Specific Functional Scale (3.2 ± 2.0 and 5.9 ± 2.3, respectively, P < .001). Performance-based (TUG) and self-report (PEQ-MS) changes in functional mobility from initial exam to discharge had low or no correlations with rehabilitation dose measures. The number of clinic visits was 12.7 ± 13.1 and rehabilitation duration was 13.7 ± 16.8 weeks.
  
  
  CONCLUSIONS
  Significant improvements in performance-based and self-report measures of physical function occurred during the prosthetic training phase of physical rehabilitation after dysvascular major LEA. Despite improvements in function, gait speed, and TUG outcomes remained below clinically important thresholds, indicating patients were limited in community ambulation and at risk for falls. Lack of moderate or greater correlation between rehabilitation dose and outcome measures may indicate the need for more specific rehabilitation dose measures.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, University of Colorado Anschutz Medical Campus, Mailstop C244, 13121 East 17th Avenue, Aurora, CO 80045.
authors.forename: Cory L
authors.initials: CL
authors.lastname: Christiansen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Veterans Affairs Eastern Colorado Health Care System, Denver, CO.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fields
authors.affiliation: Physical Therapy Department, University of Colorado Hospital, Aurora, CO.
authors.forename: Guy
authors.initials: G
authors.lastname: Lev
authors.affiliation: Physical Therapy Department, University of Colorado Hospital, Aurora, CO.
authors.forename: Ryan O
authors.initials: RO
authors.lastname: Stephenson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Stevens-Lapsley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D051341:Dependent Ambulation; D005260:Female; D005684:Gait; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016491:Peripheral Vascular Diseases / Q000534:rehabilitation / Q000601:surgery*; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012189:Retrospective Studies