The International Society for Prosthetics and Orthotics Canada

Prosthetics Education Spotlight

Interviewee: Courtney Frengopoulos, MSc MD, University of Western Ontario, Department of Health Sciences

Article: Rehabilitation outcomes after major lower limb amputation in the oldest old: a systematic review Katherine Fuller, Michael W.C. Payne, Ricardo Viana, Susan W. Hunter
University of Western Ontario, Faculty of Health Sciences
McMaster University, Michael G. DeGroote School of Medicine
Department of Physical Medicine & Rehabilitation, Parkwood Institute
University of Western Ontario, Department of Physical Medicine & Rehabilitation
University of Western Ontario, Schulich School of Medicine & Dentistry
University of Western Ontario, School of Physical Medicine

Key Takeaways

• Paucity of research investigating rehab outcomes in the oldest old age group (aged 80+) so there is a need for more research to be done involving this age group so that practitioners can better serve this population
• Some challenges associated with prosthetic rehabilitation in the oldest old including higher mortality rate and associated comorbidities
• People in this age group can be successful prosthetic users, so age alone should not disqualify someone from having an assessment by an amputee rehabilitation program

Please tell us about your lab, your team, and your research interests
While I am no longer a student at the University of Western Ontario, I was introduced to the lab during my undergraduate degree and have had the opportunity to collaborate with them on research for many years and am still fortunate enough to do so. The lab that conducted this study is based at the University of Western Ontario in London, Ontario. There are three researchers that are associated with the lab – Dr. Susan Hunter, Dr, Michael Payne, and Dr. Ricardo Viana. Dr. Susan Hunter is a professor of Department of Health Sciences, works in the physiotherapy department, and is affiliated with the Schulich School of Medicine & Dentistry. Drs. Michael Payne & Ricardo Viana physiatrists at the Parkwood Institute in London, Ontario. Together, these three individuals are key researchers at the Gray Centre for Mobility and Activity at the Parkwood Research Institute. Much of their research examines how to improve outcomes for people with limb loss or people with congenital limb differences. They focus specifically on mobility outcomes, gait abnormalities and falls, and some research has also been done on the cognitive ability of older adults in this population. The lab takes on undergraduate and graduate students for shorter time periods who help contribute to research.

What are you working on right now that you are most excited about?
I am currently working on a chart audit of older adults who have come through the prosthetic rehabilitation program at the McMaster University Amputee Rehab Group. We are examining the demographics of this population to get a more complete picture of this age group within the amputee population. A secondary goal of the audit is to compare the outcomes among more discrete groups of individuals in the older adult population. We know that age plays a role in functional outcomes, so we are currently trying to determine if there is a difference in outcome based on age among older adults living with an amputation. A master’s student in London affiliated with the aforementioned research group is also currently conducting a similar study although her research will focus on all adults over the age of 18. The results of this research will provide researchers and healthcare practitioners with a better understanding of what the population looks like so that they can be better served.

What are next steps based on your research? How can we integrate your findings into clinical practice?
Those in the oldest old can also be a difficult population to care for, due to comorbidities, interruptions to care, social factors, and cognitive impairments, but that should not disqualify them from receiving prosthetic care. Our research shows that people in the oldest old age group can be successful in their prosthetic rehabilitation, so clinicians should ask themselves how they can help them be successful when providing care to someone in this age group.
Another finding of this study is that more research is needed for this population. Our review concluded that a more holistic view of rehabilitation outcomes is needed in research as much of the published literature focused only on functional or physical outcomes which did not provide much information on the person as a whole or on how they were able to integrate into their community. A possible future multi-site perspective study could examine several outcomes such as quality of life, return to community, mental health, and social support within the oldest old population. Ideally, this study will look at three groups of individuals: those who were successful in their prosthetic rehabilitation process, those who were not, and those who were
deemed unfit to receive prosthetic care after their amputation. Understanding the differences between these groups can help us better identify barriers to care and may help improve their experience through their healthcare journey.