Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation

Matthew J Miller; Jennifer M Blankenship; Paul W Kline; Edward L Melanson; Cory L Christiansen

doi:10.1093/ptj/pzaa212

Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation

Phys Ther. 2021 Feb 4;101(2):pzaa212. doi: 10.1093/ptj/pzaa212.

Authors

Matthew J Miller^{1

2

3

4}, Jennifer M Blankenship⁵, Paul W Kline^{1

2}, Edward L Melanson^{2

6}, Cory L Christiansen^{1

2}

Affiliations

¹ Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA.
³ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.
⁴ Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.
⁵ Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Abstract

Objective: The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA.

Methods: Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30-60, 60-90, and >90 minutes), standing (0-1, 1-5, and >5 minutes), and stepping (0-1, 1-5, and >5 minutes) was also calculated.

Results: Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}-quartile 3 {Q3} = 67%-84%]), followed by standing (median = 16% [Q1-Q3 = 12%-27%]) and stepping (median = 6% [Q1-Q3 = 4%-9%]). One-quarter (median = 25% [Q1-Q3 = 16%-38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1-Q3 = 34%-54%]; stepping: median = 98% [Q1-Q3 = 95%-99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1-Q3 = 59%-78%]; dysvascular: median = 79% [Q1-Q3 = 73%-86%]) and standing (traumatic: median = 23% [Q1-Q3 = 16%-32%]; dysvascular: median = 15% [Q1-Q3 = 11%-20%]).

Conclusion: Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute.

Impact: High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA.

Keywords: Amputation; Chronic Health Conditions; Middle-Age; Older Adult; Physical Activity; Sedentary Behavior.

Published by Oxford University Press on behalf of American Physical Therapy Association 2020.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Accelerometry
Aged
Aged, 80 and over
Amputees*
Artificial Limbs*
Cross-Sectional Studies
Disability Evaluation
Exercise*
Female
Humans
Lower Extremity
Male
Middle Aged
Sitting Position*
Standing Position*
Time Factors
Walking*

Abstract

Publication types

MeSH terms

Grants and funding