Use of Standardized Outcome Measures for People With Lower Limb Amputation: A Survey of Prosthetic Practitioners in the United States.

OBJECTIVE: To assess the clinical resources available for the assessment of health outcomes in people with lower limb amputation and to understand barriers and facilitators associated with use of standardized outcome measures in clinical practice. DESIGN: Cross-sectional survey. SETTING: General community (online). PARTICIPANTS: A volunteer sample of prosthetic practitioners was recruited through national professional organizations. Eligible participants were practitioners certified by a professional prosthetics organization and currently practicing as a prosthetist, prosthetist-orthotist, or prosthetic assistant. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A custom-designed online survey on clinical use of patient-reported and performance-based standardized outcome measures to assess patients with lower limb amputation. RESULTS: A total of 375 participants completed the survey. Most participants (79%) reported that they are encouraged or required to administer standardized outcome measures in their clinic or facility. Most participants reported that use of patient-reported and performance-based outcome measures are within their scope of practice (88%) and that they have the knowledge required for outcomes measurement (84%). Few participants agreed that outcomes measurement is standardized across the profession (30%). Most participants had access to small spaces and equipment for outcomes measurement, such as short hallways (65%-94%), stairs (69%), and tablets with wireless internet connection (83%). Most participants reported that they would be willing to spend between 5 (36% of participants) and 10 (43% of participants) minutes on self-reported surveys, and between 10 (41% of participants) and 20 (28% of participants) minutes on performance-based tests. CONCLUSIONS: Outcomes measurement is encouraged or expected in contemporary prosthetic practice. Strategies to improve standardization and efficiency of administration are needed to facilitate routine use of outcome measures in clinical care.

High-Level Performance After the Return to Run Clinical Pathway in Patients Using the Intrepid Dynamic Exoskeletal Orthosis.

BACKGROUND: Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge. OBJECTIVE: To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility. METHODS: Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review. The Comprehensive High-level Activity Mobility Predictor (CHAMP) and all subtests were completed prior to and after completion of the RTR as part of routine clinical care. An analysis of covariance (ANCOVA) was used to compare CHAMP scores before and after the RTR. RESULTS: Significant improvements were found in the T test (mean change, faster by 5.3 seconds; 95% confidence interval: 3.6, 7.1 seconds; P = .03) and total CHAMP score (mean change, 4.2 points; 95% confidence interval: 3.0, 5.3 points; P<.05). No significant changes were noted in the single-legged stance subtest, the Edgren sidestep test, or the Illinois agility test. CONCLUSION: The RTR led to improvements in high-level, multidirectional mobility in IDEO users with a history of fractures. Applicability of the intervention used in this study requires further validation before widespread use. LEVEL OF EVIDENCE: Therapy, level 4. J Orthop Sports Phys Ther 2019;49(7):529-535. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8763.