title: Use of the Houghton Scale to Classify Community and Household Walking Ability in People With Lower-Limb Amputation: Criterion-Related Validity.
abstract: To examine the criterion-related validity of using the self-reported Houghton Scale to classify community-dwelling people with lower-limb amputation according to the suggested score ranges for independent community (Houghton Scale score ≥9), household and limited community (Houghton Scale scores 6-8), and limited household (Houghton Scale score ≤5) walking ability categories as referenced to performance-based balance ability and walking speed criteria.
  
  
  
  Cross-sectional cohort study.
  
  
  
  Community-based wellness walking programs in 8 states in the Mid-Atlantic, Midwest, and Southeast regions of the U.S.
  
  
  
  Volunteers (N=180; 66.5% men, n=118; mean age, 55.5±16y) 7.1±13.1 years since amputation, with transtibial-level amputation in 47% (n=79) and amputation caused by vascular disease in 49.4% (n=89).
  
  
  
  None.
  
  
  
  Self-reported data: Houghton Scale, Prosthetic Evaluation Questionnaire mobility subscale, and Activities-specific Balance Confidence (ABC) Scale. Clinical performance-based measures: balance ability assessed with 3 Berg Balance Scale (BBS) items and walking ability assessed with the timed Up and Go (TUG) test and 2-minute walk test (2MWT). The primary reference criteria were performance-based balance ability measured with the 3 BBS items and gait speed calculated from the 2MWT.
  
  
  
  On the Houghton Scale, 45.9% (78/170) of the participants scored ≥9, 30.6% (52/170) of the participants scored between 6 and 8, and 23.5% (40/170) of the participants scored ≤5. The Houghton Scale correlated with the Prosthetic Evaluation Questionnaire mobility subscale (r=.73), ABC Scale (r=.76), balance ability (r=.67), TUG test (r=-.67), and 2MWT (r=.73). The 3 Houghton Scale ability categories differed significantly from each other (P<.05) for all outcome measures: Prosthetic Evaluation Questionnaire mobility subscale, ABC Scale, balance ability, TUG test, and 2MWT.
  
  
  
  The Houghton Scale demonstrated criterion-related validity by differentiating community-dwelling people with lower-limb amputation into community, limited community/household, and household ability categories that corresponded to performance-based balance and walking criteria. Average prosthetic walking speeds for each category compared with similar walking ability categories defined in other patient populations.
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY. Electronic address: ckw7@cumc.columbia.edu.
authors.forename: Christopher Kevin
authors.initials: CK
authors.lastname: Wong
authors.affiliation: International Prosthetics and Orthotics, Mineola, NY.
authors.forename: William
authors.initials: W
authors.lastname: Gibbs
authors.affiliation: Program in Physical Therapy, Columbia University, New York, NY.
authors.forename: Elizabeth Sell
authors.initials: ES
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000592:standards; D004856:Postural Balance / Q000502:physiology; D015203:Reproducibility of Results; D014481:United States; D016138:Walking / Q000502:physiology*
keywords: Amputation; Artificial limbs; Mobility limitation; Postural balance; Rehabilitation; Walking