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Amputee Mobility Predictor. Louise Whitehead Physiotherapy Team Leader 27 th October 2011. Introduction. In 1995, Medicare adopted a 5 level functional classification system for amputees K levels developed K0 - K4

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Amputee Mobility Predictor

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Amputee mobility predictor l.jpg

Amputee Mobility Predictor

Louise Whitehead

Physiotherapy Team Leader

27th October 2011


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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


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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


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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


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Sitting balance

Sitting reach (12”)

Chair to chair transfer

Sit to stand

Attempt to stand

Immediate standing balance

Standing balance 30 secs

Single limb stance

Standing reach (12”)

Nudge test

Eyes closed

Pick up object from floor

Sit down (arms across chest)

Achievement of tasks corresponds to K levels

K0 = 1, 2

K1 = 3 – 7

K2 = 8 – 13

Tasks


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14. Initiation of gait

15. Foot advancement

16. Foot clearance

17. Step continuity

18. 180 degree turn

19. Variable cadence

20. Step over 4” obstacle

21. Stairs

+ Walking aids used

K3 + K4 relate to tasks 14 - 21

5 points available for walking aids:

1 = WC; 2 = frame;

3 = crutches; 4 = sticks

5 = none

Tasks


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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


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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)


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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


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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)


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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)


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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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