Title: Does gait speed indicate prosthetic walking potential following
lower limb amputation?
Authors:
1st Author Miss Heather Batten
Physiotherapist Advanced, Princess Alexandra Hospital/ MPhil Candidate, The
University of Queensland; Brisbane, Australia
Physiotherapy Department, Princess Alexandra Hospital, Ipswich Rd,
Woolloongabba, Queensland, Australia, 4102
Phone: +61 7 3176 2401
Email: heather.batten@health.qld.gov.au
2nd Author Dr Suzanne S. Kuys
Principal Research Fellow, The Prince Charles Hospital, Brisbane/ Griffith University,
Gold Coast, Australia
3rd Author Dr Allison Mandrusiak
Lecturer in Physiotherapy, The University of Queensland; Brisbane, Australia
4th Author Dr Steven M. McPhail
Principal Research Fellow, Centre for Functioning and Health Research/
Queensland University of Technology; Brisbane, Australia
Background: Gait speed is an indicator of walking ability, morbidity and mortality; and
is a reliable, valid and sensitive outcome measure commonly used in the
rehabilitation setting. Gait speed is a quick and efficient assessment method; yet, to
date, there has been little investigation of its potential use in populations with lower
limb amputation.
Purpose: To determine gait speed at discharge from subacute rehabilitation of a
large cohort of Australians with a unilateral lower limb amputation (transtibial level or
higher amputation) and to investigate the relationship between gait speed, prosthetic
potential (as classified by K-level) and functional independence.
Methods: Retrospective cohort study of 111 individuals admitted to subacute
inpatient rehabilitation prescribed a prosthesis following lower limb amputation from
2005 to 2011. Measures included timed 10m walk test and Functional Independence
Measure motor subscale (FIM-Motor). Prosthetic potential was measured using Klevels; the five K levels range from 0 to 4, where K0 refers to a person who does not
have the ability or potential to ambulate with a prosthesis and K4 refers to a person
with the potential for prosthetic ambulation that exceeds basic ambulation skills,
exhibiting high impact, stress or energy levels. Median and interquartile ranges were
used to describe gait speed and FIM-motor for each of the ordinal K-levels (K1-4);
which were not normally distributed. Spearman’s correlation coefficient was used to
examine the strength of association between K-level, gait speed, and FIM-Motor.
Results:
Median (interquartile range) gait speed for each K-level was: K1, 0.17 (0.150.19)m/s, K2, 0.38 (0.25-0.54)m/s, K3, 0.63 (0.50-0.71)m/s and 1.06 (0.95-1.18)m/s
for K4. Median (interquartile range) FIM-Motor scores for K-levels 1-4 were 82 (6984), 83 (79-84), 85 (83-87) and 87 (86-89), respectively. Positive correlations were
observed between K-level and discharge gait speed (rho=0.64, p<0.001), K-level
and discharge FIM-Motor (rho=0.50, p<0.001) and discharge gait speed and FIMMotor (rho=0.36, p<0.001).
Conclusions:
At discharge, lower limb amputees demonstrated a median (IQR) gait speed of 0.53
(0.37-0.69) m/s. A moderate positive association existed between K-level and gait
speed. However, even those amputees classified as having the greatest functioning
potential had discharge gait speeds consistent with a high risk of mortality. The
relatively narrow range of FIM-Motor scores observed across the four K-levels, is
likely attributed to the pragmatic requirements for safe discharge from hospital being
satisfied once people achieve these levels of functional independence. Once people
are sufficiently independent (regardless of K-level), they are usually discharged from
hospital to continue rehabilitation as an outpatient. Despite this ceiling effect, a
moderate correlation was still evident between K-level and FIM-Motor score.
Implications:
People classified at higher K-levels walked faster than those with lower K-levels.
However, gait speeds observed across all K-levels were consistent with values
indicating high risk of morbidity and mortality. Rehabilitation programs should
address factors contributing to slower gait speeds and incorporate gait speed
training during prosthetic rehabilitation. Further research is required to investigate
whether gait speed changes post discharge from hospital and what influence further
rehabilitation post hospital discharge may have on gait speed.
Keywords: amputation; gait speed
Funding acknowledgements: 2013 ISPO ANMS Research Grant
Ethics approval:
HREC (Princess Alexandra Hospital) approved May 2010;
amendment approved Feb 2012
MREC (The University of Queensland) approved Feb 2013
(expedited)
Author Biography: 200words
Presentations/ publications of work prior to WCPT: 50words