Determining Reliability of a Dual-Task Functional Mobility Protocol for Individuals With Lower Extremity Amputation

• DOI: 10.1016/j.apmr.2017.12.008
• Publication Date: 2018-01-06T17:00:32Z
• Authors: Susan W. Hunter; Courtney Frengopo...; Jeff Holmes; Ricardo Viana; Michael W. Payne
• Keywords: Adult; Aged, 80 and over; Male; Reproducibility of Results; Multitasking Behavior; Middle Aged; Amputation, Surgical; 3. Good health; Disability Evaluation; 03 medical and health sciences; Cross-Sectional Studies; 0302 clinical medicine; Lower Extremity; Task Performance and Analysis; Humans; Female; Range of Motion, Articular; Aged

To determine the relative and absolute reliability of a dual-task functional mobility assessment.Cross-sectional study.Academic rehabilitation hospital.Individuals (N=60) with lower extremity amputation attending an outpatient amputee clinic (mean age, 58.21±12.59y; 18, 80% male) who were stratified into 3 groups: (1) transtibial amputation of vascular etiology (n=20); (2) transtibial amputation of nonvascular etiology (n=20); and (3) transfemoral or bilateral amputation of any etiology (n=20).Not applicable.Time to complete the L Test measured functional mobility under single- and dual-task conditions. The addition of a cognitive task (serial subtractions by 3's) created dual-task conditions. Single-task performance on the cognitive task was also reported. Intraclass correlation coefficients (ICCs) measured relative reliability; SEM and minimal detectable change with a 95% confidence interval (MDC95) measured absolute reliability. Bland-Altman plots measured agreement between assessments.Relative reliability results were excellent for all 3 groups. Values for the dual-task L Test for those with transtibial amputation of vascular etiology (n=20; mean age, 60.36±7.84y; 19, 90% men) were ICC=.98 (95% confidence interval [CI], .94-.99), SEM=1.36 seconds, and MDC95=3.76 seconds; for those with transtibial amputation of nonvascular etiology (n=20; mean age, 55.85±14.08y; 17, 85% men), values were ICC=.93 (95% CI, .80-.98), SEM=1.34 seconds, and MDC95=3.71 seconds; and for those with transfemoral or bilateral amputation (n=20; mean age, 58.21±14.88y; 13, 65% men), values were ICC=.998 (95% CI, .996-.999), SEM=1.03 seconds, and MDC95=2.85 seconds. Bland-Altman plots indicated that assessments did not vary systematically for each group.This dual-task assessment protocol achieved approved levels of relative reliability values for the 3 groups tested. This protocol may be used clinically or in research settings to assess the interaction between cognition and functional mobility in the population with lower extremity amputation.