Brief report
Physical Disability After Severe Lower-Extremity Injury

https://doi.org/10.1016/j.apmr.2006.05.006Get rights and content

Abstract

Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ, and the LEAP Study Group. Physical disability after severe lower-extremity injury.

Objective

To investigate the use of a combined measure of decreased walking speed and gait deviation to identify high physical disability in patients with lower-limb salvage.

Design

Longitudinal study of patients with severe lower-extremity trauma.

Setting

Eight level I trauma centers.

Participants

Patients (N=276) with lower-limb salvage from the Lower Extremity Assessment Project.

Interventions

Not applicable.

Main Outcome Measures

Disability from the physical dimension of the Sickness Impact Profile (SIP), walking speed, and gait deviation were measured at 24 months of follow-up. A 1-way analysis of variance and planned comparisons compared mean SIP scores across and between the following 3 outcome groups: no impaired speed and no gait deviation, impaired speed or gait deviation, and impaired speed and gait deviation.

Results

Mean SIP scores for the physical dimension and its 2 categories of ambulation and body care and movement differed statistically across the planned comparisons. The mobility category showed that the impaired speed or deviation group was statistically similar to the group without impaired speed and gait deviation.

Conclusions

The combination of decreased walking speed and gait deviation appears to provide a valid measure of physical disability among patients with lower-limb salvage.

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

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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.

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