Outcome Measures for Patients with Lower Limb Amputations
Original Editor - Judy Scopes as part of the World Physiotherapy Network for Amputee Rehabilitation Project
Top Contributors - Sheik Abdul Khadir, Kim Jackson, Lucy Aird, Admin, Tarina van der Stockt, Stacy Schiurring, 127.0.0.1, Simisola Ajeyalemi, Lauren Lopez, Ewa Jaraczewska, Rachael Lowe, Vidya Acharya and Jess Bell
Introduction
Outcome measurement is central to the evidence-based rehabilitation of individuals with lower limb amputation. It supports clinical decision-making, goal-setting, and evaluation of intervention effectiveness across the care pathway. No single outcome measure captures every relevant domain, and there is considerable variation between measures (e.g. patient-reported vs performance-based, mobility vs balance, prosthesis satisfaction, socket comfort, or psychosocial adjustment). Selecting an appropriate measure therefore requires consideration of the patient's stage of rehabilitation, functional level, and the clinical question being asked, alongside the measure's established reliability, validity, and responsiveness to change in the relevant population. This page summarises key outcome measures with published evidence of validity for use with individuals with lower limb loss, organised by stage of rehabilitation and level of activity.
Please see the following Physiopedia pages if you would like to learn more about selecting outcome measure and their psychometric properties:
- Outcome Measures
- Using Evidence-Based Practice to Decide on an Outcome Measure
- Psychometric Properties
Outcome Measures Validated for Use in People with Lower Limb Amputations
Post-amputation
- Amputee Mobility Predictor, or modified version without a prosthesis (AMPnoPRO)
- Basic Amputee Mobility Score (BAMS): a newly developed outcome measure that evaluates four essential mobility activities post-lower limb amputation
Prosthetic Rehabilitation
The following outcome measures are included in the most recent version (2014) of the British Association of Chartered Physiotherapists in Amputee Rehabilitation (BACPAR) Outcome Measures Toolbox:[1]
- Activities-specific Balance Confidence (ABC) Scale-UK
- Amputee Mobility Predictor: note that the Amputee Mobility Predictor without prosthesis (AMPnoPRO) has the best statistical predictor for motor ability/outcome[2]
- Houghton Scale
- Locomotor Capabilities Index-5
- Trinity Amputation and Prosthesis Experiences Scales
- Timed Up and Go Test (TUG)
- L Test
- 2 min timed walk test
- 6 min timed walk test
- Berg Balance Scale
A note on measures considered but not included by BACPAR: the 2014 evidence review that underpins this Toolbox explicitly considered and excluded two other well-known measures. The SIGAM Mobility Grades were graded highly for reliability but were not recommended "due to sparse validity data" at the time.[3] The Prosthesis Evaluation Questionnaire (PEQ) was also graded highly but excluded on the basis that it was too lengthy for routine clinical use. Both remain in use in research and some clinical settings and are validated elsewhere in the literature, but clinicians should be aware that these outcomes were deliberately excluded from the BACPAR Toolbox rather than oversights.[1]
Additional Validated Measures (not included in the BACPAR Toolbox)
The measures below have published evidence of reliability and/or validity in lower limb amputation populations, but fall outside the BACPAR Toolbox's specific remit or predate/postdate its 2014 evidence review:
- Socket Comfort Score (SCS): a simple, validated single-item 0–10 scale assessing socket fit specifically; the SCS addresses a clinically important domain (comfort) not otherwise captured above[4]
- 10 Metre Walk Test (10MWT): a quick gait speed measure often used alongside the 2MWT/6MWT
- Four Square Step Test (FSST): a performance-based dynamic balance and agility measure[5]
- Prosthetic Limb Users Survey of Mobility (PLUS-M): a Rasch-based patient-reported mobility measure[6]
- Frenchay Activities Index (FAI): validated for people with lower limb amputations; it assesses broader community and domestic activity participation beyond basic mobility[7]
High-level Activity
The outcome measures listed above can be used with individuals with limb loss who perform activities at a high level. However, it should be noted that ceiling effects may be seen - i.e. the individual with amputation will achieve maximum scores when using ordinal scales, whether observed or self-reported.
The Comprehensive High-Level Activity Mobility Predictor (CHAMP) was developed to assess people with limb loss who need to return to high-level activity. This outcome measure was found to be safe and reliable with wounded army servicemen at Walter Reed Medical Center who had high-level mobility after traumatic lower limb amputations.[8][9]
Pre-Prosthetic and/or Immediate Post-Operative Period
A narrative review undertaken by the BACPAR Outcome Measures project group looked at the evidence on using outcome measures for people with lower-limb amputations in the acute or pre-prosthetic phase. Only the Functional Independence Measure (FIM) was identified as of potential interest, and a further search was conducted, adding the specific FIM title. While there is evidence that the FIM is used in the acute and/or early rehabilitation phase for people with amputation and that it can demonstrate an improvement between admission and discharge, the evidence was weak. There was no evidence that the total FIM score was effective as a predictor tool, but there was good correlation in one study for the motor subscale with prosthetic outcome.[1]
When the Toolbox was updated in November 2014, it was decided not to include the FIM or any other specific outcome measure for this population, as the current evidence was not strong enough. The other outcome measures included in the Toolbox all had good evidence with larger sample sizes. In addition, the FIM requires training before use and is recommended as a multidisciplinary team tool. Thus, it does not fit the "easy to use" criteria.[1]
Recent Developments
The BACPAR Outcome Measures Toolbox remains at Version 2 (2014) at the time of writing. BACPAR's separate Evidence based clinical guidelines for the physiotherapy management of adults with lower limb prostheses (2020)[10] and the newly updated Clinical guidelines for the pre and post-operative physiotherapy management of adults with lower limb amputations (3rd edition, 2025)[11] both continue to reference this 2014 Toolbox rather than superseding it. BACPAR's Research Officers have indicated, however, that a formal review of the Toolbox is anticipated.
Separately, international work is underway to build consensus on what should be measured following lower limb amputation, rather than simply which tools to use. The International Society of Prosthetics and Orthotics (ISPO) LEAD and COMPASS initiative is developing a core outcome set for the lower limb prosthetics sector,[12] and the ECLIPSE model synthesises meaningful outcome domains from the patient's perspective, including participation, ease/independence, safety, and psychosocial adjustment.[13]
Resources
- BACPAR Toolbox of Outcome Measures V2.
- Chartered Society of Physiotherapy Outcome Measures Toolbox
- COSMIN Outcome Measures Search
- International Society of Prosthetics and Orthotics (ISPO) LEAD and COMPASS
References
- ↑ 1.0 1.1 1.2 1.3 Cole MJ, Cumming J, Golland N, Hayes S, Ostler C, Scopes J, Tisdale L. BACPAR Toolbox of Outcome Measures, Version 2. British Association of Chartered Physiotherapists in Amputee Rehabilitation; November 2014. Available from: https://www.bacpar.org/Data/Resource_Downloads/ToolboxofOutcomeMeasures.pdf (accessed 29/July/2026)
- ↑ Spaan MH, Vrieling AH, van de Berg P, Dijkstra PU, van Keeken HG. Predicting mobility outcome in lower limb amputees with motor ability tests used in early rehabilitation. Prosthetics and orthotics international. 2017 Apr;41(2):171-7.
- ↑ Ryall NH, Eyres SB, Neumann VC, Bhakta BB, Tennant A. The SIGAM mobility grades: a new population-specific measure for lower limb amputees. Disability and rehabilitation. 2003 Jan 1;25(15):833-44.
- ↑ Hanspal RS, Fisher K, Nieveen R. Prosthetic socket fit comfort score. Disability and rehabilitation. 2003 Nov 18;25(22):1278-80.
- ↑ Sions JM, Beisheim EH, Seth M. Selecting, administering, and interpreting outcome measures among adults with lower-limb loss: an update for clinicians. Current physical medicine and rehabilitation reports. 2020 Sep;8(3):92-109.
- ↑ Hafner BJ, Gaunaurd IA, Morgan SJ, Amtmann D, Salem R, Gailey RS. Construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M) in adults with lower limb amputation. Archives of physical medicine and rehabilitation. 2017 Feb 1;98(2):277-85.
- ↑ Miller WC, Deathe AB, Harris J. Measurement properties of the Frenchay Activities Index among individuals with a lower limb amputation. Clinical rehabilitation. 2004 Jun;18(4):414-22.
- ↑ Gailey RS, Gaunaurd IA, Raya MA, Roach KE, Linberg AA, Campbell SM, Jayne DM, Scoville C. Development and reliability testing of the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in male servicemembers with traumatic lower-limb loss. WALTER REED ARMY MEDICAL CENTER WASHINGTON DC; 2013 Jan.
- ↑ Schenker A, Wolf SI, Alimusaj M, Putz C, Lehner B, Block J. High-level activity and access to sport following lower limb amputation due to malignant musculoskeletal tumors versus trauma: a prospective comparative study. Archives of Orthopaedic and Trauma Surgery. 2025 Aug 21;145(1):418.
- ↑ British Association of Chartered Physiotherapists in limb Absence Rehabilitation (BACPAR). Evidence based clinical guidelines for the physiotherapy management of adults with lower limb prostheses. 3rd ed. 2020. Available from:https://www.bacpar.org/data/About_Downloads/Firstprostheticguidelines.pdf (accessed 29/July/2026).
- ↑ British Association of Chartered Physiotherapists in limb Absence Rehabilitation (BACPAR). Clinical guidelines for the pre and post-operative physiotherapy management of adults with lower limb amputations. 3rd ed. 2025. Available from: https://www.bacpar.org/(accessed 29/July/2026).
- ↑ Kohler F. LEAD and COMPASS: tools to map the way forward for people with lower limb absence. Prosthetics and Orthotics International. 2021 Oct 1;45(5):369-72.
- ↑ Ostler C, Dickinson A, Metcalf C, Donovan-Hall M. Development of the ECLIPSE model of meaningful outcome domains following lower limb amputation and prosthetic rehabilitation, through systematic review and best fit framework synthesis. Plos one. 2024 Jul 23;19(7):e0307523.