Peripheral neuropathy prevalence and effect on mobility 12 months after prosthesis prescription among individuals with dysvascular lower extremity amputation

Abstract

AbstractObjectiveTo determine the prevalence of peripheral neuropathy (PN) and its effect on mobility in patients who were prescribed a lower limb prosthesis (LLP) after an incident dysvascular transtibial (TT) or transfemoral (TF) lower extremity amputation (LEA). We also sought to determine if the effect of PN on mobility was modified by amputation level or depression.DesignParticipants were identified retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then were contacted prospectively to obtain their self‐reported mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers.SettingThe VA CDW, the National Prosthetics Patient Database, participant mailings and phone calls.ParticipantsThree hundred fifty‐seven individuals who underwent a TT or TF amputation due to diabetes and/or peripheral arterial disease and were fitted with a qualifying LLP.InterventionsNot applicable.Main Outcomes MeasuresThe Locomotor Capabilities Index basic and advanced mobility subscale scores.ResultsTwo‐hundred thirty seven participants (66%) had a diagnosis of PN prior to prosthesis prescription. The detrimental effect of PN on achieving basic and advanced mobility was significant after adjusting for potential confounding factors (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.30–0.94; p = .03 and aOR, 0.43; 95% CI, 0.24–0.77; p = .005, respectively). The detrimental effect of PN was more pronounced in patients with depression, especially for advanced mobility (aOR, 0.36; 95% CI, 0.14–0.95; p = .04) versus no depression (aOR, 0.53; 95% CI, 0.27–1.0; p = .07).ConclusionsPN is common in patients who have undergone an LEA due to diabetes and/or vascular disease and patients with this diagnosis should be carefully evaluated. Targeted rehabilitation programs to mitigate its potential detrimental effects on mobility are important and should specifically include mental health assessment and treatment.