Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care even in industrial societies. Several studies on subjects with LLA have been focused on the efficacy of rehabilitation and factors influencing the use of prosthesis. However, literature data on the recovery of ability to walk outdoors, and thus to participate in social life in this population is limited.

To investigate potential correlations between socio-demographic and clinical factors, and the use of the prosthesis for indoor and/or outdoor walking referred to as community ambulation (CA) in subjects with LLA.

An observational cohort study on 687 LLA subjects was conducted. Socio-demographic and clinical characteristics of 302 subjects who received similar rehabilitative treatment with respect to the standard protocol were collected by a telephone survey with a structured questionnaire. The CA recovery, in terms of patient’s autonomy and participation, assessed by Walking Handicap Scale, was considered as the main outcome.

The univariate analysis demonstrated statistical significant positive correlation between CA and gender (χ2 = 3.901, P = .048); amputation level (χ2 = 24.657, P < .001); pre-LLA (χ2 = 6.338, P = .012) and current work activity (χ2 = 25.192, P < .001); prosthesis use (χ2 = 187.037, P < .01); and time from LLA (r = 0.183, P < .001); increasing age was negatively correlated with the outcome (r = –0.329, P < .001), while pain intensity was not significant. Being male (75.4%); trans-tibial (TT) amputation level (9.79%); working before (3.81%) and after LLA (7.68%); and the prosthesis use (24.63%) increased the probability of CA recovery. Multivariate binary logistic regression analysis confirmed that the prosthesis use (P < .001) and TT amputation level (P = .042) are predictors of a positive outcome (Walking Handicap Scale 4–6).

These findings highlight the importance of the use of prosthesis in people with LLA for the restoration of a good capacity of participation (CA), especially in subjects with TT amputation level. The identification of predictive factors may help tailor-made rehabilitation approaches addressing an earlier reintegration to social life.

1 Introduction

Lower limb amputation (LLA) is still a health issue requiring rehabilitation and long-term care,[1] despite the great advances in medicine and prevention of accidents in high welfare industrial societies with significant reductions in the incidence of LLA in specific at-risk populations.[2]

Several systematic reviews and epidemiologic data on LLA have been focused on the efficacy of rehabilitation in terms of the use of prosthesis[1–4] in order to compensate for the functional loss[5,6] within a rehabilitation program aimed at recovery of standing and walking ability while wearing a prosthesis.[7] Literature reports dissimilar data on percentages of amputees who successfully use the artificial limb after rehabilitation, ranging from 5%[8] to 100%[9,10] possibly related to what is meant as successful rehabilitation outcome: that is, living at home autonomously,[11] having a good level of independence,[12] Activities of daily living,[13,14] mobility,[15] and participation.[11] However, the gold standard of the rehabilitation process remains the restoration of an adequate level of functioning and participation in an indoor and/or outdoor activity, referred to as community ambulation (CA). Literature data has not sufficiently addressed this aspect in individuals with LLA.

Moreover, differences in surgical procedures, postoperative care, prosthesis manufacture, rehabilitation strategies, and geographic origin in these studies, lead to a vast heterogeneity of the samples and, as a result, difficult comparison among various observational studies on large samples of LLA[16–18] as well as in epidemiological studies.[4,19,20] Indeed, studies on return to work or social activity in people with LLA include many confounding factors which reduce the identification of the rehabilitation outcome predictors. Therefore, studies on pivotal socio-demographic (gender, age, working status) and clinical parameters (such as side, pain, and amputation level) should be carried out by minimizing the effect of confounding variables such as different rehabilitation programs and/or prosthesis manufacture, which could influence the outcome of LLA rehabilitation. To our best knowledge, few population-based studies have been conducted in a well-defined geographical area, while minimizing these factors.[21] ….

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