Baseline PTSD and depressive symptoms predict multidimensional recovery after combat-related transtibial amputation: a prospective cohort study.

The sample was small and exploratory, so subgroup estimates and predictive models are not stable. The study was observational and had no control group, so it cannot show that the rehabilitation program caused the improvements or separate them from natural recovery. All participants received robotic gait training combined with traditional physical therapy while using prostheses, so the contribution of any single component cannot be separated. The cohort was all male military personnel with combat transtibial amputations treated under wartime conditions, so results may not apply to civilians, women, other amputation levels, or lower resource settings. PTSD and depression scores were highly correlated, so the study cannot fully separate their independent effects. Psychiatric assessments were done only at the start and endpoint, so changes during rehabilitation were not measured. Exploratory predictive analyses were not externally validated and some were not adjusted for multiple comparisons. Prosthetic component details and other confounders such as daily prosthesis use, social support, and outside adherence were not measured.

The supplied text does not state funding sources or conflicts of interest.

Do not read the functional gains as proof that robotic gait training caused recovery. The study had no control group, all participants also received traditional physical therapy and continued prosthetic use, and the contribution of any single component cannot be separated. Do not use the psychiatric screening thresholds to predict an individual patient's outcome; the authors state these analyses require external validation.