Use of the Houghton Scale to classify community and household walking ability in people with lower limb amputation: criterion-related validity

Publication date: Available online 10 February 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Christopher Kevin Wong, William Gibbs, Elizabeth Sell Chen
ObjectiveTo examine the criterion-related validity of using the self-reported Houghton Scale (HS) to classify community-dwelling people with lower-limb amputations according to the suggested score ranges for independent community (HS≥9), household and limited-community (8≥HS≥6), and limited household (5≥HS) walking ability categories as referenced to performance-based balance ability and walking speed criteria.DesignCross-sectional cohort studySettingCommunity-based wellness-walking programs in 8 Mid-Atlantic, Mid-West, and Southeast statesParticipants180 volunteers (66.5% men, n=118) mean age 55.5±16.0 years, with 7.1±13.1 years since amputation, at the transtibial level in 47.0% (n=79), due to vascular disease in 49.4% of cases (n=89).InterventionsNoneMain Outcome MeasuresSelf-reported data: HS, Prosthetic Evaluation Questionnaire mobility subscale (PEQ-MS), and Activities-specific Balance Confidence (ABC) scale. Clinical performance-based measures: balance ability assessed with 3 Berg Balance Scale (BBS) items, and walking ability assessed with Timed-Up-and-Go (TUG) and 2-Minute-Walk-Test (2MWT). The primary reference criteria were 1) performance-based balance ability measured with the 3 BBS items and 2) gait speed calculated from the 2MWT.Results45.9% (78/170) scored HS≥9, 30.6% (52/170) scored 8≥HS≥6, and 23.5% (40/170) scored 5≥HS. HS correlated with PEQ-MS (r=0.73), ABC (r=0.76), balance ability (r=0.67), TUG (r=-0.67), and 2MWT (r=0.73). The 3 HS ability categories differed significantly from each other (p<0.05) for all outcome measures: PEQ, ABC, balance ability, TUG and 2MWT.ConclusionThe HS demonstrated criterion-related validity by differentiating community-dwelling people with lower-limb amputations into community, limited-community/household, and household ability categories that corresponded to performance-based balance and walking criteria. Average prosthetic walking speeds for each category compared to similar walking ability categories defined in other patient populations.



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