Peripheral neuropathy prevalence and effect on mobility 12 months after prosthesis prescription among individuals with dysvascular lower extremity amputation.
Daniel C Norvell, Elizabeth G Halsne, Alison W Henderson and 5 others
PMID 39206670WHAT IT FOUND
Veterans with dysvascular lower limb amputation and peripheral neuropathy were less likely to achieve independent basic and advanced mobility with a prosthesis 12 months after prescription.
The risk was higher for those with transfemoral amputation or major depressive disorder. Screen for neuropathy and depression early in rehabilitation.
Key findings
0166% of veterans with dysvascular lower limb amputation had a diagnosis of peripheral neuropathy prior to prosthesis prescription.
02After adjusting for confounders, peripheral neuropathy was significantly associated with not achieving basic mobility (aOR 0.53) and not achieving advanced mobility (aOR 0.43).
03The detrimental effect of peripheral neuropathy on mobility was stronger in patients with major depressive disorder for both basic and advanced mobility outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Peripheral neuropathy diagnosis was based on retrospective ICD codes from a clinical database, not on standardized clinical examination, so the severity and specific type of neuropathy are unknown. The study did not have access to post-prescription rehabilitation data, so it is unclear if patients received targeted therapy for neuropathy. Vision loss, which can affect balance and mobility, was not included in the analysis. The sample size for transfemoral amputees with peripheral neuropathy was small, leading to wide confidence intervals and non-significant results in this subgroup, despite a strong observed effect. The study population was exclusively veterans, which may limit generalizability to other healthcare systems or demographics.
Declared interests
The authors declared no conflicts of interest. The study was supported by the Department of Veterans Affairs.
The easy way to misread this
Do not assume that the lack of statistical significance in the crude analysis or in the transfemoral subgroup means peripheral neuropathy has no impact. The adjusted analysis showed a significant negative effect, and the non-significant transfemoral result is likely due to small sample size rather than absence of effect.