Evaluation of the BLARt Score to Predict Walking Ability in Patients with Lower Limb Amputations in Northern Ireland

Background: Following lower limb amputation, patients experience uncertainty regarding whether they will benefit from a lower limb prosthesis. The BLARt assessment tool, completed at the point of referral in the early postoperative period, demonstrated a strong ability to predict whether a patient would be able to walk with a prosthetic limb during initial development. However, its external validity remains unclear. Objectives: Evaluate whether the BLARt score predicts prosthetic walking at the point of referral in the early postoperative period, among patients from Northern Ireland with a lower limb amputation. Study Design: Service evaluation. Methods: Retrospective review of 280 patients with lower limb amputations on a vascular surgery ward (2021–2023). BLARt scores were routinely collected in the early postoperative period, following amputation. Walking mobility outcome using the Special Interest Group in Amputee Medicine (SIGAM) mobility grading was routinely assessed at completion of early walking training. We explored the ability to transfer (SIGAM B), walk (SIGAM C, D, E, or F), and abandon or not walk (SIGAM A, died or did not complete rehabilitation) with a prosthesis and the predicted BLARt score. Results: The majority of patients with a high BLARt score, at the time of referral, did not walk or transfer with a lower limb prosthesis (>12 = 92%, >16 = 96%, and >18 = 95%). Area under the receiver operator curve for inability to walk with a prosthesis confirmed the predictive ability of the BLARt score (AUC 0.808, SE 0.03, 95% CI 0.75–0.86). Conclusions: People with a BLARt score less than 13 were more likely to walk with a prosthesis following a lower limb amputation. A high BLARt score was strongly associated with patients not being able to walk after a lower limb amputation. Patients with a moderately high BLARt score (13–19) may benefit from a prosthesis for transfers. Clinical Relevance Statement: We believe this article is timely given the increasing number of patients with lower limb amputations across the United Kingdom, the high mortality rates following amputation, and the finite capacity within amputee rehabilitation services. It is therefore important that we evaluate tools in clinical practice that have the potential to identify patients most likely to benefit from a prosthesis. This could allow streamlining of referrals into a service.