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Prosthet Orthot Int. 2013 Oct;37(5):362-8. doi: 10.1177/0309364612470482. Epub 2013 Jan 17.

Ramp descent performance with the C-Leg and interrater reliability of the Hill Assessment Index.

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School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33613, USA.



Transfemoral amputees have decreased ability to descend ramps and hills. The Hill Assessment Index quantifies transfemoral amputee ramp performance, but interrater reliability has not been assessed.


To determine whether C-Leg use improves hill descent gait and evaluate the Hill Assessment Index's interrater reliability.


Twenty-one transfemoral amputees descended a ramp while timed and video recorded, using their nonmicroprocessor prosthetic knee. Subjects were fitted and accommodated with a C-Leg and retested. Test times were compared, and ramp performances were independently reviewed using the Hill Assessment Index by two raters. Hill Assessment Index scores were compared between knee conditions within raters for performance and between raters to assess the Hill Assessment Index's interrater reliability.


Mean Hill Assessment Index scores were greater for C-Leg compared to nonmicroprocessor prosthetic knee for both raters. C-Leg resulted in faster ramp descent. Strong correlations resulted between raters on Hill Assessment Index scores for nonmicroprocessor prosthetic knee (intraclass correlation coefficient = 0.97) and C-Leg (intraclass correlation coefficient = 0.99).


C-Leg improves Hill Assessment Index ramp descent performance and time. In descent quality, C-Leg offers the possibility of eliminating assistive device use and/or improving step length in the absence of an assistive device. C-Leg resulted in 23% gait speed increase during ramp descent. The Hill Assessment Index had very good interrater reliability but should be assessed for intrarater reliability, minimal detectable change, and validity.


Amputee; downhill; gait; outcome measure; slope

[Indexed for MEDLINE]

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