Measuring the Importance of Outcome Measures
Every amputee has concerns about receiving the right prosthesis. Traditionally, prosthetic design has been based upon the informed but subjective opinions of the patient and practitioner. Not surprisingly, this process is prone to errors. If prosthetic technology is over- or under-prescribed, patients with amputations do not receive optimal devices and do not achieve positive outcomes.
Most healthcare professions have standardized measures upon which they base patient outcomes. e orthotics and prosthetics profession is following suit. By adopting a company-wide, Outcomes-Based Protocol to prosthetics evaluation and care, Ability Prosthetics & Orthotics is establishing itself as a model for standardizing the application of objective outcome measures across a multi-office, multi-region prosthetics patient care company.
The protocol—which enables Ability practitioners to determine which prosthetic components are ideal for each amputee patient initially, as well as over time—consists of three components:
- Amputee Mobility Predictor
- StepWatchTM Activity Monitor
- Prosthesis Evaluation Questionnaire
The Amputee Mobility Predictor (AMP) is the first objective and practical method for measuring amputee capability before and after a prosthetic fitting. Originally developed by Robert S. Gailey Jr., PhD, PT, assistant professor in the University of Miami Leonard M. Miller School of Medicine Department of Physical Therapy, to help determine the Medicare K-level into which amputee patients fit, AMP is a series of activities, administered in 15 minutes or less, that tests a unilateral lower-limb amputee’s mobility without a prosthesis (AMPnoPRO) and predicts his or her mobility potential with a prosthesis (AMPPRO).
AMP testing begins by measuring an amputee’s ability to maintain balance from a seated position and then progresses to increasingly challenging activities that include seated transfers, single-leg stance, and ambulation. The practitioner assesses each activity with a concrete score; most tasks are scored on a 0 to 2 scale: 0 for inability to complete, 1 for completion with assistance, and 2 for fully independent completion. e maximum achievable score for AMPnoPRO is 43, and the maximum for AMPPRO is 47. After testing, the practitioner then converts the AMP mean score to its associated K-level.
By using quantified results based on consistent scoring criteria, AMP’s purpose is to maintain a consistent evaluation standard from patient to patient. Ability’s clinicians apply the AMP system to arrive at the most reliable K-levels and prescriptive data possible.
Ability’s amputee care also includes the use of the Step-Watch activity monitor. Worn on the ankle, the StepWatch records the number of steps a patient takes over an extended monitoring period—typically one to two weeks—to provide the practitioner with accurate and objective data to document and assess the patient’s activity level and function, track patient progress, determine patient compliance, and compare therapeutic interventions.
The Prosthesis Evaluation Questionnaire (PEQ) is a comprehensive, self-report instrument for individuals with amputations to evaluate the function of their prostheses and prosthesis-related quality of life. Using the PEQ helps Ability practitioners not only assess whether the prosthetic solution is working, but also whether or not the individual is enjoying a better quality of life as a result.
An outcomes-based prosthetics practice model ensures accurate, objective, and consistent clinical prosthetic evaluations; an optimal prosthetic device matched for t and function; provider accountability and validity; patient satisfaction with the prosthesis; and improved efficiency. Using outcomes- based protocols advances prosthetics practice from being an “art form” to being “state-of-the-art.”
In 1995, Medicare adopted a five-level functional classification system for individuals with amputations:
K0: Patient does not have the ability or potential to ambulate or transfer safely with or without assistance, and a prosthesis does not enhance his or her quality of life or mobility.
K1: Patient has the ability or potential to use a pros- thesis for transfers or ambulation on level surfaces at fixed cadence—a typical limited or unlimited house- hold ambulator.
K2: Patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces—a typical community ambulator.
K3: Patient has the ability or potential for ambulation with variable cadence—a typical community ambulator with the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic use beyond simple locomotion.
K4: Patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels—typical of the prosthetic demands of the child, active adult, or athlete.
Ability Prosthetics & Orthotics is proud to be the exclusive provider of the MyoPro, a revolutionary new custom myoelectric elbow orthosis. The MyoPro enables individuals afflicted with stroke and other neuro-muscular conditions to self-initiate and control movement of a partially paralyzed arm using their own muscle signals.
- Only custom upper extremity myoelectric elbow orthosis
- Clinically proven to improve mobility with therapeutic & functional outcomes
- Non-invasive sensor technology
- Intuitive controls for ease of use in setup & everyday functionality
- Utilized in progression from rehabilitation setting to activities of daily living
Call us at 1-800-455-0058 for a free patient evaluation.