The diagnostic importance of exercise testing in developing appropriate rehabilitation programmes for patients following transfemoral amputation.

ABSTRACT

AIM: The aim of this study was to determine whether an arm ergometry exercise test can successfully predict a clinician's decision for prosthetic fitting, and to define what other factors are also important predictors of a patient's ability to walk with a prosthesis. METHODS: The study included 63 patients who had undergone transfemoral amputation due to peripheral vascular disease and who had been admitted for primary inpatient rehabilitation. Participating patients went through standard admission procedures and performed an intermittent sub maximal arm ergometry exercise test in the first week after admission consisting of a two-minute exercise routine with a one-minute pause in-between by means of the Angio V2. The work loads started at 10 W and were increased by 10 W at each level. The cranking rate was 50 to 55 rpm. RESULTS: The patients reached an output level of 20 W on average. Those patients selected for fitting with a prosthesis achieved higher levels on the exercise stress test (26 versus 12 W, P<0.000). The results of the exercise stress test, the 6-minute walking test and the functional independence measures (FIM) at admission, as well as their age and gender, allowed for successful discrimination between patients who were fitted with a prosthesis and those who were not (P<0.000). The best discriminator was that of the results achieved on the exercise stress test. Using the five previously mentioned variables, 83.6% of the patients were successfully classified as to whether or not they were fitted for a prosthesis on the basis of our clinical decision. CONCLUSION: The exercise stress test is a good predictor of prosthetic fitting. It also anticipates the possibility of cardiovascular complications during rehabilitation programmes. Combined with the 6-minute walk, the FIM, and age, it may be an important criteria to consider in making the decision about the appropriateness of prosthetic fitting.