A goal-directed rehabilitation protocol for people with transfemoral amputation receiving osseointegration prostheses.

Abstract

Osseointegration (OI) has become an increasingly popular option for people with amputations around the world. However, limited information is available regarding the rehabilitation protocols before and after OI surgery, particularly for the civilian population who face several constraints. To evaluate the effectiveness of a civilian-focused, goal-directed rehabilitation protocol for patients with transfemoral amputation receiving a screw-type OI prosthesis to optimize functional outcomes. A retrospective cohort study of patients with transfemoral amputation who received OI surgery. A national rehabilitation innovation center. Ten patients treated by the same orthopedic surgeon using the Osseoanchored Prostheses for the Rehabilitation of Amputees (OPRA) system were included in this study. Prehabilitation and rehabilitation protocols for the civilian population were developed, which outlined week-by-week, progressive rehabilitation goals before and longitudinally after the OI surgery. After Stage 2 of the surgery, patient outcome was evaluated using outcome measures at 6 months and 1 year. On average, the number of rehabilitation sessions received by the patients was 15.9 ± 4.5 at 6 months, which increased to 26.7 ± 10.2 at 1 year. There were significant improvements in the Amputee Mobility Predictor (37.9 ± 5.0 vs. 38.9 ± 4.8, p = .003), 6-Minute Walk Test (225.3 ± 118.5 vs. 264.0 ±143.3 m, p = .02), and 10 M fast walk (11.9 ± 3.5 vs. 9.3 ± 2.4 seconds, p = .03). The 10-M self-paced walk test reduced from 19.5 ± 9.9 seconds at 6 months to 12.1 ± 4.7 seconds at 1 year, although the difference was insignificant (p = .20). At the conclusion of the study, all patients were walking post OI surgery. Given the constraints faced by civilians with transfemoral amputation, we proposed a rehabilitation protocol for the population who received OI prostheses. Critical clinical milestones were presented to guide rehabilitation progression. Initial results showed improvements in certain outcome measures between 6 months and 12 months following Stage 2 surgery. However, long-term randomized control studies are needed to further validate its efficacy.