Houghton Scale of prosthetic use in people with lower extremity amputations: Reliability, validity, and responsiveness to change

Objective: To evaluate the responsiveness to change and the floor and ceiling effects of the Houghton Scale. Design: One-week and 3-month test-retest to evaluate reliability, validity, and responsiveness to change. Setting: Amputee rehabilitation program. Participants: Persons (N= 125) with unilateral or bilateral lower-extremity amputation who were wearing a prostheses: I group (n=49) for the reliability component and another group (n=76) for the responsiveness and validity component. Interventions: Not applicable. Main Outcome Measures: Responsiveness to change, ceiling and floor effects, and reliability and convergent validity. Results: Evaluation of responsiveness to change (n=76) showed that the total score increased from a mean +/- standard deviation of 6.14+/-2.40 at discharge to 7.70+/-2.62 (P<.001) at follow-up 3 months later. Floor and ceiling effects were not detected for the overall score but were noted for the individual subscales. The internal consistency was moderate at discharge (Cronbach alpha=.71) and follow-up (Cronbach alpha=.70). The Houghton Scale correlated significantly, although moderately, with the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r=.393, P<.01) and the 2-minute walk test at admission (r=.620, P<.01) and discharge (r=.653, P<.01). The reliability (intraclass correlation coefficient =.96) of the Houghton Scale was high (n=49). Conclusions: The Houghton Scale is appropriately responsive to change in prosthetic use in individuals with lower-limb amputation after rehabilitation.