A comparison of three measures of progress in early lower limb amputee rehabilitation

Objective: To assess the responsiveness to change and validity of three est ablished outcome measures in relation to early lower limb vascular amputee rehabilitation: the Functional Independence Measure (FIM), the Office of Po pulation Censuses and Surveys Scale (OPCS) and the Amputee Activity Score ( AAS). Design: Prospective observational study. Setting: Inpatient amputee rehabilitation unit. Subjects: Fifty-one consecutive patients admitted for rehabilitation follow ing lower limb amputation for vascular disease. Procedure: To study the responsiveness to change differences between total scores and between subsection scores at different times were analysed. To a ssess validity, comparisons of the total scores of the measures were made w ith each other, and the total scores for each measure were compared with ot her outcomes. Results: Complete scores were obtained on 34 subjects. All measures showed significant change between admission and discharge (p < 0.00001) but only t he AAS showed change between discharge and follow-up (p < 0.0001). Subsecti on analysis revealed expected improvements in mobility. During the inpatien t stage progress was also detected in certain activities of daily living in the FIM and OPCS. The measures correlated with each other (P < 0.001). All of the measures' admission scores correlated with duration of stay (OPCS p < 0.005, AAS p < 0.006, FIM p < 0.009) and admission OPCS also correlated with discharge placement (p < 0.036). Conclusion: The FIM and OPCS are suitable for the inpatient stage but the A AS would appear to be the best measure at time of discharge and thereafter, and further studies are justified.