Award Date

5-17-2019

Degree Type

Dissertation

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

Advisor 1

Szu-Ping Lee

First Committee Member

Merrill Landers

Second Committee Member

Daniel Young

Number of Pages

18

Abstract

Background and Purpose: The number of people with limb loss is rapidly growing, partly due to an aging society and the prevalence of diabetes. Physical Therapy (PT) has been shown to improve perceived functional outcomes and quality of life in older adults and individuals with diabetes, but it is unclear why certain patients do not receive PT after amputation and whether the beneficial outcomes shown in other populations translate to individuals with limb loss. The purpose of this study was to determine whether receiving PT among patients with limb loss correlates with an improved quality of life, better mobility, and a decrease in fear of falling avoidance behavior when compared to those who did not receive PT. We also evaluated patient perception regarding confidence and satisfaction with their prostheses and barriers that prevented therapy. Subjects: 48 patients with lower limb loss with prosthetic devices who were at least 6 months post-amputation were surveyed. Methods: 40 male and 8 female (57.8±15.1 years) participants were recruited from local prosthetic and PT clinics, rehabilitation hospitals, and an amputee patient support group. All participants completed the following surveys: Short-Form 36 survey (SF-36), mobility section of Prosthesis Evaluation Questionnaire (PEQ), Fear of Falling Avoidance Behavior Questionnaire (FFABQ), and the Perception of Confidence of Mobility and Perception of Satisfaction of Mobility sections of the Amputee Perception Survey. Results: Of our participants, 38 received Physical Therapy (YesPT) and 10 did not (NoPT). The YesPT group included individuals with unilateral above the knee (AK; 42.1%) and below the knee (BK; 42.1%) amputations, and 15.8% of higher level (i.e. hip disarticulation) or bilateral amputations. The NoPT group consisted of 10% AK and 90% BK amputations. A higher percentage of individuals in the YesPT group lost their limbs due to vascular causes than NoPT (36.8% vs 20%). There were no statistically significant differences in SF-36 Total (YesPT: 78.0±29.7 vs NoPT: 87.5±18.6; p=0.115), PEQ (YesPT: 86.3±32.1 vs NoPT: 85.0±29.5; p=0.907), FFABQ (YesPT: 13.2±14.8 vs NoPT: 7.0±7.5; p=0.208), Perception of Confidence of Mobility section (YesPT: 7.4±2.4 vs NoPT: 8.7±1.7; p=0.128), or Perception of Satisfaction of Mobility section (YesPT: 7.3±2.4 vs NoPT: 6.9±3.2; p=0.653). Discussion: Our research suggests that the presence of a more complex amputation (i.e. high level and bilateral) and a vascular etiology may be associated with receiving PT treatment after amputation. Barriers to receiving PT included cost, lack of health insurance, or patients not feeling they needed PT. Although no significant differences were found when comparing final outcomes among the YesPT and NoPT groups, there is a possibility that initial measures at the time of amputation may not have been similar; those that received PT may have initially had lower levels of mobility and function and needed PT to catch up to those that did not. Conclusion: Our research did not show any statistically significant difference in SF-36, PEQ, FFABQ, or Amputee Perception Survey scores between individuals that received PT following lower limb amputation compared to those who did not receive PT. However, we were able to identify trends within our data, including a greater proportion of individuals receiving PT as a result of AK, bilateral, or vascular caused amputations when compared to individuals with BK, unilateral, or non-vascular caused amputations. We were also able to identify perceived barriers to receiving PT.

Keywords

Physical Therapy; Lower Extremity; Amputation; Lower Limb Loss; Self-Reported Outcomes; Patient Perception; Mobility

Disciplines

Medicine and Health Sciences | Physical Therapy | Rehabilitation and Therapy

File Format

pdf

File Size

335 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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