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Predicting mobility outcomes for amputees early in rehabilitation is a process fraught with difficulty but nevertheless important because walking ability influences the choice of appropriate prosthetic components for the individual. The choice is usually based on the skill and experience of the prescribing clinician. In a retrospective study of hospital records published in the April issue of Prosthetics and Orthotics International, Matthijs Spaan and co-workers (2017)tested the ability of three tests of motor function administered at admission to rehabilitation to predict walking ability at discharge. A multiple regression analysis used age, sex, cause and level of amputation and one of three tests of motor function as predictors of walking ability at discharge. The study demonstrated that the Amputee Mobility Predictor Assessment Tool (AMPnoPRO) was a better predictor of discharge outcomes than the Balance test or the Lower-Extremity Motor Coordination Test.

It is well known that obesity is a risk factor for heart disease and diabetes. Health practitioners often use Body Mass Index (BMI, calculated as the ratio of body mass in kilograms to the square of height in metres) to estimate total body fat and the relative risk of developing weight-related diseases. The index is widely recognized as a poor index particularly for individuals with high muscularity. In amputees, the missing mass of amputated limbs also affects the validity of BMI. The Amputee Coalition provides an on-line calculator to correct BMI for missing limb mass but the assumptions underlying the calculator have never been tested. Alexandra Frost and colleagues (2017)have compared amputee-corrected BMI estimates of adiposity with measurements using DXA (dual-energy X-ray absorptiometry), a much more reliable and valid index of adiposity. They found that the amputee-corrected BMI underestimates health risk for obese amputees and overestimates risk for lean, muscular amputees. Health professionals need to be aware of the shortcomings of BMI when providing health-related advice.

Providing prostheses for people with disabilities in rural and remote areas is very challenging if patients must travel great distances to clinical facilities. Problems are often exacerbated by a lack of trained personnel in these areas. In a paper recently published in OnlineFirst, Liezel Ennion, Anton Johannesson, Anthea Rhoda (2017)evaluated the Össur® Direct Socket manufacturing system for use in KwaZulu-Natal in South Africa. The mixed methods study included quantitative outcome measures (HRQoL and OPUS) and qualitative outcomes based on interviews with patients. Their data supported the use of the direct socket system which provided an acceptable quality solution in a single visit.

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Tim Bach

Prosthetics and Orthotics International (POI)