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Award powers research into prosthesis success

Most older vascular amputees fail to cope with their prostheses. A physio has won an award to look at why and what can be done to improve services for these patients. Matthew Limb reports

A physiotherapist has won a major award to study how best to improve rehabilitation for elderly vascular patients who have had a leg amputated. Jane Cumming will examine whether it is possible to predict which patients will benefit from a prosthetic replacement and which may not. The national average age for a vascular amputee is 69. Around half of these patients go on to try an artificial limb but most give up after a while and spend the rest of their lives in a wheelchair. Ms Cumming told Frontline: 'We have a particularly high failure rate in terms of the ability of this group to be able to ambulate in a functional, social way.'

Many amputees believe life will return to 'normal' after being fitted with a prosthesis but struggle to cope with the effort, exhaustion and discomfort it can bring, she says. Walking with an artificial leg places considerable strain on the heart and can lead to a greater risk of heart attacks. Only about 14 per cent of patients continue with their prostheses to become 'community ambulators'.

Ms Cumming, who is a clinical specialist physiotherapist at South Tees Hospitals trust, says more evidence is needed to back up clinical decisions regarding suitability for prosthetic rehabilitation. She will study 'prognostic indicators' for successful rehabilitation in transfemoral - above the knee - amputees. The research project starts this month after Ms Cumming won a GBP 58,000 Leadership Through Research grant awarded by the Health Foundation, an independent charity. The two-year pilot study will look first at the evidence base to support prosthetic rehabilitation and review available literature.

Researchers will also work with a group of patients, aged 60-plus, to learn more about their medical histories, views and experiences of rehabilitation. A physiological study will examine whether the risk of heart problems can be minimised for those learning to walk using a prosthesis. The project is a partnership with the University of Teesside Centre for Rehabilitation Sciences. Ms Cumming is studying for a masters degree in health sciences at the university.

The Health Foundation provides grants for research that 'will make a direct difference to the quality of patient care'. Award winners receive personal development training to enhance their leadership skills. Ms Cumming said she hoped the research would yield a better model for managing health services for this particular patient group and feed into national clinical guidelines. A bigger, multicentre clinical trial may follow.

She said: 'These patients are very vulnerable. Their life, at the end of the day, with vascular problems is likely to be a short one,' she told Frontline. 'We have to ask is it right that we are guiding them towards prosthetic rehab, or should we be guiding them more towards wheelchair independence or whatever?' She added: 'No one yet has come up with a definitive answer to the problem of the borderline success rate that we have with this group of people.'

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