Lower limb amputation (LLA) results in a significant decline in function both locally and internationally. In Johannesburg South Africa, the LLA population is generally underprivileged and the two tertiary level hospitals do not offer long term rehabilitation to them on an inpatient basis. Thus the researchers needed to pilot tools which can be used to report on LLA outcomes in this Metropolitan area.

Aims:

To ensure reliability of the instruments.

To ensure ease of use of the instruments both by the researcher and the understanding by people with LLA

To report on the long-term outcomes of LL in this Metropolitan area using these tools

Relevance/significance: it is vital to check reliability before using instruments that were not designed locally.

Setting: Chris Hani Baragwanath Hospital (CHBH), Johannesburg, South Africa, a tertiary level hospital

Ethics: institutional ethical clearance was obtained (M110124).

Participants: participants (n=15(10% of the main study)) from CHBH were included if they had a unilateral LLA. They were excluded if they had bilateral LLA, people under the age of 18, people who were wheelchair bound.

Methods: a cross-sectional observational study was conducted. Consecutive sampling was used. Participant consent was obtained. Interviews were conducted using the Barthel index to measure function (BI), Modified Amputee Body Image Scale (MABIS), Participation Scale (P-Scale), Euroqol EQ-5D quality of life (EQ-5D), Modified Locomotor capabilities index (MLCI). Timed Up and Go test (TUG) was used to test the risk of falling. Translations into Zulu & Sotho were done. All participant data were kept confidential and the autonomy of the participants was protected.

Analysis: Data were analyzed using STATA Version 11.0. Internal consistency was measured using Cronbach’s alpha. Spearman’s correlation was calculated and percentiles also established.

Results: Cronbach’s alpha BI=0.66, MABIS=0.86, P-Scale=0.88, EQ-5D=0.44, and MLCI=0.91 respectively. Percentiles and medians BI= 25^th 19, 50^th  20 and 75^th 20, MABIS=25^th 35, 50^th 46 and 75^th 55, P-Scale=25^th 3, 50^th 12, and 75^th 30, MLCI=25^th 29, 50^th 40, and 75^th 42 TUG=25^th 12, 50^th 17, and 75^th 23, EQ-5D VAS=25^th 50, 50^th 75 and 75^th 90, Age=25^th 45, 50^th 58 and 75^th 66, years since amputation=25^th 0, 50^th 1 and 75^th 20.

Correlation between the participant’s time since amputation and current function revealed r=-0.26 (TUG), r=-0.24 (P-Scale), r=0.49 (EQ-5D VAS). The BI, MABIS and MCLI demonstrated no correlation with time since amputation.

Conclusion: The above outcome measures are reliable and fit for use in the main study. They show good internal consistency. Good long term physical outcomes such as participation depends on time since amputation and body image is not correlated to time since amputation. Participants were generally highly functional although they had marked body image disturbance.

Implications: the above outcome measures can be used in the main study.

Keywords: reliability, outcome measures, lower limb amputation

Funding source acknowledgement: special thanks to the Faculty research committee (FRC) for funding the study