Sunday, November 27, 2022

Amputee Complexity Score -Reply summary part 2

Ted Trower

————————————————————————————–

Good Timing. There was an intern or some individual that just
sent out a survey to see how amputees are managed by the prosthetist
and
physical therapist. It had 4 surveys listed to find

out which one you used; if any. I found it very enlightening
since I have not used any formal

performance evaluation when I have dispensed a new prosthetic
socket of
any type; just my chart notes. I think this is an important issue for
the Academy to address and stress it’s use routinely be done. I am
sorry I
cannot refer you to the female individual since I deleted the message
(just
a quick habit sometimes). I will see if I can find the survey address
on my sent mail option.

I hope someone on the list serve has the name and contact
information
for her so you can get your answers.

————————————————————————————–

The type of residual limb presented is very important. A two
inch, conical, residual limb on a geriatric dysvascular amputee is
different than a healthy 8″ cylindrical residual limb on a young
traumatic amputee.

————————————————————————————–

Have you seen the Amputee Mobility Predictor (AMP) that Bob Gailey,
PT
developed? It’s the only tool availble that was designed for amputees
that shows progress for things such as single and double limb balance,
fatigue, etc. It also predicts (quit accurately) the patient’s K-level
before ever receiving a prosthesis.

http://www.oandp.org/olc/lessons/html/SSC_06/Gailey_AMP_Arch_of_Phys_Med_Rehab_2002.pdf
[http://www.oandp.org/olc/lessons/html/SSC_06/Gailey_AMP_Arch_of_Phys_Med_Rehab_2002.pdf]

————————————————————————————–

I know that different groups are working on
patient classification activities but none that are looking at a basic
listing of associated comorbidities, ranking these to get a summary
complexity score.

Why not give it a run?

————————————————————————————–

Seeing things from both sides of the fence, I would suggest you
consider these factors as well:

Time since amputation (1st prosthesis v. 5th?)

Amputation level

Activity level

Age

Pain assessment scale (like used in emergency rooms)

Family support?

Physiological state (may be difficult to assess)

I realize these have little to do with the physical creation of the

limb, but are all factors in adaption to and acceptance of the new
limb.

This would be a very interesting study for someone to research and
present at a state or national meeting.

————————————————————————————–

You may have hit upon why outcome measurements in our field are
either
difficult or inaccurate.

One way to accomplish what you are trying to do is to define the
ideal
patient and then subtract or add scores for deviations from ideal.
Variables could include height weight, stump length, diabetes, blood
pressure, etc

————————————————————————————–

I think you have touched on a very interesting subject. Why would
it

be helpful to score (or otherwise assess) relative difficulty prior to

beginning the fitting process? It’s an interesting idea, but I’m not
sure I

understand how it would effect treatment. Couldn’t these concerns be
more

accurately assessed after the fact?

————————————————————————————–
I’m
not sure if this is exactly what you’re looking for, but have you
heard of the PAVET score? Here is a link to the document. It is a great
indicator when working with transfemoral amputees to see objectively if
they would be good microprocessor candidates.

https://www.bcbsil.com/provider/pdf/forms/pavet.pdf
[https://www.bcbsil.com/provider/pdf/forms/pavet.pdf]

===================

End of replies.

Clearly there is interest in the question, and the question itself
still needs some definition. Several people indicated a desire to help
work on it so I think I’ll start with a round table discussion via
email. If anyone else wants to be involved please let me know.

Ted A. Trower CPO, FAAOP
A-S-C Orthotics & Prosthetics
Jackson, MI
Continuing Education Chairman
Michigan Orthotics & Prosthetics Association

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