Predicting the use of prostheses by vascular amputees

Objective: To evaluate our accuracy in predicting the use of prostheses by patients undergoing major lower limb amputation. Design: Prospective study, with multiple assessors, ''blind'' to the predictions made by each other. Materials: Sixty-one patients (35 male: age 51-91, median 79) having their first major lower limb amputation. Methods: Five members of the rehabilitation team (surgeon, specialist in prosthetics, nurse, physiotherapist and occupational therapist) each recorded predictions of prosthetic use and mobility before amputation and during the first 2 weeks thereafter Patients were followed up 6-24 months later. Results: At follow-up 17 patients had died. Of the remaining 44 (25 below-knee and 19 above-knee amputees), 23 of 27 (85%) who had been predicted as using prostheses were doing so, while only 11 of 17 (65%) had been correctly predicted as non-users. Nevertheless, only two of the patients not using prostheses contrary to prediction had ever had prostheses made for them, and both had developed problems with the other leg at a later elate. Different members of the rehabilitation team were similar in their ability to predict outcome. Conclusions: Inappropriate fitting of prostheses can be kept to a minimum by a team approach to rehabilitation, but amputees may defy careful prediction by the development of new medical problems.