Mobility Studies

1. Mobility Studies Lauren Kark

2. Introduction

3. Outcome Measures Locomotor Capabilities Index Barthel Index Functional Independence Measure Office of Population Consensus and Surveys Scale Amputee Activity Score Functional Measure for Amputees Houghton Scale Prosthetic Profile of the Amputee Frenchay Activities Index Patient Generated Index Short Form 36 Short Form 12 Sickness Impact Profile Attitude to Artificial Limb Questionnaire Amputation Related Body Image Scale Body Image Questionnaire Prosthesis Evaluation Questionnaire Perceived Social Stigma Scale Questionnaire for Persons with Transfemoral Amputation Trinity Amputation and Prosthesis Experience Scale Russek’s Code Special Interest Group in Amputee Medicine Rivermead Mobility Index Orthotics and Prosthetics National Outcome Tool Amputee Mobility Predictor Timed-Up-and-Go Test L-Test 2-Minute Walk Test 6-Minute Walk Test 10-Metre Walk Test Energy Expenditure Temporospatial Data Kinematics Kinetics

4. Outcome Measures Time, money, clinical impracticality TUG, timed-up-and-go; TWT, timed walk test

5. Hypothesis Relationships exist between self-report data, functional outcome measures and quantitative gait analysis. Complex gait parameters can be predicted using simpler, cheaper and faster outcome measures such as questionnaires and functional ability assessments.

6. Hypothesis

7. Aims To develop a clinical tool that enables perceptive and functional outcome measures to provide insights into quantitative gait parameters. To use self-report questionnaires to obtain quality-of-life related information from a well represented proportion of lower limb amputees. To conduct biomechanical analysis on a number of lower limb amputees. To explore relationships between perception, functional outcome measures and quantitative gait analysis.

8. Experimental Design Ethics Approval (HREC 07247) Subject recruitment Analysis Mail-out questionnaire study Visit UNSW? Subject participation complete No Yes Subject participation complete Analysis Physical testing Analysis of relationships between questionnaires and physical testing

9. Part 1. Questionnaire Study

10. Mail-Out Questionnaire Demographics Short-Form 36 Functional Measure for Amputees Prosthesis Evaluation Questionnaire

11. Participant Characteristics

12. Short-Form 36 PF, physical functioning; RP, role limitations due to physical; BP, bodily pain; GH, general health; VT, vitality; SF, social functioning; RE, role limitations due to emotional; MH, mental health; PCS, physical components scale; MCS, mental components scale

13. Short-Form 36 – Influence of Pain * Defined as an awareness of pressure and proprioception in the phantom limb (Legro et al, 1998)

14. Locomotor Capabilities Index

15. Locomotor Capabilities Index

16. Prosthesis Evaluation Questionnaire AM, ambulation; AP, appearance; FR, frustration; PR, perceived response; RL, residual limb health; SB, social burden; SO, sounds; UT, utility; WB, well-being

17. Comparison to Published Results Short-Form 36 • Similar to Legro et al. (1999), Pezzin et al. (2000), Smith et al. (1995) and Hagberg et al. (2001) Locomotor Capabilities Index • Higher than other published results Prosthesis Evaluation Questionnaire • Mixed results • Frustration and social burden lower

18. Part 2. Physical Testing

19. Physical Testing Three-dimensional gait analysis Six-minute walk test (or two-minute walk test) Timed-up-and-go test Energy expenditure Questionnaires

20. Participant Characteristics

21. Six-Minute Walk Distance

22. Oxygen Cost

23. Timed-Up-and-Go Test

24. Self-Selected Walking Speed

25. Step-Length

26. Gait Summary Measures – Gait Deviation Index Kark, L. et al., Use of gait summary measures with lower limb amputees, Gait and Posture. 2011; (35(2): 238 – 243.

27. Gait Summary Measures – Gait Profile Score Kark, L. et al., Use of gait summary measures with lower limb amputees, Gait and Posture. 2011; (35(2): 238 – 243.

28. Gait Summary Measures Kark, L. et al., Use of gait summary measures with lower limb amputees, Gait and Posture. 2011; (35(2): 238 – 243.

29. Gait Symmetry SL, step length; GDI, gait deviation index; GPS, gait profile score; GVS, gait variable score; HF, hip flexion/extension; KF, knee flexion/extension; ADP, ankle dorsi/plantarflextion; HA, hip adduction/abduction; FPA, foot progression angle

30. Part 3. Relationships

31. Outline Predicting gait deviation The role of gait deviation in patient satisfaction

32. 1. Predicting Gait Deviation

33. Participant Characteristics

34. Types of Predictors Age Time since amputation Participant Characteristics Level of amputation Gender BMI Ambulation Quantitative Gait Parameters Appearance Frustration Questionnaires - PEQ - Perceived Response Residual Limb Health Social Burden Sounds Utility Well-Being Step Length Functional Outcomes Walking Speed TUG Test 6MWD

35. Univariate Analysis ρ = 0.70 BMI, body mass index; nSL, normalised step-length; WS, self-selected walking speed; TUG, timed-up-and-go test; TWD, timed walk distance; PF, physical functioning scale; AM, ambulation scale.

36. Predictor Types A Demographics B Questionnaire Scales (PEQ) C Functional Outcome Measures Multivariate Analysis – Regression Analysis 90 One Type of Predictor Two Types of Predictors All 80 70 R2 60 50 40 30 20 10 0 A B C A-B A-C B-C A-B-C

37. AM_C: Rate your ability to walk in close spaces when using your prosthesis UT_G: Rate how much energy it took to use your prosthesis for as long as you needed it. Multivariate Analysis R2 UT_G tstand tstand AM_C tstand AM_C

38. Summary The gait deviation index could be predicted by: • The distance walked in six minutes • The patient’s perception of their own ability to ascend stairs • The time taken to stand • Chronological age

39. 2. The Role of Gait Deviation in Patient Satisfaction Kark and Simmons, Patient satisfaction following lower-limb amputation: the role of gait deviation. Prosthetics and Orthotics International, 2011. 35(2): 225 - 233

40. Participant Characteristics

41. Satisfaction in the Prosthesis Evaluation Questionnaire

42. Patient Satisfaction PCcurtrain and PCalltrain were omitted from further analysis because 25% of respondents reported that they had not received gait training.

43. Correlates of Satisfaction Participant demographics did not correlate significantly with any of the satisfaction measures Level of amputation showed small correlation with satisfaction with walking Self-report measures showed the strongest correlation • Ambulation with: walking, well-being and quality of life • Frustration with: happiness with prosthesis and satisfaction with prosthetist • Perceived response with: quality of life • Social burden with: walking, well-being, and quality of life Performance-based and gait deviation did not correlate significantly with any of the satisfaction measures

44. Summary In this cohort, gait deviation was relatively unimportant to the amputee Self-reported functional ability in a variety of areas (including physical, mental and social domains) had the greatest influence on patient satisfaction Further advocates for multidisciplinary rehabilitation

45. Future Work Development of a standardised set of outcome measures, which will facilitate comparison between rehabilitation facilities, and ultimately result in improved outcomes for individuals with lower-limb amputation.

46. Thank you. Questions?