A post-discharge functional outcome measure for lower limb amputees: test-retest reliability with trans-tibial amputees.

There are approximately 700 lower limb amputations performed throughout Scotland each year. A national system of survey and analysis conducted by the Scottish Physiotherapy Amputee Research Group (SPARG) provides information on these patients up until discharge from hospital. However, there has been no method of collecting long-term functional and prosthetic use information following discharge. The Functional Measure for Amputees (FMA) has, therefore, been developed from the Prosthetic Profile of the Amputee (PPA) questionnaire, designed by Gauthier-Gagnon and colleagues in Canada (Grisé et al, 1993). Modifications to the PPA were carried out to make it more appropriate for the Scottish amputee population; these changes were approved by the original authors. The test-retest reliability of the 14-question FMA was assessed using a repeat postal questionnaire study. One hundred and thirty-three (133) from a possible 390 trans-tibial amputees were returned. Comparing sociodemographic and clinical variables between consenters and non-consenters showed no evidence to support sample bias. Continuous data items on the FMA analysed using an intraclass correlation coefficient showed ICC values of 0.74, 0.85, 0.96 and 0.64. Categorical data items analysed using percentage agreements showed reliability of over 70% for seven items, between 40% and 70% for three items and between 20% and 40% for the remaining three items. The FMA questionnaire was found to be reliable on the majority of its questions and moderately reliable on the remaining questions during successive follow-up postal administrations.

An evaluation of the Amputee Mobility Aid (AMA) early walking aid.

The most popular early walking aid (EWA) in the United Kingdom (UK) is the Pneumatic Post-Amputation Mobility aid or PPAM aid. A disadvantage of this device is that it does not allow a trans-tibial amputee to flex or extend the knee during walking. The Amputee Mobility Aid (AMA) was developed to allow knee movement, enabling trans-tibial amputees to practise a more natural gait. The benefits of using EWAs include early walking, reduction in post-operative oedema and improvement in patient morale. This pilot study investigated the pneumatic bag/stump interface pressures of the PPAM aid and the AMA. In addition, the range of motion of the knee on the amputated side and the mechanical knee of the AMA were compared. The AMA was found to have higher interface pressures than the PPAM aid during standing and similar pressures during supported walking. Subjects using the AMA did flex and extend their knee during walking but through a reduced range of motion. There were no significant differences between the angular movements of the AMA's mechanical knee and the patient's knee within it.

Screening for diabetes in lower limb amputees: a pilot study.

The Saint Vincent Declaration includes 5-year targets to improve the outcome of diabetic patients as a central tenet. Meeting these targets requires a comprehensive screening and monitoring programme to establish the current incidence of diabetic complications and show that the major goals of the declaration are being achieved. The Scottish Physiotherapy Amputee Research Group and the Scottish Vascular Audit Group jointly organized a three month prospective screening programme of 146 patients presenting for a lower limb amputation. The results suggest that a significant proportion of patients have undiagnosed diabetes. Further, only around half of the patients eligible for testing actually had a test done, highlighting the difficulties associated with establishing a national screening programme. This programme is now ongoing and particular importance is being given to improving the proportion of patients actually being tested.

Three measures of functional outcome for lower limb amputees: a retrospective review.

Outcome measures are becoming increasingly important in health care. Functional outcome measures are of particular importance for lower limb amputees since much of the rehabilitation process is concerned with increasing mobility and personal independence. The Scottish Physiotherapy Amputee Research Group (SPARG) has used three measures of functional outcome: the Barthel Index, Russek's classification and the Locomotor Index. The review reported here involves 938 patients having a primary amputation at the transtibial or transfemoral level between October 1992 and July 1997. Differences in function due to age and level of amputation are well known clinically and the measures were compared by looking at their ability to detect these differences. The Barthel Index lacked sensitivity because of ceiling effects and should not be considered as a suitable functional outcome measure for amputee patients. Russek's classification does detect significant differences but requires a large number of patients making it unsuitable for single hospital investigations. The Locomotor Index demonstrates significant differences due to age and amputation level despite fewer patients being assessed by this measure during the period covered by this paper. The range of the Locomotor Index can be extended to cover more active amputees by considering its 'advanced activities' subscale separately. The Locomotor Index is a promising measure and should be considered by rehabilitation teams looking for a valid, reliable and sensitive functional outcome measure for use with lower limb amputees.

Direct measurement of the optical properties of human breast skin.

The optical properties of thin tissue samples are obtained using goniometric apparatus. Direct measurements of the scattering of 633 nm light by 20-120 microns thick samples of in vitro human breast epidermis and dermis are numerically integrated to obtain values for the scattering and absorption coefficients mu s and mu a, respectively, and the anisotropy parameter g. The total attenuation coefficient mu t is obtained from transmission measurements. The Beer-Lambert law is found to be sufficiently valid for congruent to 100 microns thick samples to be used as the basis of the numerical integration. However, normalisation errors involved with the integration mean that only approximate values of mu a could be obtained. Values of congruent to 40 mm-1 are obtained for mu t and mu s, with the value of mu a estimated as 1 mm-1. The optical properties of human breast epidermis and dermis are found to be similar at 633 nm, and the two could be considered as a single layer for modelling light propagation at this wavelength. Further, the intersubject variability seen in this study suggests that a model that uses a range of values for each optical property may be more useful in a clinical situation.