Preservation of functional capacity after prosthetic rehabilitation: an explorative cohort-study into the declination of functional outcome.

An important aim of prosthetic rehabilitation is functioning independently at
home. During the rehabilitation period the treatment team tries to achieve this
aim by training towards an optimal level of (physical) functioning. However,
the professionals of the treatment team all share the same concern: the
declination of functional outcome after discharge from the rehabilitation
centre. This concern most of all focuses on the older amputees. The problem is
that this concern has never been objectified.

Current scientific literature does not bring any clarification on this subject.
Most of the articles on functional outcome of patients with a lower limb
amputee concern the so-called cross-sectional design. In other words the
functional outcome has been measured at one specific time after the amputation
and is not related to the level of functional outcome at discharge from the
rehabilitation centre. The few follow-up studies that are conducted do show
contradictory results: stabilisation of the functional level after two months
versus declination of the functional outcome after six months. The differences
in time of follow-up and the several different measurements that are used, can
easily account for this diference.

This research project is designed to objectify the professionals concern and to
identify the factors that may affect the preservation of functional capacity
after prosthetic rehabilitation.

The results of this research project will be used to improve the existing
treatment program. The factors that are of influence on functioning at home can
be integrated in the treatment program. The assumption is that the amputees
will be better prepared for functioning at home. Secondary, this project will
enable the professionals with measurement tools to evaluate their treatment
evidence based.

The objective of this study is twofold:
1) To objectify if amputee patients show a decline in level of functional
capacity after discharge from the rehabilitation centre.
2) To identify which factors according to the patients may effect the
preservation of functional capacity after prosthetic rehabilitation.

Central questions of this research project are:
1) Does the functional capacity of patients with a lower limb amputation
decline after discharge from the rehabilitation centre?
2) Which factors may effect the preservation of functional capacity after
prosthetic rehabilitation?

The study design used is an explorative cohort study. Quantitative research
methodology will be used to answer the first research question. Therefore the
functional capacity will be measured by using two physical perfomance tests,
movement registration and two questionnaires. The measurements will take place
at discharge (T0) and three (T1) and six months (T2) after discharge.

Qualitative research methodology will be used to answer the second research
question. By means of a semi-structured interview patients with a lower limb
amputation will be asked which factors may affect their functioning at home.

The measurements used in this research project are especially developed for
this diagnose group. On top of that they relate to the normal movement patterns
of amputees (like walking or standing up from a chair). The patients are not at
risk by participating in this research project.
Participation in this research project means that patients have to deal with an
extra time-effort. By scheduling the measurements at the same time as the
(control-) visits to the doctor, patients do not need to spend extra time on
travelling.