Amputee Mobility Predictor by w88nz3

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									Amputee Mobility Predictor

            Louise Whitehead
            Physiotherapy Team
            Leader
            27th October 2011
Introduction


   In 1995, Medicare adopted a 5 level functional
    classification system for amputees
   K levels developed K0 - K4
   Bob Gailey developed the Amputee Mobility
    Predictor (AMP) to help to determine which K
    levels amputees fit into
   AMP PRO / AMPnoPRO
K levels

   K0 – Patient does not have the ability or potential to walk or
    transfer with or without assistance and a prosthesis does not
    enhance their QOL or mobility
   K1 – Patient has the ability to use a prosthesis for transfers or
    walking on level surface at fixed cadence (indoor)
   K2 – Patient has the ability to walk indoors and outdoors including
    negotiating kerbs, stairs and uneven surfaces (community)
   K3 - Patient is able to walk with variable cadence and may require
    prosthetic consideration for work, hobbies or sport
   K4 – Patient requires a prosthesis which allows high impact, stress
    or energy levels, typical of a child, active adult or athlete
AMP PRO

   Designed to assess an amputee’s existing
    mobility or potential to mobilise with a
    prosthesis
    –   Items taken from Tinetti’s Performance-Orientated
        Assessment of Mobility Problems (POMA) & Duke
        Mobility Skills Profile (DMSP)
    –   No cost, easy & quick to administer
    –   Equipment = stopwatch, ruler, pencil, 2 chairs, set of 3
        steps and a 4” obstacle (step)
    –   21 tasks - scored out of 47
    –   Guidance notes for scoring
Tasks

1.    Sitting balance
2.    Sitting reach (12”)             Achievement of tasks
3.    Chair to chair transfer          corresponds to K levels
4.    Sit to stand
5.    Attempt to stand
6.    Immediate standing balance      K0 = 1, 2
7.    Standing balance 30 secs        K1 = 3 – 7
8.    Single limb stance
9.    Standing reach (12”)            K2 = 8 – 13
10.   Nudge test
11.   Eyes closed
12.   Pick up object from floor
13.   Sit down (arms across
      chest)
Tasks

14.   Initiation of gait
15.   Foot advancement           K3 + K4 relate to
                                  tasks 14 - 21
16.   Foot clearance
17.   Step continuity            5 points available for walking
18.   180 degree turn             aids:
19.   Variable cadence             1 = WC; 2 = frame;
20.   Step over 4” obstacle        3 = crutches; 4 = sticks
                                   5 = none
21.   Stairs

+ Walking aids used
Methodology

   191 lower limb amputees in study
   Subjectively put into K0-K4 categories
   24 subjects in reliability study – average
    time since amputation > 5 years
   167 in validity study
    –   Predictive validity & concurrent validity
    –   K0 + K1 – average time from amp 2 yrs
    –   K3 + K4 – over 10 years
Results

   Inter rater reliability (0.99)
   Test-retest reliability (0.96 - 0.98)
   Predictive validity – significantly predicted
    patient’s level of function with prosthesis
   Concurrent validity – correlated well with 6 min
    walk test & Amputee Activity Survey (AAS)
   AMP PRO distinguished between K0 – K4 but not
    validated (Gailey 2006)
Dundee experience

   17 patients tested at IP discharge + @ 3
    week follow up
    –   Transtibial = 14
    –   Tranfemoral = 2
    –   Bilateral = 1

   Average scores for transtibial patients
    –   IP D/C = 36/47
    –   3 week follow up = 40/47
Dundee experience

   Average increase in score (all levels) = 4
   Patients whose scores did not improve had
    difficulties preventing prosthetic use during 3 week
    period (N=3)

   Quick & easy to administer
   Minimal training required
   No ceiling effect with our patients @ 3 weeks
    (most still using walking aids)
CHAMPS

   Developed to address ceiling effect @ K4
    level
   5 point test as adjunct to AMP PRO
    –   Single limb stance (aim 30 secs)
    –   Medicine ball putt (sit on floor + throw)
    –   Edgren side step test (4m course – no. of cones passed
        in 10 secs)
    –   T-test (run forwards, left, right & backwards)
    –   Illinois agility test (start & finish on floor – run
        different directions, turning & figure of 8)
References

   Gailey RS, Roach KE, Brooks Applegate E, Cho B, Cunnliffe
    B, Licht S, Maguire M, Nash MS (2002) The Amputee
    Mobility Predictor: An instrument to assess determinants
    of the lower limb amputee’s ability to ambulate. Arch of
    Phys Med & Rehabil 83:613-627
   Gailey RS (2006) Predictive outcome measures versus
    functional outcome measures in the lower limb amputee.
    Journal of Prosthetics & Orthotics 18:1S;51-60
   BACPAR toolbox of outcome measures BACPAR version 1
    Feb 2010

								
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