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Ocampo Plazas M.L.1, Ortega Hernandez A.M.1, Arias Reina M.A.1, Garzón Gomez C.P.1, Contreras Sarmiento D.1, Hernandez Alvarez E.D.1, Escobar Aviles F.C.1, Solorzano Bravo M.A.1
1Universidad Nacional de Colombia, Departamento del Movimiento Corporal Humano, Bogotá, Colombia
Background: Most amputations in Colombia are lower-limb amputations, on men under 40. Rehabilitation focuses primarily on clinical condition management and doesn´t include physical fitness evaluation as a key element of exercise prescription. Such evaluations are very important, as optimal physical-fitness conditions encourage prosthetic adaptation and amputees' functional rehabilitation.
Purpose: To develop and validate a physical fitness evaluation battery for pre-prosthetic unilateral lower-limb amputees.
Methods: A descriptive study of the construction and validation of scales, aimed at the theoretical construction of an evaluation battery, beginning with a review of the international literature that orients the evaluation of fitness in the study target population tests, according to international tests and assessments used in the measurement of physical capability in patients with amputated limbs. Validation of the battery by expert judges in the criteria of relevance, adequacy and consistency of each test included in the battery. Application of the battery to an amputated client, to verify the batterys measurement properties.
Results: The literature review did not yield batteries designed for evaluating fitness for health of lower-limb amputees, but it did offer some tests for determining physical capabilities. A battery was assembled of five tests for assessing the elements of physical fitness: body composition (height, weight, body density, fat/fat-free mass ratio); strength (isokinetic dynamometry); flexibility (Flexitest); and cardiorespiratory endurance (upper- and lower-limb cycloergometry and upper-limb-only cycloergometry for patients with lower-limb claudication).
Tests were chosen for greatest reliability and applicability to lower-limb amputees. Only the mathematical equation for weight determination lacked validity and reliability studies; it was included regardless, because it was designed specifically for lower-limb amputees and takes varying amputation levels into account.
Validation established the tests relevance, adequacy and consistency. The experts scored the battery and arrived at consensus percentages from 67% to 100%. The lowest ratings corresponded to the combined cycloergometric test, height/weight measurements, and isokinetic dynamometry (67%, 78% and 89% respectively). The other tests (body density, fat/fat-free mass ratio, Flexitest) attained 100% consensus.
The battery was then applied to an amputee patient to refine the measurement properties. Adjustments were made to the required materials, verbal patient instructions, methods and forms for recording data.
Conclusion(s): Trans-tibial amputees see their basic physical capacities altered by lengthy immobilization and hospitalization, disruptions in everyday activities, and hindered participation in leisure and work activities. Evaluation of their physical fitness conditions is essential, and yet, the literature pays little attention to methods, processes and tests for such evaluation.
After a careful and rigorous review, there is now a physical fitness evaluation battery to support evaluation processes, decision-making, and physiotherapeutic interventions for pre-prosthetic lower-limb amputees.
As a fundamental element of exercise prescription, physical fitnesss evaluation prior to prosthetic adaptation benefits the patient, allowing exercise as an intervention strategy to respond to the users particular conditions and preventing the negative deconditioning effects of immobilization.
Implications: Physiotherapist has a validated battery to evaluate physical fitness in lower-limb amputees in the pre-prosthetic phase. The objective data provided strengthens the processes of intervention, recovery, and rehabilitation, offering tools for early design and implementation of exercise-focused intervention programs.
Funding acknowledgements: This work received financial support from the National University of Colombia through the call Research, Creation and Innovation Program.
Topic: Disability & rehabilitation
Ethics approval: The study was approved by the Ethics Committee of Medicine Faculty of the National University of Colombia, in act 006-048
All authors, affiliations and abstracts have been published as submitted.
