title: The development and validation of the AMPREDICT model for predicting mobility outcome after dysvascular lower extremity amputation.
abstract: OBJECTIVE
  The objective of this study was the development of AMPREDICT-Mobility, a tool to predict the probability of independence in either basic or advanced (iBASIC or iADVANCED) mobility 1 year after dysvascular major lower extremity amputation.
  
  
  METHODS
  Two prospective cohort studies during consecutive 4-year periods (2005-2009 and 2010-2014) were conducted at seven medical centers. Multiple demographic and biopsychosocial predictors were collected in the periamputation period among individuals undergoing their first major amputation because of complications of peripheral arterial disease or diabetes. The primary outcomes were iBASIC and iADVANCED mobility, as measured by the Locomotor Capabilities Index. Combined data from both studies were used for model development and internal validation. Backwards stepwise logistic regression was used to develop the final prediction models. The discrimination and calibration of each model were assessed. Internal validity of each model was assessed with bootstrap sampling.
  
  
  RESULTS
  Twelve-month follow-up was reached by 157 of 200 (79%) participants. Among these, 54 (34%) did not achieve iBASIC mobility, 103 (66%) achieved at least iBASIC mobility, and 51 (32%) also achieved iADVANCED mobility. Predictive factors associated with reduced odds of achieving iBASIC mobility were increasing age, chronic obstructive pulmonary disease, dialysis, diabetes, prior history of treatment for depression or anxiety, and very poor to fair self-rated health. Those who were white, were married, and had at least a high-school degree had a higher probability of achieving iBASIC mobility. The odds of achieving iBASIC mobility increased with increasing body mass index up to 30 kg/m2and decreased with increasing body mass index thereafter. The prediction model of iADVANCED mobility included the same predictors with the exception of diabetes, chronic obstructive pulmonary disease, and education level. Both models showed strong discrimination with C statistics of 0.85 and 0.82, respectively. The mean difference in predicted probabilities for those who did and did not achieve iBASIC and iADVANCED mobility was 33% and 29%, respectively. Tests for calibration and observed vs predicted plots suggested good fit for both models; however, the precision of the estimates of the predicted probabilities was modest. Internal validation through bootstrapping demonstrated some overoptimism of the original model development, with the optimism-adjusted C statistic for iBASIC and iADVANCED mobility being 0.74 and 0.71, respectively, and the discrimination slope 19% and 16%, respectively.
  
  
  CONCLUSIONS
  AMPREDICT-Mobility is a user-friendly prediction tool that can inform the patient undergoing a dysvascular amputation and the patient's provider about the probability of independence in either basic or advanced mobility at each major lower extremity amputation level.
authors.affiliation: VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Czerniecki
authors.affiliation: VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.affiliation: VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Williams
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Wash.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Thompson
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Oregon Health and Science University, Portland, Ore.
authors.forename: Greg
authors.initials: G
authors.lastname: Landry
authors.affiliation: VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hakimi
authors.affiliation: VA Puget Sound Health Care System, University of Washington, Seattle, Wash; Department of Rehabilitation Medicine, University of Washington, Seattle, Wash.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Speckman
authors.affiliation: Spectrum Research, Inc, Tacoma, Wash. Electronic address: dan@specri.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Norvell
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D057187:Independent Living; D008124:Locomotion; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D016017:Odds Ratio; D018579:Patient Selection; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States