Assessing the physiological demands of daily life in persons with lower limb amputation
Assessing the physiological demands of daily life in persons with lower limb amputation
A lower limb amputation (LLA) has major impact on daily functioning and independent living. To achieve functional rehabilitation goals, adequate cardiorespiratory fitness is essential. However, current knowledge regarding both level of cardiorespiratory fitness and physiological demands of activities of daily living (ADL) in this population is limited. Therefore, this dissertation of Loeke van Schaik investigates cardiorespiratory fitness, metabolic costs, and relative aerobic load during ADL in persons with LLA.
A systematic review demonstrates that, compared with able-bodied controls, walking with a prosthesis requires substantially more energy for persons with LLA. Oxygen consumption and heart rate increase particularly with more proximal amputation levels and at higher walking speeds. Evidence regarding activities other than walking remains scarce. A survey among 125 persons with LLA and 44 healthcare professionals shows that they prioritize different ADL tasks during rehabilitation, underscoring the need for further research and shared decision-making.
Analysis of cardiopulmonary exercise tests shows a markedly reduced peak oxygen uptake (V̇O₂peak: 14.6 ± 4.1 ml/kg/min), more than 50% below age-related reference values. Age was the only significant predictor of cardiorespiratory fitness level. Finally, a pilot study shows that ADL tasks impose a relative load exceeding 100% of the ventilatory threshold in persons with LLA, indicating a high physiological strain that cannot be sustained over time.
Together, these findings highlight the importance of individual assessment of cardiorespiratory fitness and relative aerobic load. This provides guidance for developing physiologically informed rehabilitation programs, with the potential to optimize post‑amputation rehabilitation and ultimately improving participation and daily functioning.