Anushua Banerjee

Question: Can a personalized post-rehabilitation intervention, guided by wearable sensor data, clinical outcomes, and expert review, improve functional mobility in individuals with lower limb amputation (LLA) who exhibit unmet mobility needs? Design: Prospective observational study with a nested intervention. Participants: Fifty-eight adults with LLA, recruited from military and civilian sites. Based on three months of community-based monitoring and clinical assessments, an expert panel identified 26 individuals as requiring additional support; 19 completed the intervention. Intervention: Tailored combinations of physical therapy, prosthetic adjustments, and/or motivational interviewing delivered over three months based on individual needs and goals. Outcome Measures: Performance-based tests, patient-reported outcomes, daily step count, and progress toward self-defined mobility goals. Change from baseline was assessed using minimal clinically important difference (MCID) thresholds. Between-group comparisons (Responders vs Non-Responders), and equivalence testing with a non-intervention group were conducted. Results: Following intervention, 68% of participants improved in functional outcomes, goal attainment, or both. Among Responders, 46% exceeded the MCID for sit-to-stand performance, with 17– 33% meeting thresholds for other mobility and quality-of-life measures. Responders had lower body mass index, fewer comorbidities, showed greater gains in step count, physical performance and prosthesis-related quality of life. Equivalence testing showed Amputee Mobility Predictor scores among Sustained Responders became statistically comparable to those who never required intervention. Most participants maintained gains at follow-up. Conclusion: A personalized intervention approach guided by integrated data and experts review may improve real-world outcomes in individuals with LLA. These findings support reassessment to identify residual needs and deliver targeted support beyond standard care.