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134 KAHLE ET AL.

are successfully able to walk with a prosthesis in a age was associated with lower motor FIM™ gains,
community setting (10). Hamamura et al. found, in but no direct correlation between age and prosthetic
a high quality article, that the successful ambulatory candidacy was reported (21). Wong et al., in a high
group had a significantly higher VO2 max compared quality article, reported that age was not a signif-
with the failure group (17). van Eijk et al., in a medium icant predictive factor in affecting the outcome in
quality article, reported that functional ambulation TTA patients (19). van Eijk et al., in a medium qual-
(Functional Ambulation Catagories (FAC) score, ity article, reported that age was not significantly
which measures the independency of gait) was associated with prosthetic use (20). Sansam et al.
significantly positively associated with prosthetic previously reported that, in most studies, older age
use (20). Guanard et al., in a high quality article, at the time of amputation had an adverse effect on
reported rehabilitation-related factors, such as lower walking potential, with six studies reporting a much
limb strength, standing and dynamic balance, and stronger dependence of walking ability on age than
ability to displace the center of mass over the base on comorbidity. There is disagreement on the extent
of support, were all significantly related to ability to to which age is a factor in determining prosthetic
perform high-level mobility activities (31.) Sansam candidacy or success. The majority of the studies,
et al. previously reported that two medium to high including the higher quality evidence, suggests that
quality studies with the same first author have looked age does have a role in prosthetic and functional
at physical fitness and its relationship to walking abil- determinations but that it should not restrict candi-
ity following unilateral above knee amputation. Both dacy.
studies concluded that a %VO2 max of at least 50%
could be regarded as a guideline value for the level Comorbidities
of fitness required for successful ambulation with Chin et al. reported that, when there is a low prev-
an above-knee prosthesis. This provides agreement alence of commodities, older HDA patients were able
that fitness parameters, particularly cardiorespiratory to successfully walk with a prosthesis in a community
fitness, can be an important factor in determining setting (10). Hamamura et al. reported a significant
prosthetic candidacy and success.
difference between the successful and unsuccessful
Age ambulator groups in the number of comorbidities,
Erjavec et al. found that age was a key determining with fewer comorbidities having a positive effect
predictive factor in combination with the results of the (17). Webster et al., in a high quality article, reported
exercise stress test, a 6MWT at admission, the FIM™ that a history of dialysis was associated with signifi-
at admission, and consideration of gender, allowing cantly less prosthetic ambulation (18). Wong et al.,
the successful discrimination between patients who in a high quality article, reported that amputation
were fit with a prosthesis and those who were not due to diabetes, high total white count, erythrocyte
(11). Grameaux et al. reported a statistically signifi- sedimentation rate, C-reactive protein, urea, creati-
cant worse result in bioenergetic efficiency related to nine, neutrophils, absence of pulses, low ABI, and Toe
age when taken into account with amputation level Brachial Index were significantly associated with poor
(24). Hamamura et al. reported, in a high quality clinical outcomes in TTA patients (19). van Eijk et al.,
study, no significant difference between the suc- in a medium quality article, reported multimorbidity
cessful and unsuccessful ambulator groups when was not significantly associated with prosthetic use
considering age (17). Webster et al., in a high quality (20). Sansam et al. previously reported that the effect
article, reported that increased age was associated of comorbid conditions on walking outcome is not
with significantly less prosthetic ambulation (18). clear. In the majority of studies investigating the role
Stineman et al. reported ADL function and mobility of comorbidities, the conclusions have been drawn
(physical functioning) using gains in motor FIM™ from secondary analyses or in conjunction with other
scores achieved by rehabilitation discharge. Advanced factors. At this time, the majority of the evidence is