Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules.

QUESTIONS Can rules be developed to predict the risk of non-use of prostheses by people with lower limb amputation following discharge from rehabilitation? Are these clinical prediction rules valid? DESIGN Retrospective and prospective cohort study designs. PARTICIPANTS Consecutive tertiary rehabilitation patients: 135 retrospective (103 males, mean age = 56 years, SD 15) and 66 prospective (58 males, mean age = 54 years, SD 16). METHOD Medical records were audited for potential predictor variables. Retrospective participants were interviewed at a median of 1.9 years after discharge (IQR 1.4 to 2.5) and prospective participants at a median of 1.3 years (IQR 1.1 to 1.4). RESULTS Clinical prediction rules were identified at 4, 8 and 12 months after discharge, and validated. Amputation levels above transtibial and mobility-aid use were common predictors for all three time frames. At 4 months, if four out of five predictor variables were present (LR+ = 43.9, 95% CI 2.73 to 999+), the probability of non-use increased from 12 to 86% (p<0.001). At 8 months, if all three predictor variables were present (LR+ = 33.9, 95% CI 2.1 to 999+), the probability of non-use increased from 15 to 86% (p<0.001). At 12 months, if two out of three predictor variables were present (LR+=2.8, 95% CI 0.9 to 6.6), the probability of non-use increased from 17 to 36% (p<0.031). CONCLUSIONS These validated clinical prediction rules have implications for rehabilitation and service model development. [Roffman CE, Buchanan J, Allison GT (2014) Predictors of non-use of prostheses by people with lower limb amputation after discharge from rehabilitation: development and validation of clinical prediction rules.Journal of Physiotherapy60: 224-231].