Three measures of functional outcome for lower limb amputees: A retrospective review

Outcome measures are becoming increasingly important in health care. Functional outcome measures are of particular importance for lower limb amputees since much of the rehabilitation process is concerned with increasing mobility and personal independence. The Scottish Physiotherapy Amputee Research Group (SPARG) has used three measures of functional outcome: the Barthel Index, Russek's classification and the Locomotor Index. The review reported here involves 938 patients having a primary amputation at the transtibial or transfemoral level between October 1992 and July 1997. Differences in function due to age and level of amputation are well known clinically and the measures were compared by looking at their ability to detect these differences. The Barthel Index lacked sensitivity because of ceiling effects and should not be considered as a suitable functional outcome measure for amputee patients. Russek's classification does detect significant differences but requires a large number of patients making it unsuitable for single hospital investigations. The Locomotor Index demonstrates significant differences due to age and amputation level despite fewer patients being assessed by this measure during the period covered by this paper. The range of the Locomotor Index can be extended to cover more active amputees by considering its ‘advanced activities’ subscale separately. The Locomotor Index is a promising measure and should be considered by rehabilitation teams looking for a valid, reliable and sensitive functional outcome measure for use with lover limb amputees.

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Objective Measures of Functional Outcome in Recovery from Open Lower Limb Fractures – A Report from an Ortho-Plastic Research Clinic

10.21203/rs.3.rs-24944/v1 ◽

2020 ◽

Author(s):

Pallister I ◽

Gregory Jack Handley ◽

Sharon Maggs ◽

Ann-Marie Davies ◽

Amanda Kyle ◽

...

Keyword(s):

Functional Outcome ◽

Outcome Measures ◽

Lower Limb ◽

Step Test ◽

Objective Measures ◽

Range Of Movement ◽

Lower Limb Fractures ◽

Functional Outcome Measures ◽

Limb Fractures ◽

Time Point

Abstract BACKGROUNDOpen lower limb fractures are serious, potentially life-changing injuriesrequiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery.Our hypothesis was that objective measures combining strength, agility and balance would better reflect recovery than isolated parameters (e.g. range of motion) and would compare well to patients’ perceived recovery.METHODSAdultopen lower limb fracture patients were followed-up at 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism,injurypattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs)(range of movement and MRC strength grade) were compared to combined OFOMs(timed up and go (TUAG), comfortable and fast gait speed (CGS and FGS), Edgren Side Step Test(ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) scoreand Disability Rating Index (DRI)). RESULTS68 patients (54 male) with a medianage of 45 years (range 20-75). Neither range of movement,strength nor Single Leg balance consistently improved with time. TUAG, ESST, CGS, FGS and GPE scoresshowed consistent improvement, with TUAG and FGS showing highest proportion of improving results at each time-point. Patients’ estimation of recovery paralleled these measures with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score compared favourably withthe DRI having a higher proportion of improving responses at each time-point. DISCUSSIONFunctional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuringmobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery.Trial registrationSouth West Wales REC 06/WMW02/10)

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Outcome measurement for orthopaedic trauma inpatients

South African Journal of Physiotherapy ◽

10.4102/sajp.v64i3.112 ◽

2008 ◽

Vol 64 (3) ◽

Cited By ~ 1

Author(s):

E. Moghazy ◽

Q. Louw

Keyword(s):

Systematic Review ◽

Functional Outcome ◽

Outcome Measures ◽

Outcome Measure ◽

Outcome Measurement ◽

Orthopedic Trauma ◽

Orthopaedic Trauma ◽

Item Generation ◽

Functional Outcome Measures ◽

Initial Research

In clinical physiotherapy, there is growing importance for theaccuracy and reliability of assessment and outcome measures. There are nooutcome measure instruments for orthopaedic trauma inpatients published inthe literature. This paper reports on the initial research to develop an outcomemeasure for orthopaedic trauma inpatients. Item generation was done by doinga systematic review of published functional outcome measures. Item reductionwas conducted by using a panel of physiotherapists and patients. A total of115 functional items were generated and this was reduced to 29 functionalitems deemed appropriate for othopaedic trauma inpatients. A lthough furtherpsychometric properties should now be tested, the draft outcome measure can serve as a guide in the education ofundergraduate students as well as to clinicians working in orthopedic trauma wards.

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Reference values for developing responsive functional outcome measures across the lifespan

Neurology ◽

10.1212/wnl.0000000000003847 ◽

2017 ◽

Vol 88 (16) ◽

pp. 1512-1519 ◽

Cited By ~ 27

Author(s):

Marnee J. McKay ◽

Jennifer N. Baldwin ◽

Paulo Ferreira ◽

Milena Simic ◽

Natalie Vanicek ◽

...

Keyword(s):

Functional Outcome ◽

Outcome Measures ◽

Reference Values ◽

Lower Limb ◽

Functional Performance ◽

Neuromuscular Disorders ◽

Childhood And Adolescence ◽

Balance Test ◽

Eyes Closed ◽

Functional Outcome Measures

Objective:To generate a reference dataset of commonly performed functional outcome measures in 1,000 children and adults and investigate the influence of demographic, anthropometric, strength, and flexibility characteristics.Methods:Twelve functional outcome measures were collected from 1,000 healthy individuals aged 3–101 years: 6-minute walk test, 30-second chair stand test, timed stairs test, long jump, vertical jump, choice stepping reaction time, balance (Star Excursion Balance Test, tandem stance eyes open and closed, single-leg stance eyes closed), and dexterity (9-hole peg test, Functional Dexterity Test). Correlation and multiple regression analyses were performed to identify factors independently associated with each measure.Results:Age- and sex-stratified reference values for functional outcome measures were generated. Functional performance increased through childhood and adolescence, plateaued during adulthood, and declined in older adulthood. While balance did not differ between the sexes, male participants generally performed better at gross motor tasks while female participants performed better at dexterous tasks. Height was the most consistent correlate of functional performance in children, while lower limb muscle strength was a major determinant in adolescents and adults. In older adults, age, lower limb strength, and joint flexibility explained up to 63% of the variance in functional measures.Conclusions:These normative reference values provide a framework to accurately track functional decline associated with neuromuscular disorders and assist development and validation of responsive outcome measures for therapeutic trials.

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Measuring recovery after open lower limb fractures: combined objective functional tests and global perceived recovery outperform narrower metrics and a standard generic patient reported outcome measure

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04356-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ian Pallister ◽

Gregory Jack Handley ◽

Sharon Maggs ◽

Ann-Marie Davies ◽

Amanda Kyle ◽

...

Keyword(s):

Functional Outcome ◽

Outcome Measures ◽

Lower Limb ◽

Gait Speed ◽

Spearman Correlation ◽

Lower Limb Fractures ◽

Patient Reported ◽

Functional Outcome Measures ◽

Limb Fractures ◽

Objective Functional

Abstract Background Open lower limb fractures are serious injuries requiring combined ortho-plastic surgery and have significantly worse outcomes than similar closed fractures. There is little objective published data to determine which functional outcome measures best reflect progress or completeness of physical recovery. Our hypothesis was that objective measures combining strength, mobility and balance would better reflect recovery than isolated parameters (e.g. range of motion ROM) and would compare well to patients’ perceived recovery. Methods Adult open lower limb fracture patients were reviewed 6 and 12 weeks, 6, 9 and 12 months post-injury. The mechanism, injury pattern, age, gender and treatment were recorded. Isolated parameter objective functional outcome measures (OFOMs) (ROM and MRC strength grade) were compared to combined OFOMs (timed up and go, comfortable gait speed and fast gait speed, Edgren Side Step Test (TUAG, CGS, FGS, ESST) and Single Leg balance. Patient reported outcomes were recorded (Global Perceived Effect (GPE) score and Disability Rating Index (DRI)). Statistical analysis used non-parametric tests (e.g. Spearman correlation) compared each with time since injury. Results Sixty-eight patients (54 male) with a median age of 45(20–75) years. Of the 19 isolated OFOMs, only knee flexion and ankle plantar flexion ROM and strength improved with time (Spearman correlation p = 0.042, 0.008, 0.032, 0.036 respectively). TUAG, ESST, CGS, FGS and GPE scores showed significant improvement (Spearman correlation p < 0.001). Patients’ estimation of recovery paralleled these measures (Spearman correlation p < 0.001) with all but 2 patients achieving the minimum clinical important difference in DRI by 12 months compared to baseline. However, the GPE score had a higher proportion of improving responses than DRI at each time-point. Discussion Functional recovery is a key determinant in patients returning to work, providing for themselves and their family or resuming independent living for older patients. This study has demonstrated time-related improvements in combined OFOMs measuring mobility, strength, agility and balance paralleling patients’ perception of recovery in the 12 months after open lower limb fractures. Over the same time-frame, the simple GPE score compared favourably with the DRI. Such parameters could become part of a defined core outcomes set. Focussing rehabilitation towards these combined OFOMs may help hasten recovery. Trial registration South West Wales REC 06/WMW02/10).

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Aligning Graduate Medical Education Improvement Projects With Merit Incentive-Based Payment System Requirements via Functional Outcome Measures

American Journal of Medical Quality ◽

10.1177/1062860620918295 ◽

2020 ◽

pp. 106286062091829

Author(s):

Marc Gruner ◽

John T. Mansfield ◽

Nolan Gall ◽

Bryan Murtaugh ◽

Matthew Maxwell

Keyword(s):

Functional Outcome ◽

Outcome Measure ◽

Payment System ◽

Incentive Payment ◽

Graduate Medical ◽

Functional Outcome Measure ◽

Education Improvement ◽

Successful Establishment ◽

System Requirements ◽

Functional Outcome Measures

The Merit-based Incentive Payment System (MIPS) is a requirement for all physicians for value-based reporting. Medicare has approved registries as a mechanism for MIPS reporting. Concurrently, residencies continue to abide by the Accreditation Council for Graduate Medical Education’s (ACGME’s) curriculum requirement of utilizing/practicing quality improvement (QI).The objectives of this study were as follows: (1) incorporate a meaningful functional outcome measure into an electronic health record (EHR) to track spine functional outcomes; (2) generate a report containing covariables extracted from the EHR system to provide trackable data for current and future resident QI projects/investigations; and (3) establish an infrastructure to align ACGME QI initiatives with the MIPS requirements. This pilot study and retrospective analysis successfully demonstrates how a meaningful functional outcome measure can be incorporated into the EHR system for QI. Moreover, it demonstrates successful establishment of infrastructure for alignment of QI projects for ACGME residency requirements with MIPS requirements.

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Predictive Outcome Measures Versus Functional Outcome Measures in the Lower Limb Amputee

JPO Journal of Prosthetics and Orthotics ◽

10.1097/00008526-200601001-00006 ◽

2006 ◽

Vol 18 (Proceedings) ◽

pp. P51-P60 ◽

Cited By ~ 28

Author(s):

Robert S. Gailey

Keyword(s):

Functional Outcome ◽

Outcome Measures ◽

Lower Limb ◽

Lower Limb Amputee ◽

Predictive Outcome ◽

Functional Outcome Measures

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A longitudinal study of age equivalent receptive communication and performance on functional outcome measures in congenital myotonic dystrophy

Muscle & Nerve ◽

10.1002/mus.25770 ◽

2017 ◽

Author(s):

M. McIntyre ◽

M. Dixon ◽

E. M. Pucillo ◽

D. DiBella ◽

R. Crockett ◽

...

Keyword(s):

Longitudinal Study ◽

Functional Outcome ◽

Myotonic Dystrophy ◽

Outcome Measures ◽

Congenital Myotonic Dystrophy ◽

Receptive Communication ◽

And Performance ◽

Functional Outcome Measures

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The Effects of a Skilled Physical Therapy (PT) Intervention on Functional Outcome Measures in Patients With ESRD on Hemodialysis: Results of the Prohealth & Fitness Renal Rehabilitation Program

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2012.02.192 ◽

2012 ◽

Vol 59 (4) ◽

pp. B61

Keyword(s):

Physical Therapy ◽

Functional Outcome ◽

Outcome Measures ◽

Rehabilitation Program ◽

Functional Outcome Measures

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Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

Prosthetics and Orthotics International ◽

10.1080/03093640600608074 ◽

2006 ◽

Vol 30 (2) ◽

pp. 155-164 ◽

Cited By ~ 5

Author(s):

Ji Cheol Shin ◽

Eun Joo Kim ◽

Chang Il Park ◽

Eun Sook Park ◽

Kyoo-Ho Shin

Keyword(s):

Clinical Features ◽

Lower Limb ◽

Daily Living ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Medical Problems ◽

Amputation Level ◽

Significant Difference ◽

Bilateral Lower Limb ◽

Lower Limb Amputees

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation ( p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators ( p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores ( r = −0.518 vs. r = −0.550) ( p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.

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