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

• Published in: Journal of vascular surgery 2011-08, Vol.54 (2), p.412-419
• Main Authors: Norvell, Daniel C., PhD, Turner, Aaron P., PhD, Williams, Rhonda M., PhD, Hakimi, Kevin N., MD, Czerniecki, Joseph M., MD
• Format: Article
• Language: English
• Subjects: Aged; Amputation - adverse effects; Analysis of Variance; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Chi-Square Distribution; Diabetic Angiopathies - complications; Diabetic Angiopathies - diagnosis; Diabetic Angiopathies - physiopathology; Diabetic Angiopathies - surgery; Disability Evaluation; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Hospitals, Veterans; Humans; Logistic Models; Lower Extremity - blood supply; Male; Medical sciences; Middle Aged; Mobility Limitation; Motor Activity; Patient Satisfaction; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - diagnosis; Peripheral Vascular Diseases - physiopathology; Peripheral Vascular Diseases - surgery; Prospective Studies; Quality of Life; Recovery of Function; Risk Assessment; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Washington
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.01.046

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.