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132 KAHLE ET AL.

Predictive Factors Supported with Three to Five Pre-Amputation Living Status
References in This Literature Review Several reports in this literature review collected

Ability to Stand on One Leg data on factors related to living status, such as marital
In a medium quality study, Grameaux et al. iden- status and independence. However, none of them
reported correlations on living status being a predic-
tified the one-leg balance test as appropriate for early tive characteristic of walking ability following lower
evaluation in the immediate follow-up of the ampu- extremity amputation (18,21,22,26).
tation in order to establish a prognosis for success
in prosthetic ambulation (24). Hamamura et al., in Cause of Amputation

a high quality study, identified the patient’s ability to Some authors reported cause of amputation as a
stand on one leg on the non-amputated limb as one factor in prosthetic candidacy; however, there was
of the most valuable factors contributing to successful no association of cause as a predictive characteristic
prosthetic ambulation in geriatric amputees, report- of walking candidacy (11,21,27). Hamamura et al.
ing significance in successful prosthetic walkers (17). reported on cause of amputation, yet no significant
van Eijk et al., in a medium quality article, reported difference between the two groups (successful and
that one-leg balance was significantly positively asso- unsuccessful ambulators) was observed (17). Wezen-
ciated with prosthetic use (20). These reports are berg et al. found that the presence of an amputation
consistent with previous reports identifying the ability as a result of vascular deficiency was significantly
to stand on one leg as indicative of better walking associated with a lower VO2 peak of 29.1%, whereas a
potential after unilateral lower limb amputation (5). traumatic amputation was not significantly associated
Cognition and Mood Disturbance with a difference in VO2 peak compared with controls.
Webster et al. reported, in a study of high quality, Having a vascular amputation was associated with a
26.4% decrease in VO2 peak compared with having an
that management of depression and promotion of amputation because of trauma (28). In a second later
social support may have a positive effect on pros- article, Wezenberg et al. found traumatic amputees
thetic use (18). O’Neill et al., in a report of medium walked at the same VO2 as able-bodied controls but
quality, concluded that identified cognitive deficits did so at a lower walking speed. Vascular amputees
may indicate augmented rehabilitation or provision walked at an even slower speed with a substantially
of alternative mobility rehabilitation (25). Stineman higher VO2. Both amputee groups chose a walking
et al. reported ADL function and mobility (physi- speed that was lower than the most efficient walking
cal functioning) using gains in motor FIM™ scores speed. Consideration of peak aerobic capacity is an
achieved by rehabilitation discharge. Psychosis was important factor when aiming to improve walking
associated with lower motor FIM™ gains, but no direct ability in amputees (14). Finally, peak aerobic capac-
correlation between psychosis and prosthetic candi- ity is an important determinant for walking ability.
dacy was reported (21). In the previous Sansam et al.
article, cognitive ability was consistently found to be Sansam et al. also reported an association between
a significant predictor of walking ability following the cause of amputation and walking potential in five
studies, with subjects undergoing an amputation for
rehabilitation, with a superior outcome reported in dysvascularity achieving a poorer outcome than those
those with better cognitive ability (5).
due to trauma or other non-vascular causes (5).
Gender
Four high quality studies found no association Predictive Factors Previously Reported Supported
between gender and walking ability following lower With Six or More References in This Literature
limb amputation, suggesting it is not a predictive Review
determinant (19-22). Previous studies also found no Amputation Level
consistent association with gender (5).
Artwert et al., in a high quality article, reported
that functional use of a prosthesis in TTA patients