Journal Article and Summary

The article that I chose was titled ‘Effectiveness of an Evidence-Based Amputee Rehabilitation Program.’ The study had the aim of understanding how a tailored therapy program can improve prosthetic weight-bearing, musculoskeletal endurance, walking speed, and even 1-year survival rate. It was a randomized cohort trial done with the Miami VA and University of Miami School of Medicine.

They did the research because a 2013 review of VA services including almost 13,000 veterans  found that only 55% received rehabilitation postoperatively. And of those who did, many were not rehabilitated to their full potential level of function as they were still deemed a high risk for falls at discharge. Because of the importance of postamputation PT, there was a need for the development of a rehabilitation program that targets impairments and limitations specific to amputees.

The Amputee Mobility Predictor is a quick and easily administered assessment tool designed to measure the functional status of amputees with and without the use of a prosthesis (AMPPro and AMPnoPro, respectively). Each AMP task is designed to assess a person’s ability to perform specific physical skills at the activity level (general tasks/demands and mobility); in addition, each AMP task is also comprised of a number of components (neuromusculoskeletal and movement-related functions) within the body such as bed-to-chair transfers, rising from a chair, foot clearance, and step length. From here limitations are identified and specific exercises are prescribed to address those deficits.

The primary purpose of this study was to determine if an evidence-based amputee rehabilitation program will improve the functional mobility of people with unilateral amputation who have previously completed a traditional prosthetic rehabilitation program.

Two research physical therapists assumed different roles and were blinded from each other throughout the study. One physical therapist who administered the AMPPro, AMPnoPro, and 6MWT at baseline and at the end of the 8-week intervention was blinded to group assignment (intervention vs wait-list control) and all intervention data. At the conclusion of baseline testing, participants were randomly assigned to either the 8-week intervention or wait-list control for 8 weeks. The other physical therapist implemented the EBAR program for all participants. The EBAR program was administered for 60 minutes, 3 times per week for 8 weeks. The AMP and 6-MWT were also administered at the conclusion of weeks 2, 4, and 6 to assess change in function and modify the exercise prescription as outlined in the EBAR program

The EBAR program consisted of 5 primary components: (1) cardiopulmonary endurance and flexibility, (2) trunk and lower limb strengthening, (3) balance and coordination, (4) weight-bearing and stance control, and (5) prosthetic gait training

The mean age was 63.25 years, mean time since amputation was 8.1 years, 81.2% were male, and 75% lost their limb because of peripheral vascular disease or diabetes mellitus.

The intervention group’s mean AMPPro score increased from 36.4 to 41.7 while the wait-list control group’s score remained unchanged from 35.3 to 35.6 (P = .004). Similarly, the AMPnoPro mean score of the intervention group improved from 23.2 to 27.1, while the wait-list control group score also remained unchanged (24.7 to 25.0; P = .04). The 6MWT distance of the intervention group improved from a mean of 313.6 m to 387.7 m (P = .04), while the wait-list control group again demonstrated virtually no change (262.6 m to 268.8 m)

Even though the participants enrolled in this study were many years postamputation and post-rehabilitation, those who received the 8-week EBAR program demonstrated clinically significant improvement in mobility as measured by the AMPPro, AMPnoPro, and 6MWT.

One of the biggest limitations to this study was the sample size. They approached 326 candidates, of which 306 were unable to declined to participate. In my research I found an older systematic review from 2016 that looked at 8 RCTs and they all only ranged from 4 to 60 participants. So obviously, there is a need for intervention research with larger populations.

Some of the questions I still had from the study include when is best time after amputation surgery to administer specific exercises, what is the appropriate duration for physical therapy, and how do we know when a patient has reached their maximum potential? Should this therapy wait until basic movements such as sitting balanced and transferring have become easy for the patient?

Future EBAR research should include a multi-site study at Veteran Affairs facilities and private sector hospitals that care for people with LLA