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

Susan W Hunter; Courtney Frengopoulos; Jeff Holmes; Ricardo Viana; Michael W Payne

doi:10.1016/j.apmr.2017.12.008

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

Arch Phys Med Rehabil. 2018 Apr;99(4):707-712. doi: 10.1016/j.apmr.2017.12.008. Epub 2018 Jan 6.

Authors

Susan W Hunter¹, Courtney Frengopoulos², Jeff Holmes³, Ricardo Viana⁴, Michael W Payne⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; School of Physical Therapy, University of Western Ontario, London, Ontario, Canada. Electronic address: susan.hunter@uwo.ca.
² Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
³ School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada.
⁴ Department of Physical Medicine and Rehabilitation, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada.

PMID: 29317224
DOI: 10.1016/j.apmr.2017.12.008

Abstract

Objective: To determine the relative and absolute reliability of a dual-task functional mobility assessment.

Design: Cross-sectional study.

Setting: Academic rehabilitation hospital.

Participants: 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).

Interventions: Not applicable.

Main outcome measures: 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.

Results: 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.

Conclusions: 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.

Keywords: Amputation; Cognition; Rehabilitation; Walking.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Amputation, Surgical / rehabilitation*
Cross-Sectional Studies
Disability Evaluation*
Female
Humans
Lower Extremity / physiopathology
Male
Middle Aged
Multitasking Behavior / physiology*
Range of Motion, Articular
Reproducibility of Results
Task Performance and Analysis*

Grants and funding

CIHR/Canada