http://informahealthcare.com/dre ISSN 0963-8288 print/ISSN 1464-5165 online Disabil Rehabil, 2014; 36(14): 1148–1155 ! 2014 Informa UK Ltd. DOI: 10.3109/09638288.2013.833307 RESEARCH PAPER Exercise testing as a screening measure for ability to walk with aprosthesis after transfemoral amputation due to peripheral vascular disease Tatjana Erjavec 1 , Gaj Vidmar 1,2 , and Helena Burger 1 1 University Rehabilitation Institute, Republic of Slovenia, Ljubljana, Slovenia and 2 Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia Abstract Purpose: To establish at which exercise-power level is the vascular response, as measured by oxygen uptake, closest to the response during the 6-min walk test (6 MWT) in people after lower-limb amputation due to peripheral vascular disease (PVD). Method: A prospective exploratory cohort study was conducted. 6 MWT and exercise testing using a hand-wheel ergometer (starting at 10 W and increasing the workload by 10 W) were performed in 101 consecutively recruited participants after transfemoral amputation due to PVD. Agreement of oxygen uptake during 6 MWT and exercise testing was compared between the groups defined by the exercise-power level reached. Results: Linear regression through origin with Chow test for comparing slopes indicated that oxygen uptake at 30 W agreed more with 6 MWT than at 20, 40 or 50 W. Analyses of observed differences (one-way ANOVA with post-hoc tests, Jonckheere–Terpstra test) confirmed 30 W to be the recommendable threshold. Conclusions: At the level of 30 W, the oxygen uptake during the exercise was the closest to the 6 MWT, so we estimated that to be the minimum required level for walking using a prosthesis after transfemoral amputation due to PVD. ä Implications for Rehabilitation  Exercise testing after transfemoral amputation.  Walking with a prosthesis causes notable strain to the person’s vascular system: after the 6-min walk test, the participants’ heart rate reached 75% of the maximum predicted heart rate on average.  The study shows that persons after transfemoral amputation due to peripheral vascular disease who reach the level of 30 W or more in exercise testing with an arm ergometer at admission to rehabilitation are likely to be able to walk in-doors using a prosthesis. Keywords Amputation, exercise testing, oxygen uptake, prosthesis, walking History Received 23 August 2012 Revised 4 August 2013 Accepted 6 August 2013 Published online 10 September 2013 Introduction The main aim of rehabilitation of people after lower-limb amputation is to enable them to function as well as possible and improve their quality of life. The main wish of these people is to be able to walk again. To achieve that goal, prosthetic fitting is usually essential. However, standing up and walking with a transfemoral prosthesis is demanding in terms of energy and motor abilities [1–4], and can sometimes even endanger the amputee’s health. Before prosthesis fitting, it should, therefore, be established how much load would walking with a prosthesis put on the individual and whether walking with a prosthesis is a realistic rehabilitation goal [5]. Known predictors of good walking ability after lower limb amputation are cognition, fitness, ability to stand on one leg, independence in activities of daily living (ADL) and pre-operative mobility [6]. It is not possible to determine all of them by one simple test. Cognition is important for learning how to don and doff a prosthesis and for walking with it; the Kendrick Object Learning test has been suggested to predict the ability to successfully learn to don, doff and walk with a prosthesis [6]. Fitness has to be assessed by maximal oxygen uptake (%VO 2max ) [5–8]. Maximal oxygen uptake has been assessed using the one- leg cycling test [7], but others found that at the beginning of their rehabilitation the people after trans-femoral amputation have problems with sitting balance on the bicycle, so a hand wheel ergometer has been preferred to assess %VO 2max [5,8]. The ability to stand on one leg can be applied either as an independent test or as part of some other test, such as the Amputee Mobility Predictor (AMP) [9]. There is strong evidence for a relation between balance and walking ability [10]. In our clinical experience, Address for correspondence: Assist. Prof. Gaj Vidmar, PhD, University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI-1000 Ljubljana, Slovenia. Tel: +386 1 4758440. Fax: +386 1 4376 589. E-mail: gaj.vidmar@ir-rs.si