Prosthetics and Orthotics International Three Measures of Functional Outcome for Lower Limb Amputees: a Retrospective Review Properties of the Flexible Pressure Sensor under Laboratory Conditions Simulating the Internal Environment of the Total Surface Bearing Socket Conventional Patellar-tendon-bea

Outcome measures are becoming increasingly important in health care. Functional outcome measures are of particular importance for lower limb amputees since much of the rehabilitation process is concerned with increasing mobility and personal independence. The Scottish Physiotherapy Amputee Research Group (SPARG) has used three measures of functional outcome: the Barthel Index, Russek's classification and the Locomotor Index. The review reported here involves 938 patients having a primary amputation at the transtibial or transfemoral level between October 1992 and July 1997. Differences in function due to age and level of amputation are well known clinically and the measures were compared by looking at their ability to detect these differences. The Barthel Index lacked sensitivity because of ceiling effects and should not be considered as a suitable functional outcome measure for amputee patients. Russek's classification does detect significant differences but requires a large number of patients making it unsuitable for single hospital investigations. The Locomotor Index demonstrates significant differences due to age and amputation level despite fewer patients being assessed by this measure during the period covered by this paper. The range of the Locomotor Index can be extended to cover more active amputees by considering its 'advanced activities' subscale separately. The Locomotor Index is a promising measure and should be considered by rehabilitation teams looking for a valid, reliable and sensitive functional outcome measure for use with lower limb amputees. Introduction Clinicians involved in the rehabilitation of lower limb amputees increasingly need to use outcome measures to demonstrate that they are providing a clinically effective service. Functional assessment measures are of particular importance for this group of patients since much of the rehabilitation process is associated with improving mobility and personal independence. Recognising that physiotherapy is a central component of all amputee rehabilitation programmes, the Scottish Physiotherapy Amputee Research Group (SPARG) was established in 1991 to evaluate current physiotherapy practice concerning the management of amputees and to disseminate the results (see Physiotherapy 79, p.649). The group comprises every senior physiotherapist in Scotland (population approximately 5.5 million) with a clinical responsibility for amputee patients; at present, 26 physiotherapists fall into this category. In addition, SPARG has members representing the British Association of Chartered Physiotherapists in Amputee Rehabilitation, the British Association of Prosthetists and Orthotists and the David Murray Foundation (a Scottish charitable organisation working with amputees). SPARG also works closely with the Scottish Vascular Audit Group whose membership comprises all consultant vascular surgeons in Scotland and with the Information and Statistics Division at the Scottish Office Department of Health. One of SPARG's core activities is to conduct All cor respondence to be addressed to Mrs M. E. Condie, National Centre for Training and Educat ion in Prosthet ics and Orthot ics , Universi ty of St ra thclyde, 131 St. James Road, Glasgow G 4 OLS, Scotland, UK.