Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science


Health and Rehabilitation Sciences


Hunter, Susan W.


This thesis sought to investigate the changing characteristics of people with lower limb amputations (LLAs) who participate in prosthetic rehabilitation programs and evaluate an under-investigated subgroup; the oldest old (aged 80 years and older). Study 1 included 601 consecutive admissions to a Canadian prosthetic rehabilitation program from 2012 to 2019. Although participant’s age did not increase at admission over time, individuals presented with a higher number of comorbidities each year. Participants were admitted from amputation surgery faster over time. Study 2 assessed functional prosthetic rehabilitation outcomes for the oldest old against participants aged 50 to 79 years old. Despite the oldest old having reduced balance confidence compared to all other age groups, they demonstrated similar potential for walking ability. These findings show that the participant profile is changing for individuals accepted for prosthetic rehabilitation, and advanced age alone should not be a disqualifying factor for admission to these programs.

Summary for Lay Audience

More people are expected to have lower limb amputations at advanced ages due to population aging and an increase in conditions such as diabetes and peripheral vascular disease. People aged 80 years old and older (oldest old) are part of the fastest-growing age group in Canada, yet most of the current amputee literature fails to consider the oldest old as a separate group. Prosthetic rehabilitation programs allow people to become trained in walking with their prosthetic limb, which is the main contributing factor to quality of life in this population. While these programs aim to improve function, progress may be negatively affected by the multiple health issues present in advanced age groups. It is therefore important to understand the impact of advanced age on prosthetic rehabilitation outcomes to maximize gains related to walking and quality of life. The objective of Study 1 was to evaluate how the population has changed over time at admission to prosthetic rehabilitation programs. Study 1 found that while participants did not get older at admission to prosthetic rehabilitation over time, individuals had an increased number of health issues each year at admission. Further, the time period between amputation surgery and admission to the program became shorter each year. Study 2 compared functional outcomes (i.e., endurance) of the oldest old participants to younger groups aged 50 to 79 years old. The oldest old had similar potential for ability to walk with a prosthesis as individuals aged 60 and older but had lower confidence in performing activities without losing their balance. These studies provide novel insight into the changing needs of individuals with limb loss who participate in prosthetic rehabilitation and the oldest old group specifically. These projects give clinicians a better understanding of the relationship between age and prosthetic rehabilitation outcomes, which is important for service delivery.

Creative Commons License

Creative Commons Attribution-Share Alike 4.0 License
This work is licensed under a Creative Commons Attribution-Share Alike 4.0 License.