Beyond Functional Mobility: Psychosocial Adaptation as a Distinct Dimension of Lower Limb Prosthetic Rehabilitation

Background Functional mobility alone may not fully reflect rehabilitation success after lower limb amputation. Patient-reported prosthetic satisfaction, psychosocial adaptation, and perceived functional competence may represent partially independent dimensions of recovery. This study investigated the multidimensional relationships among mobility, prosthesis-related satisfaction, and psychosocial adaptation in individuals with traumatic lower limb amputation. Methods This cross-sectional observational study included 70 adults with traumatic lower limb amputation who were current prosthesis users. Participants underwent multidimensional assessment using K-level classification, Locomotor Capability Index-5 (LCI-5), Houghton Scale, Timed Up and Go (TUG), Trinity Amputation and Prosthesis Experience Scales (TAPES), SF-12, and Falls Efficacy Scale. Participants were categorized into lower activity (K1–K2) and higher activity (K3–K4) groups. Results The higher activity group demonstrated significantly better Houghton scores ( p = 0.008), TUG performance ( p < 0.001), TAPES disability scores ( p < 0.001), prosthesis satisfaction ( p = 0.008), SF-12 physical ( p < 0.001), SF-12 mental ( p < 0.001), and LCI-5 scores ( p < 0.001). In contrast, TAPES psychosocial scores ( p = 0.176) and fall efficacy ( p = 0.062) did not significantly differ between groups. Receiver operating characteristic (ROC) analysis showed the strongest discriminative performance for the Houghton Scale (area under the ROC curve [AUC] = 0.809, 95% CI: 0.710–0.908) and LCI-5 (AUC = 0.802, 95% CI: 0.699–0.905), followed by SF-12 physical (AUC = 0.750) and SF-12 mental scores (AUC = 0.732). Hierarchical clustering suggested a dominant functional mobility cluster and a partially distinct psychosocial-prosthetic adaptation cluster. Conclusion K-level and mobility-based measures primarily reflect ambulatory capacity but do not fully capture psychosocial adaptation. Multidimensional assessment may better characterize rehabilitation success after lower limb amputation.