Brief reportPhysical Disability After Severe Lower-Extremity Injury
Section snippets
Participants
At 24 months, 330 patients who underwent lower-limb reconstruction after severe high-energy trauma were enrolled in the Lower Extremity Assessment Project (LEAP). High-energy trauma was defined as Gustillo grade IIIB and IIIC fractures, selected grade IIIA fractures, dysvascular limbs, major soft-tissue injuries to the tibia, and severe foot injuries.5 Previous results5 found a minimal association between the characteristics of the injury and functional outcomes. The current analysis included
Results
At 24 months, the overall mean physical dimension SIP subscore ± standard deviation (SD) was 9.4±9.8, and the mean scores for mobility, ambulation, and body care and movement were 6.7±13.5, 16.7±14.3, and 7.2±9.4, respectively. Fifty-four percent of subjects had at least 1 gait deviation and 32% had a walking speed less than 73m/min.
Mean SIP scores for the physical dimension and each of its categories differed statistically across the 3 groups, with group 3 consistently having higher disability
Discussion
Various physical performance measures are recommended in the literature, yet there is little consensus on a standard measure for physical mobility.9 As hypothesized, patients with both impaired speed and gait deviation had statistically higher disability scores than patients with either impaired speed or gait deviation.
Three distinct groups were found for the ambulation and body care and movement categories. Unexpectedly, only 2 distinct groups were identified in the mobility category. Subjects
Conclusions
Although the separate measures of walking speed and gait deviation provide clinicians with valuable information regarding physical functioning, a combination of these measures appears to provide a valid measure of physical disability for patients with lower-limb salvage.
Acknowledgments
The LEAP Study Group is Ellen J. MacKenzie, PhD, Michael J. Bosse, MD, James F. Kellam, MD, Andrew R. Burgess, MD, Lawrence X. Webb, MD, Marc F. Swiontkowski, MD, Roy Sanders, MD, Alan L. Jones, MD, Mark P. McAndrew, MD, Brendan Patterson, MD, Melissa L. McCarthy, ScD, Thomas G. Travison, PhD, and Renan C. Castillo, MS. We acknowledge the tireless efforts of the study coordinators and physical therapists at each of the 8 LEAP study sites. Their dedication to the study’s objectives and their
References (10)
- et al.
Reorganization of gait after limb-saving surgery of the lower limb
Am J Phys Med Rehabil
(2003) Performance-oriented assessment of mobility problems in elderly patients
J Am Geriatr Soc
(1986)- et al.
Lower extremity function and subsequent disabilityconsistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery
J Gerontol A Biol Sci Med Sci
(2000) - et al.
Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait
Phys Ther
(2002) - et al.
An analysis of outcomes of reconstruction or amputation of leg-threatening injuries
N Eng J Med
(2002)
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Supported by the Johns Hopkins Center for Injury Research and Policy and National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention (grant no. CE000198-03) and the National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health (grant no. RO1-AR42659).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.