Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation.

AIM: To develop and examine the psychometric properties, including responsiveness and interrater reliability, of a new outcome measure for the evaluation of basic mobility activities after a major lower extremity amputation - The Basic Amputee Mobility Score (BAMS). METHODS: The four following essential activities were chosen through consensus meetings with experienced amputee physiotherapists: (i) supine in bed to sitting on the edge of the bed; (ii) bed to wheelchair transfer; (iii) indoor wheelchair mobility; and (iv) get up from a wheelchair to standing on the non-amputated leg. Each activity is scored from 0 to 2 (0 = not able to; 1 = able to with assistance/guiding; and 2 = independent), and cumulated to a 1-day BAMS score of 0-8. Validity and responsiveness were established in 106 consecutive in-hospital patients with a major dysvascular lower extremity amputation, while reliability and agreement were examined in an additional sample of 30 patients. RESULTS: The 30-day mortality risk was reduced by 88% (HR = 0.12, 95% CI 0.02-0.68) for those out of bed (BAMS ≥2 points) at the first physiotherapy assessment, while BAMS scores improved between the first and the discharge assessment, with a standardized response mean of 1.3. Reliability assessments resulted in a weighted Kappa value of 0.98, a standard error of measurement of 0.32 and a minimal detectable change of 0.89 points. No systematic between-rater bias was seen (P = 0.3). CONCLUSIONS: The BAMS was feasible in all patients, and showed a large responsiveness, excellent interrater reliability and with a change of 1 point indicating a real change in performances. Geriatr Gerontol Int 2018; 18: 138-145.

Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation.

INTRODUCTION: Balance is beneficial for daily functioning of patients with a lower limb amputation and sometimes assessed by the one-leg stand test (OLST). The aims of the study were to examine (1) the number of trials needed to achieve performance stability, (2) the interrater reliability of the OLST in patients with a major non-traumatic lower limb amputation, and (3) to provide a test procedure. METHODS: Thirteen women and 23 men with a mean age (SD) of 67.4 (10.6) years; 19 below-knee and 17 above-knee amputees who performed the OLST at a mean of 14.5 (4.5) days post-amputation. All patients performed five timed OLST-trials with 1-min rest intervals between trials, supervised by a physical therapist, of which 28 included in the reliability-part conducted this twice, separated with a mean of 3.4 (0.78)h. Repeated measures Friedman determined the number of trials needed to ensure stable OLST-scores while the ICC1.1, the standard error of measurement (SEM) and the smallest real difference (SRD) determined reproducibility. RESULTS: No learning curve was found for the five OLST-trials (p=0.241), with the best of the five trials reaching a median (25-75% quartile) of 2.9 (1.7-8.2)s, and with only six patients able to stand for more than 10s. The ICC (95% CI), SEM and SRD were respectively 0.87 (0.61-0.96), 0.99 s and 2.74 s. CONCLUSION: Findings suggest that the best of five trials be used for the OLST in unilateral non-traumatic amputee patients as we found excellent interrater reliability and acceptable agreement when using this score.