Defining successful mobility after lower extremity amputation for complications of peripheral vascular disease and diabetes

Abstract

Background: Information about longer-term functional outcomes following lower extremity amputation for peripheral vascular disease and diabetes remains limited. This study examined factors associated with mobility success during the first year following amputation.

Methods: Prospective cohort study of 87 amputees experiencing a first major unilateral amputation surgery. Seventy-five (86%) participants completed 12-month follow-up interview.

Results: Twenty-eight subjects (37%) achieved mobility success, defined as returning to or exceeding a baseline level of mobility on the locomotor capability index (LCI-5). Forty-three subjects (57%) were satisfied with their mobility. Individuals who were 65 years of age and older (risk difference [RD] = -0.52; 95% confidence interval [CI]: -0.75, -0.29), reported a current alcohol use disorder (RD = -0.37; 95% CI: -0.48, -0.26), had a history of hypertension (RD = -0.23; 95% CI: -0.43, -0.03) or treatment for anxiety or depression (RD = -0.39; 95% CI: -0.50, -0.28) were less likely to achieve mobility success. Mobility success was associated with mobility satisfaction (RD = 0.36; 95% CI: 0.20, 0.53) and satisfaction with life (RD = 0.28; 95% CI: 0.06, 0.50). Although higher absolute mobility at 12 months was also associated with mobility satisfaction and overall life satisfaction, 50% of individuals who achieved success with low to moderate 12-month mobility function reported they were satisfied with their mobility.

Conclusion: Defining success after amputation in relation to an individual's specific mobility prior to the development of limb impairment which led to amputation provides a useful, patient-centered measure that takes other aspects of health, function, and impairment into account.

Fig 1.

Time points for assessing level of mobility from premorbid function to 12 months after amputation. *The patient’s recall of his or her mobility before a decline in function due to disability in the limb that underwent amputation. One subject died after enrollment before the locomotor capability index (LCI) score could be assessed. **Subjects who were enrolled presurgically completed the LCI questionnaire then and at 6 weeks to assess their premorbid mobility. These two scores demonstrated strong agreement with a Spearman correlation coefficient of 0.83 (P < .003).

Fig 2.

Diagram depicting screening and enrollment numbers.