Assessment of the dynamics of motor abilities, psychoemotional status, and quality of life in wounded servicemen with sarcopenia after transtibial amputation under the influence of physical therapy

A total of 95 male servicemen of the Armed Forces of Ukraine were examined. The control group consisted of 36 individuals without amputations who had participated in combat operations. The study group included 59 wounded servicemen with transtibial amputation and sarcopenia, who were randomly assigned into two subgroups. The first subgroup underwent a standard physical therapy program aimed at stump preparation for prosthetic fitting, training in the use of a temporary prosthesis, and restoration of basic motor functions. The second subgroup followed a developed comprehensive physical therapy program that additionally included interventions targeting sarcopenia, such as resistance training, endurance exercises, coordination and balance training, as well as an educational component focused on lifestyle modification. Patients were assessed at baseline, after four weeks, and after twelve weeks using measures of motor performance, functional mobility, psychoemotional status, and quality of life, including the L-test of functional mobility, the Six-Minute Walk Test, the Functional Gait Assessment, the Activities-specific Balance Confidence Scale, the Locomotor Capabilities Index, the Amputee Mobility Predictor, as well as questionnaires assessing psychosocial adaptation, anxiety and depression, and quality of life. At baseline, patients with transtibial amputation and sarcopenia demonstrated markedly reduced functional mobility, endurance, and balance compared to the control group, accompanied by low balance confidence, elevated levels of anxiety and depression, and reduced quality of life. At the stage of early prosthetic fitting, a statistically significant improvement in most parameters was observed, reflecting the positive effect of restoring limb support function; however, functional adaptation remained incomplete and did not reach the level of the control group. After twelve weeks of rehabilitation, further significant improvements were noted in L-test performance, Six-Minute Walk Test distance, Functional Gait Assessment scores, Locomotor Capabilities Index, and Amputee Mobility Predictor scores, indicating enhanced functional independence and walking ability. Concurrently, reductions in anxiety and depression levels were observed, along with improvements in psychosocial adaptation, decreased activity limitations, and increased quality of life across all domains. More pronounced positive changes were observed in patients who followed the comprehensive physical therapy program, characterized by faster recovery of functional performance, greater reduction in psychoemotional distress, and better reintegration into daily activities. The findings indicate that recovery after transtibial amputation is a staged process determined by both prosthetic intervention and the structure of the rehabilitation program. The inclusion of targeted interventions addressing sarcopenia contributes to more effective restoration of functional mobility, psychoemotional status, and quality of life, supporting the implementation of a comprehensive approach in the physical therapy of wounded servicemen.