Mobility and Outcome Measures

 

Amputee Activity Score

A measure of function for outpatient lower limb amputees wearing a prosthesis. It is a self-report tool, carried out by interview. The level of activity achieved depends both on functional capacity and amount of activity carried out.

• Day HJ. (1981). The assessment and description of amputee activity. Prosthetics & Orthotics International. 5(1):23-8

Amputee Mobility Predictor (AmpPro / AmpNoPro)

A tool used to predict the ambulatory potential of lower limb amputees, and measure function post-rehabilitation. It was developed to provide a more objective approach to rating amputees under the various K Classifications. The test can be performed with or without the prosthesis.

There is a general feeling that the AmpNoPro may underestimate potential when used with new amputees, but has been found useful in rationalising componentry during presecription of interim / temporary prostheses. Similarly, AmpPro can assist in deciding on definitve prosthesis componentry.

• The AmpPro form & instructions can be viewed in this article:
  Gailey R et al (2002). The Amputee Mobility Predictor: An Instrument to Assess Determinants of the Lower-Limb Amputee’s Ability to Ambulate. Archives of Physical Medicine & Rehabilitation, 83, 613-627.
• AmpNoPro is the mobility assessment to be performed without the prosthesis.
• The article by Gailey et al (2002) cites the mean scores achieved in the AmpPro and AmpNoPro for different K Classifications.

Hill Assessment Index

A 12 point ordinal scale to assess different gait patterns during ascent or descent of slopes. It was developed to detect differences in function with different knee units.

K Classification

A scale containing descriptive functional levels for prosthetic users, developed by the American Orthotic & Prosthetic Association. Often used in classifying components for prosthetic prescription.

• View the K Classification here.

Locomotor Capabilities Index

Measures the amputees mobility function with the prosthesis during and after rehabilitation. The amputee is asked to subjectively rate their own capabilities.

• Franchignoni F et al (2004). Reliability, Validity, and Responsiveness of the Locomotor Capabilities Index in Adults With Lower-Limb Amputation Undergoing Prosthetic Training. Archives of Physical Medicine & Rehabilitation, 85, 743-748.
• Gauthier-Gagnon, C (1998). Tools for outcome measurement in lower limb amputation. Montreal: University of Montreal.
• Geake T et al (2006).The Locomotor Capability Index in diagram form: The Stanmore-Kingston Splat. Prosthetics & Orthotics International, 30, 3, 300-304.
• View the LCI Assessment form here.

Prosthetic Profile of the Amputee (PPA)

Used to measure function of unilateral lower limb amputees with or without their prosthesis, with respect to usage of the prosthesis. It is a self-report tool, carried out by telephone or interview. Data analysis is complex.

• The Locomotor Capabilities Index is part of the PPA.

Russeks's Code

Measures lower limb amputee mobility with the prosthesis, using observation to grade performance over the preceding 1-2 weeks.

SIGAM (Special Interest Group in Amputee Medicine)

Measures the functional mobility of lower limb amputees with either functional or cosmetic prostheses

• Ryall N et al (2003). The SIGAM mobility grades: a new population specific measure for lower limb amputees. Disability & Rehabilitation, 25, 15, 833-844.

Stair Assessment Index

A 14 level ordinal scale to assess functional abilities of transfemoral amputees during ascent and descent of stairs. It was specifically designed to detect differences in gait styles between prosthetic devices.

Walking Ability Index

A simple scale for measuring the walking ability of amputees. For full definitions, see the article by Siriwardena et al (1991). Broadly, the categories are (over a 10 foot distance):

1. Normal Gait - fully mobile with a prosthesis, normal walking pattern.
2. Abnormal Gait - fully mobile with a prosthesis, abnormal walking pattern.
3. Use of 1 cane or crutch.
4. Use of 2 canes or crutches.
5. Walking with a frame only.
6. Unable to walk - uses a wheelchair.

• Siriwardena, GJA et al (1991). Factors influencing rehabilitation of artheriosclerotic lower limb amputees. Journal of Rehabilitation, Research & Development, 28, 35-44.

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Generic Rehabilitation Tools

 

4 Stick Step Test

 

Actvities Specific Balance Scale (ABC Scale)

• Powell L ad Myers A (1995): ‘The Activities-specific Balance confidence (ABC) scale’. Journal of Gerontology, 50: M28-M34. This is a 16 item questionnaire where patients are asked to rate their confidence in whether they will lose their balance whlie performing a set of activities.

Barthel Index

Originally developed for neurological populations, but also useful for amputee clients, this index is in common usage. It evaluates 10 activities of daily living using an ordinal scale. There are different versions, and there may be a ceiling effect where clients score well but continue to have significant disability.

• View the Barthel Assessment form.

Frenchay Activities Index (FAI)

 

Functional Ambulation Classification (FAC)

Measures ability to negotiate various terrains, including outdoors, slopes, curbs and stairs.

• View the Functional Ambulation Classification.
• Holden M, et al (1986). Gait assessment for neurologically impaired patients: Standards for outcome assessment. Physical Therapy, 66, 1530-1539.

Functional Independence Measure (FIM)

Another scale in widespread use with all diagnostic groups in rehabilitation. It measures disability and the impact of disease on the person's functional abilities, describing the amount and type of assistance required. It is therefore said to assess the burden of care. It uses a seven point scale to score 18 functional items.

Lateral Reach Test

Measures ability to reach side to side in bilateral stance.

• Brauer S, et al (1999). Lateral reach: a clinical measure of medio-lateral postural stability. Physiotherapy Res Int, 4, 2, 81-88.

L-Test of Functional Mobility

• Deathe & Miller (2005). This test is an expanded version of the Timed Up & Go. The patient begins seated, facing the doorway. He rises, walks 3m to the doorway, turns 90 degrees and walks another 7m down the hallway, turns 180 degrees, and returns to the starting seat. The test was developed in response to a supposed ceiling effect with the TUG. The authors stated that a change greater than 3 seconds was indicative of real functional change, and report on mean times for amputees of different levels, cause of amputation, and aid usage.

Modified Tinetti Assessment

Assessment for balance and gait. Commonly used as a falls screening tool in NSW public hospitals.

• View an example of the Modified Tinetti Form here.

Rivermead Mobility Index (RMI)

Originally developed for use with neurological conditions, this measures function in terms of ability to perform a range of mobility tasks, giving a score out of 15. This index has been shown to be reliable, but there have been reports of a ceiling effect when used with lower limb amputees.

• View the Rivermead Mobilty Index here.
• Ryall, NH et al (2003). Is the Rivermead Mobility Index appropriate to measure mobility in lower extremity amputees? Disability & Rehabilitation, 25, 143-153.

10m Walk Test

Measures timing and spatial aspects of walking, including velocity, cadence, and step/stride lengths. The test is carried out over 14m, but the measurement only occurs in the middle 10, leaving the first and last 2m for acceleration & deceleration.

Timed Up & Go

Tests mobility by assessing ability to rise from a seated position, walk 3m, turn around and return to the seated starting position. The paper by Stevens et al (2009) references mean TUG times for transtibial and transfemoral amputees.

• Mathias, S et al (1986). Balance in elderly patients: the "Get up and Go" test. Archives of Physical Medicine & Rehabilitation, 67, 387-389.
• Podsiadlo, P et al (1991). The timed "up and go": a test of functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148.
• Schoppen, T et al (1999). The "timed up and go" test: reliability and validity in persons with unilateral lower limb amputation. Archives of Physical Medicine & Rehabilitation, 80, 825-828.
• Stevens, P et al (2009). Clinically Relevant Outcome Measures in Orthotics and Prosthetics. Journal of Prosthetics and Orthotics, February 2009, Vol 5, No 1. www.oandp.org

Two Minute / Six Minute Walk Tests

Measures functional mobility over time / distance, therefore including cardiovascular fitness in the test. The 2-minute walk is said to be highly correlated with the 6-minute walk.

The Six Minute Walk test is carried out at the client's self-selected walking speed. The paper by Stevens et al (2009) references mean and range for six minute walks for amputees under different K Classifications.

Parker et al (2010) found that the 2 minute walk as a measure of capacity (what the amputee is capable of) correlated well with measures of performance (what the amputee actually does) as measured by a step activity monitor.

• Brooks, D et al (2001). The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation. Archives of Physical Medicine & Rehabilitation, 82, 1478-1483.
• Butland, RJ et al (1982). Two-, six-, and 12 minute walking test in respiratory disease. British Medical Journal, 284, 1607-1608.
• Parker, K et al (2010). Ambulation of People with Lower-Limb Amputations: Relationship Between Capacity and Performance Measures. Archives of Physical Medicine and Rehabilitation, 91, 543-549.
• Stevens, P et al (2009). Clinically Relevant Outcome Measures in Orthotics and Prosthetics. Journal of Prosthetics and Orthotics, February 2009, Vol 5, No 1. www.oandp.org

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Quality of Life Scales

 

Attitude to Artifical Limb Questionnaire (AALQ)

Used to measure quality of life for amputees wearing a prosthesis. Items include satisfaction with prosthesis, attitude of others, mobility, and restoration of body image. It is a self-report tool, carried out independently, or via interview.

Orthotics & Prosthetics National Outcomes Tool

A scale developed to assess client satisfaction, quality of life, and prosthetists perception of functional ability.

• Gauthier-Gagnon, C (1998). Tools for outcome measurement in lower limb amputation. Montreal: University of Montreal.

Perceived Social Stigma Scale (PSSS)

Measures quality of life in terms of perceived social stigma resulting from limb loss.

Prosthesis Evaluation Questionnaire (PEQ)

Measures prosthetic related quality of life. It includes 9 subscales, which may be used independently of each other.

• Gauthier-Gagnon, C (1998). Tools for outcome measurement in lower limb amputation. Montreal: University of Montreal.
• Legro M et al (1998). Prosthesis Evaluation Questionnaire for Persons With Lower Limb Amputations: Assessing Prosthesis-Related Quality of Life. Archives of Physical Medicine & Rehabilitation, 79, 931-938.

SatPro (Satisfaction with Prosthesis)

A survey used to determine users satisfaction with their prosthesis, consisting of 15 questions.

• View the SatPro here.

Sickness Impact Profile (SIP)

Commonly used measure of quality of life in functional and behavioural terms for all diagnostic groups in rehabilitation. It is a self-report instrument.

Socket Comfort Score (SCS)

Developed in an attempt to quantify socket discomfort and pain. Higher values indicate more comfort.

• Hanspal RS et al (2003). Prosthetics socket fit comfort score. Disability & Rehabilitation, 25, 22, 1278-80.

SMAF

 

Trinity Amputation & Prosthetic Experience Scale (TAPES)

A self-report measure of quality of life of amputees who use a prosthesis, with regards to health. It assesses a person's adjustment to the prosthesis with respect to psychosocial factors, activity restrictions, satisfaction, and pain.

• Gallagher P et al (2000). Development & psychometric evaluation of the Trinity Amputation & Prosthesis Experience Scales (TAPES). Rehabilitation & Psychology, 45, 130-154.
• View the scale at the Dublin Psychoprosthetics Group, at www.psychoprosthetics.ie/tapes-r.html

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General References

1. Condie E, Scott H & Treweek S (2006). Lower Limb Prosthetic Outcome Measures: A Review of the Literature 1995 to 2005. Journal of Prosthetics & Orthotics, 18, Num 1S, p13-
2. Gauthier-Gagnon, C (1998). Tools for outcome measurement in lower limb amputation. Montreal: University of Montreal.
3. Hill, K et al (2001). Manual for Cinical Outcome Measurement in Adult Neurological Physiotherapy. APA Neurology Special Group (Victoria), 2nd edition.
4. Rommers, GM et al (2001). Mobility of People with Lower Limb amputations: scales and questionnaires: a review. Clinical Rehabilitation, 15, 92-102.
5. Stevens, P et al (2009). Clinically Relevant Outcome Measures in Orthotics and Prosthetics. Journal of Prosthetics and Orthotics, February 2009, Vol 5, No 1. www.oandp.org

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