Landmark Article by Robert S. Gailey PhD, PT
Bob Gailey is a physical therapist from Miami who has devoted his professional career to helping increase the quality of therapy available to lower limb amputees who wear prostheses. He is an excellent teacher and has inspired countless of his colleagues to improve their ability to teach patients how to fully benefit from the functional performance inherent in their prosthetic devices.
The results of several years' effort to develop a practical test instrument to objectively determine an amputee's Medicare Functional Level have just been published in the Archives of Physical Medicine and Rehabilitation. [Gailey et al, The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate, Arch Phy Med Rehab 83[5]:613-627; May 2002] Gailey and colleagues worked very hard to come up with a practical method that can be used by any interested clinician in the real world, despite the time pressures of Managed Care restrictions and similar barriers.
The results of their investigation are very encouraging. Inter-rater and intra-rater reliability were between 97% and 99%, suggesting that this is a very accurate determination and that it corresponds very closely to the subjective decisions made by experienced clinicians. Since it takes less than 15 minutes to administer and requires little equipment or space, the Amputee Mobility Predictor © should prove to be practical in a clinical setting. This is one of the first critical steps in establishing objective data about amputee rehabilitation that will help us make more defensible decisions about the level of technology individual patients receive.
Equally significantly, Gailey et al's research showed that a version of the instrument that did not require wearing a prosthesis was also highly predictive. This may help in determining the components for the initial prosthesis, and ultimately minimize the widespread tendency toward being too conservative in the prescription and therefore failing to offer every amputee the most functional level of technology that they can utilize.
Kudos to the folks at OSSUR for immediately picking up on this important scientific work, and for incorporating the information into their training courses, starting at the CAPO meeting. The abstract for this article is posted on the Web at http://www.idealibrary.com/links/doi/10.1053/apmr.2002.32309 and a PDF file of the entire text can be downloaded [for a fee] from the same site.
It is heartening to see that using functional performance as the basis for prescription criteria, as has been advocated by expert prosthetists for many decades, is proving to be such a sensible way to allocate rehabilitation resources. The development of objectively valid instruments based on clinical insights is one step in the long process of developing realistic outcome measurements of the results of individual patient care.
