Functional Outcomes Measures for Limb Loss
Calling all physical therapists that work with patients with limb loss! It is important to understand the available functional outcomes measures for this patient population and why it is so important to choose the correct one for the patient. Currently, insurance companies are requiring patients to have evaluations from a physical therapist, a physician, and a prosthetist to determine an appropriate K level (functional level) and a correlating prosthesis. Insurance companies also require physical therapists to choose a functional outcome measure for patients that will demonstrate a potential for growth to justify physical therapy interventions. This can become a problem when the prosthetist and the therapist choose the same intervention and have different outcomes. For example, a prosthetist using the AMPPRO may appropriately score the patient slightly higher to justify a high level prosthesis while a physical therapist may appropriately score a patient slightly lower to justify therapeutic interventions. This test is very sensitive and subjective so that only a few points will change the category outcome of the patient. That being said, most insurance companies look only for the AMPPRO to make prosthetic justifications. What is the best current solution? Multiple functional outcomes measures at an evaluation! High level patients will tend to "cap out" on the AMPPRO and will require a separate measure to justify therapeutic interventions. Below are the best currently available functional outcomes measures!
AMPPRO/AMPnoPRO: The amputee mobility predictor with a prosthesis and the amputee mobility predictor without a prosthesis is a twenty item functional test designed to classify the patient in the appropriate K level. www.oandp.org/olc/lessons/html/SSC_06/Gailey_AMP_Arch_of_Phys_Med_Rehab_2002.pdf
CHAMP: The construct validity of comprehensive high level activity mobility predictor is a performance based outcome measure with four separate tests that provide the patient with a baseline score at the completion of the outcomes measure. https://www.rehab.research.va.gov/jour/2013/507/jrrd-2012-05-0100.html
PlusM: The prosthetic limb users survey of mobility is a self report survey used for measuring mobility in adults with lower limb amputations. http://plus-m.org/
Two minute walk test: Quick and simple test completed by measuring the distance covered by the patient in two minutes. www.archives-pmr.org/article/S0003-9993%2802%2900252-6/fulltext
Timed Up and Go: Swiftly applied functional test that requires little equipment and space with high validation. https://www.physio-pedia.com/Timed_Up_and_Go_Test_(TUG)