Peripheral neuropathy prevalence and effect on mobility 12 months after prosthesis prescription among individuals with dysvascular lower extremity amputation

Abstract

Objective: To determine the prevalence of peripheral neuropathy (PN) and its effect on mobility in patients who were prescribed a lower limb prosthesis (LLP) after an incident dysvascular transtibial (TT) or transfemoral (TF) lower extremity amputation (LEA). We also sought to determine if the effect of PN on mobility was modified by amputation level or depression.

Design: Participants were identified retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then were contacted prospectively to obtain their self-reported mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers.

Setting: The VA CDW, the National Prosthetics Patient Database, participant mailings and phone calls.

Participants: Three hundred fifty-seven individuals who underwent a TT or TF amputation due to diabetes and/or peripheral arterial disease and were fitted with a qualifying LLP.

Interventions: Not applicable.

Main outcomes measures: The Locomotor Capabilities Index basic and advanced mobility subscale scores.

Results: Two-hundred thirty seven participants (66%) had a diagnosis of PN prior to prosthesis prescription. The detrimental effect of PN on achieving basic and advanced mobility was significant after adjusting for potential confounding factors (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.30-0.94; p = .03 and aOR, 0.43; 95% CI, 0.24-0.77; p = .005, respectively). The detrimental effect of PN was more pronounced in patients with depression, especially for advanced mobility (aOR, 0.36; 95% CI, 0.14-0.95; p = .04) versus no depression (aOR, 0.53; 95% CI, 0.27-1.0; p = .07).

Conclusions: PN is common in patients who have undergone an LEA due to diabetes and/or vascular disease and patients with this diagnosis should be carefully evaluated. Targeted rehabilitation programs to mitigate its potential detrimental effects on mobility are important and should specifically include mental health assessment and treatment.

FIGURE 1

STROBE diagram depicting total numbers identified in the Veterans Affairs Corporate Data Warehouse, total numbers and reasons for exclusion, and final number enrolled. This figure was reproduced from part of a figure from another manuscript using the same data set to develop a prediction model. CDW, Corporate Data Warehouse; PAD, peripheral arterial disease; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; TF, transfemoral; TT, transtibial.

FIGURE 2

Adjusted odds ratios (aOR)* and 95% confidence intervals (CIs) comparing neuropathy versus no neuropathy for achieving basic mobility stratified by amputation level. *Adjusted for all variables included in Table 1 in a multivariable logistic regression model.

FIGURE 3

Adjusted odds ratios (aOR)* and 95% confidence intervals (CIs) comparing neuropathy versus no neuropathy for achieving basic mobility stratified by presence/absence of major depressive disorder (significant ORs are in bold). *Adjusted for all variables included in Table 1 in a multivariable logistic regression model.

FIGURE 4

Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) comparing neuropathy versus no neuropathy for achieving advanced mobility stratified by amputation level significant ORs are in bold). *Adjusted for all variables included in Table 1 in a multivariable logistic regression model.

FIGURE 5

Adjusted odds ratios (aOR)* and 95% confidence intervals (CIs) comparing PN versus no PN for achieving advanced mobility stratified by presence/absence of major depressive disorder (significant ORs are in bold). *Adjusted for all variables included in Table 1 in a multivariable logistic regression model. PN, peripheral neuropathy.