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ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.  DOI: https://doi.org/10.33137/cpoj.v1i2.32040                                                                          

 

1 

 
OPEN  ACCESS 

ABSTRACT (ORAL PRESENTATION)  

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

FACTORS ASSOCIATED WITH MOBILITY APPREHENSION IN AMPUTEES 

Shannon L. Mathis*1,  

1The University of Alabama in Huntsville, USA. 
* E-mail: shannon.mathis@uah.edu 

DOI: https://doi.org/10.33137/cpoj.v1i2.32040  

 

INTRODUCTION 

Studies report that after lower-limb amputation, patients 

have high levels of pain in the form of chronic low back 

pain, residual limb pain, and phantom pain leading to 

restrictions in functional activity1. Patients with high 

levels of pain and disability may develop avoidance 

behaviors. Vlaeyen et al. presents the fear-avoidance 

model, which suggests that after an injury there are two 

pathways a patient will take based on their interpretation 

of acute pain 2. Pain that is perceived as non-threatening 

leads to the patient’s recovery and return to normal 

activities of daily life. Pain that is perceived as 

threatening, or pain catastrophizing, causes anxiety and 

induces mobility apprehension which leads to avoidance 

behaviors. Avoidance behaviors may then lead to greater 

pain, depression, and disability3 . Factors described in the 

literature that are related to mobility apprehension were 

measured in a sample of lower limb amputees. The 

purpose was to determine which of pain intensity, 

interference, and catastrophizing lead to increased 

mobility apprehension.  

METHODS 

 Subjects: Amputee Coalition Conference attendees were 

recruited for participation (see Table 1). Apparatus: 

Subjects completed the Tampa Scale for Kinesiophobia 

(TSK) to measure mobility apprehension. The Brief Pain 

Inventory (BPI) measures pain intensity which consists 

of a patient’s current, worst, least, and average pain. The 

pain interference subscale quantifies general activity, 

mood, walking ability, normal work, relations with other 

people, sleep, and enjoyment of life. The Pain 

Catastrophizing Scale (PCS) measures the tendency to 

ruminate and magnify pain sensations.  Self-report 

instrument data are presented in Table 2. Data Analysis: 

Descriptive statistics were explored to present mean and 

standard deviations for all outcomes. A multivariable 

linear regression model included all variables of interest 

and results are presented in Table 3.   

 

RESULTS 

Mobility apprehension was the main variable of interest 

with a mean score of 34. This score is approaching the 

cut-off score of 39 representing a high level. Half of the 

participants were questioned about recent falls and fear 

of falls. Of the 31 respondents, 16 (52%) experienced a 

fall within the last year and 9 (29%) reported a fear of 

falls. 

DISCUSSION 

This data presents an attempt to determine factors 

associated with mobility apprehension among lower limb 

amputees. The findings were that pain catastrophizing 

was directly related to mobility apprehension. Results 

indicate that a similar trial with a larger sample that is 

more representative of a wider cross-section of lower-

limb amputees is warranted.  

 

Table 1.  Participant Characteristics 

Characteristic n (%) 

Mean Age (years, SD)  48.3 (14.8) 

Sex 

• Female 

• Male 

 

36 (68%) 

17 (32%) 

Race 

• White 

• Non-white 

 

43 (81%) 

10 (19%) 

Mean Years Since Surgery 

(SD) 

11.3 (13.5) 

 

 

mailto:shannon.mathis@uah.edu
https://doi.org/10.33137/cpoj.v1i2.32040


 

 

Mathis S.L. FACTORS ASSOCIATED WITH MOBILITY APPREHENSION IN AMPUTEES. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, 
ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018.  DOI: https://doi.org/10.33137/cpoj.v1i2.32040                                                                          

 

2 

 
OPEN  ACCESS 

ABSTRACT (ORAL PRESENTATION)  

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

 

Table 2.  Self-report instrument data 

Characteristic M (SD) 

Mobility Apprehension 

   High, ≥ 39 (n, %) 

   Low, < 39 (n, %) 

34.2 (6.0) 

10 (20%) 

41 (80%) 

Pain Intensity  1.6 (1.7) 

   High, ≥ 5 (n, %) 7 (13%) 

   Low, < 5 (n, %) 47 (87%) 

Pain Interference  2.5 (2.6) 

   High, ≥ 5 (n, %) 13 (25%) 

   Low, < 5 (n, %) 40 (75%) 

Pain Catastrophizing 9.1 (10.0) 

   High, ≥ 24 (n, %) 4 (8%) 

   Low, < 24 (n, %) 37 (92%) 

 

 

Table 3.  Multivariable regression for factors 

associated with mobility apprehension 

Characteristic β (p) 

Pain Intensity 0.25 (.48) 

Pain Interference  -0.03 (.96) 

Pain Catastrophizing 0.31 (<.0001) 

     

CONCLUSION  

Pain catastrophizing was positively associated with 

mobility apprehension.  

SIGNIFICANCE 

Results may assist clinicians by further understanding 

mobility apprehension and the fear-avoidance model. 

REFERENCES 

1. Sinha et al. Influence of adjustments to amputation and 

artificial limb on quality of life in patients following lower 

limb amputation. Int J Rehabil Res. 2014, 1;37(1):74-9. 

DOI:10.1097/MRR.0000000000000038 

2. Vlaeyen et al. Fear of movement/(re)injury in chronic low 

back pain and its relation to behavioral performance. 

Pain.1995; 62, 363-372. DOI: 10.1016/0304-3959(94)00279-

N 

3. Archer et al. Early postoperative fear of movement predicts 

pain, disability, and physical health six months after spinal 

surgery for degenerative conditions. Spine J. 2014;14, 759-

767. DOI:10.1016/j.spinee.2013.06.087 

 

 

https://doi.org/10.1097/MRR.0000000000000038
https://doi.org/10.1016/j.spinee.2013.06.087

