If you’ve read my last post, you have a working knowledge of what the AmpPro/AmpnoPro evaluation is and how that score sets a quantitative value, known as the K-level. You also know that the K-level is one of the tools your prosthetist uses to decide the best components for you at that level and that your insurance will use that K-level to approve your components (normally 80%).
Dr. Brian Hafner, out of the University of Washington, is the principal investigator for a study intended to develop a new performance test (like the AmpPro/AmpnoPro) to measure an amputee’s mobility (and K-level). If any of you went to the Amputation Coalition Conference in San Antonio, you might have been part of the study. The tasks that the team asked us to do were interesting – some were quite different from the AmpPro/AmpnoPro test, and some were variations of those same tasks. In my opinion, and from only a patient’s point of view, I found some of them much more functional. One of the objectives of the study is to better align the tasks a patient is asked to do with their capabilities. Dr. Hafner believes this will make the test quicker and easier to administer and provide clinicians with better information about a patient’s functional abilities.
Another of the study’s objectives is to combine the new performance test with an existing self-report survey, called the PLUS-M (Prosthetic Limb Users Survey of Mobility) to provide a more holistic evaluation of a patient’s mobility. Dr. Hafner believes it’s very important to consider both the clinician’s assessment of mobility as well as the patient’s view of their mobility outside the clinic for the K-level evaluation. Ultimately, Dr. Hafner hopes that these two instruments will help to better define new K-Levels that help lower limb prosthetic users receive components that better align with their needs in order to be as independent and as active as possible.
The testing that Dr. Hafner and his team did at the Amputee Coalition meeting was intended to help them determine which tasks provide the best information about patients’ mobility. Dr. Hafner and his team have already whittled the test down from 45 to 33 tasks, and it will be whittled down even more as the study progresses. The focus now is to use the data they gathered to pinpoint redundancies and optimize the test for individual patients. Dr. Hafner says the new test will be different from the AmpPro in that not everyone will be asked to do the same tasks. Rather, people will only be asked to do those tasks that are most suited to their mobility level. Using this approach, he expects that the new test might only require a patient to be administered 5 or 6 tasks, rather than the 14 or 15 tasks usually administered in the entire evaluation.
There are many purposes for this new eval, according to Dr. Hafner. It will be more efficient and more relatable to the individual, and clinically, it is easier and faster to administer than the current AmpPro. He hopes to create a database where people can access and compare their scores each time they take the eval and look at their K-level progression as they improve. Another important purpose is creating policy change. The Center for Medical Services (CMS) sets policy for Medicare, and usually, the large insurance companies follow suit. Change, as always, will come slowly.
The research team at Washington University, in conjunction with researchers at the University of Miami, are hoping that PTs and prosthetists will adopt this new eval that encompasses both the amputees’ perceived views of what they can do (PLUS-M survey – if you would like to take a look at the survey, you can go to PLUS-M.org) and the actual tasks that they can do when evaluated in a facility that can accommodate the tests by people who are trained to administer it. This, in turn, will give a clearer indication of K-levels as well as give more information to the PT to help amputees learn the skills they need to navigate in the real world.
Once this research study wraps up and the results are in, Dr. Hafner would like to do a similar study for amputees who do not yet have a prosthesis (as the test they are currently developing is for people who are using a prosthesis). For many, passing the AmpnoPro is difficult, as they are dealing with a very new normal and have a lot on their plates besides PT. Functional skill levels right after amputation are not going to be the same skill sets as those with prostheses; however, they should be correctly evaluated for the appropriate K-level. Ultimately, the K-levels themselves need to be addressed. Should K-levels be the same for below the knee as they are for above the knee? Hip Disartic? Hemi-Pelvic? Should a person like me, who cannot physically walk without crutches, be one point away from the highest K-level? Do we need to differentiate the K-levels and add more levels? Should there be a different K-level set for each kind of amputation? All good questions!
This kind of research CAN change policy. Dr. Hafner and his team, previous to this study, were successful in doing research on the Ottobock C-leg that helped to convince CMS to change the C-leg’s experimental status, thereby having it covered by insurance as DME (Durable Medical Equipment), thereby making it more affordable to those amputees who need it.
The bottom line is that a better-designed evaluation will result in better outcomes for the amputee, both for reaching physical goals and for receiving the correct prosthetic components to achieve those goals. Surgeons, physical therapists, and prosthetists must work together as a team, and an evaluation that considers current technology is paramount for those successful outcomes.
And remember, you don’t know how much strength you have until you are called upon to use it.