Revista Pesquisa Em Fisioterapia · Oct 22, 2026

Functional prosthesis use and patient-centered outcomes following lower-limb amputation: a longitudinal observational study

By Matuti GDS, Credidio BM, Ceregatti M et al.

ABSTRACT | OBJECTIVE: To characterize the epidemiological and functional profile of individuals with unilateral lower limb amputation treated at a referral rehabilitation center in the state of São Paulo, and to identify factors associated with the achievement and maintenance of patient-centered functional goals. METHODS: This longitudinal observational study included 36 individuals with unilateral transtibial, or transfemoral amputation discharged from physiotherapy between May and December 2023 at a referral rehabilitation center in São Paulo, Brazil. Patient-centered outcomes were assessed using the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) at rehabilitation discharge and six months later. Functional prognosis for prosthesis use was assessed using the Blatchford Allman Russell tool (BLAR-t), and demographic, clinical, gait, and prosthesis use characteristics were collected. Changes in patient-reported occupational performance and satisfaction, goal attainment, functional status, and daily prosthesis use were analyzed longitudinally. RESULTS: Thirty-six individuals were included in the initial assessment (mean age 60 ± 13 years; 64% male), of whom 28 completed the six-month follow-up. Most participants had undergone transtibial amputation (64%), with diabetic vascular disease being the primary etiology (67%). COPM performance and satisfaction scores improved significantly from the start of rehabilitation to discharge and remained stable after six months. The most frequent goals set by patients were resuming walking (75%), receiving a prosthesis (65%), and achieving independence in daily activities (30%). At discharge, 83% of participants had a BLAR-t prognosis favorable for functional prosthetic use or use for transfers, and 65% of those who set walking as a goal achieved it above the expected level; however, only 33% achieved "independence in daily activities with the prosthesis" at the expected level. Transtibial amputees showed significantly longer daily prosthetic use times than transfemoral amputees (7.5 vs. 3 hours/day; p<0.01), while older age was associated with more limited prosthetic use (p=0.02). Younger individuals were also more likely to maintain functional gait six months after discharge (p=0.03). CONCLUSION: Individuals with unilateral lower limb amputation showed significant improvements in patient-reported occupational performance and satisfaction following rehabilitation, with these gains maintained at the six-month follow-up. Most participants met or exceeded their functional goals, particularly regarding gait. In contrast, functional use of the prosthesis for activities of daily living was a goal achieved beyond expectations by less than half the sample. Younger individuals and those with transtibial amputations demonstrated better functional performance and longer daily prosthesis use. The study results highlight the importance of individualized strategies, longitudinal monitoring of functional and patient-centered outcomes, and public policies that consider regional epidemiological characteristics.

doi.org/10.17267/2238-2704rpf.2026.e6904Open accessPopulations