Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation.
Michael Chislett, Michelle Ploughman, Jason McCarthy
PMID 33543107WHAT IT FOUND
Despite prescreening, 21.4% of amputees failed prosthetic fitting.
Above-knee amputation and low initial function predicted longer stays. Dependence in dressing and unhealed skin predicted fitting failure. Age and sex did not predict outcomes.
Key findings
0121.4% of patients had an unsuccessful prosthetic fitting despite prior screening.
02Dependence in dressing and skin ulceration on the residual limb or remaining foot were associated with failed prosthetic fitting.
03Above-knee amputation and lower admission FIM scores were associated with longer length of stay.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was retrospective, so it could only analyze data that had already been collected. Success was judged subjectively by the treating physiotherapist at discharge, with no long-term follow-up on prosthetic use. The sample was homogeneous, consisting mostly of older adults with diabetes or vascular disease, limiting generalizability to younger patients or other amputation causes. The screening tool (LLAMS) was completed by clinicians who also provided treatment, introducing a risk of confirmation bias.
Declared interests
The authors declared no conflicts of interest. The study was part of a quality improvement initiative.
The easy way to misread this
Do not use the LLAMS score to definitively predict which patients will fail prosthetic fitting. Although it was associated with outcomes, its ability to discriminate between success and failure was poor, and no clinically useful cutoff value could be identified.