Researcher(s)
- Dyllan Dinbokowitz, Biomedical Engineering, University of Delaware
Faculty Mentor(s)
- Jaclyn Sions, Department of Physical Therapy, University of Delaware
Abstract
Medicare Functional Classification Levels (K-level) classify functional mobility following lower-limb amputation (LLA) from non-ambulatory (i.e., K0) to community-ambulatory (i.e., K3/K4). At preparatory, or first, prosthetic fitting clinicians rely on subjective K-level assessment as objective assessment tools are limited, which may introduce bias. This study identified factors associated with K-level assignment at time of preparatory versus definitive (i.e., subsequent) prosthesis prescription among adults with LLA.
A retrospective chart review of adults with unilateral transtibial amputation (TTA) who received preparatory and definitive prostheses at Independence Prosthetics-Orthotics clinics was conducted. Demographics, amputation history, primary insurance status, prosthetic treatment timeline, and assigned K-level at preparatory and definitive prescription were analyzed. Between group differences were performed to inform which factors were included in subsequent regression analyses (p<0.05). Separate logistic regression models were used to assess the relationship between independent community ambulation, i.e., K3 or K4 assignment, and age at amputation, sex, dysvascular LLA etiology, primary insurance type and prosthetic fitting timeline for both preparatory and definitive prescription.
Fifty adults with TTA were included in the analysis (68% male, 68% dysvascular amputation, median 59 years-old [25th,75th percentile = 51, 68]; 44% and 72% of participants were classified as K3/K4 at preparatory and definitive evaluation, respectively. Younger age, male sex, and non-dysvascular etiology were significantly associated with K3/K4-level assignment at preparatory prescription, while Medicare recipients were found to have 6.6 times reduced odds of being assigned K3/K4 functional status at definitive prescription.
Previous literature suggests that Medicare coverage and reimbursement requirements influence prosthesis prescription practices, which may bias functional level assignment. Our findings suggest K-level assignment may be influenced by demographic and insurance-related factors, highlighting the need for objective assessment tools during both preparatory and definitive prosthetic evaluations.