Houghton Scale

Introduction

The Houghton Scale was developed by a team of British researchers, led by a vascular surgeon named A.D. Houghton, MD. They were out to determine the rate of successful rehabilitation among individuals with lower-limb amputations of vascular etiologies. The scale quantifies functional outcomes among people with lower-limb amputations. Devin et al[1] proposed Houghton Scale parallels Medicare K-level classifications. They implied a score > 9 on the Houghton scale indicative of satisfactory rehabilitation corresponds to the K3 functional level (the ability to walk at variable cadence and negotiate most environmental obstacles for prosthesis use beyond simple locomotion) while Houghton score > 6 indicative of mobility on the prosthesis around the house corresponds to the K2 functional level (ability to walk outdoors and negotiate low environmental barriers-curbs and stairs)and Houghton Scale scores < 6 are suggested as corresponding to the K1 functional level (ability to walk on level, indoor surfaces)[2]

Objective

The Houghton scale[3] is a 4-item instrument that accesses prosthetic use in people with lower extremity amputations. It reflects a person’s perception of prosthetic use. It's self-administered and easy to score.

Intended Population

The scale is intended for use by individuals with lower limb amputation

Method of Use

The first 3 items are scored on a 4-point scale and it attempts to capture prosthetic wearing habits whilst the fourth question has 3 dichotomous (yes/no) items that assess a patient’s comfort level when negotiating different outdoor surfaces. Results are reported as a total score out of 12, with higher scores indicating greater performance and greater comfort.

Houghton scale1.jpg

Houghton Score Categories

It defines community and household walking ability.

  • Houghton Scale score ≥ 9- independent community
  • Houghton Scale scores 6–8- household and limited community
  • Houghton Scale score ≤ 5- limited household

Evidence

Miller et al[4] compared the Houghton Scale with the Prosthesis Evaluation Questionnaire (PEQ) and the Locomotor Capabilities Index of the Prosthetic Profile of the Amputee (PPA) and concluded that Houghton Scale had modest internal consistency, good test retest reliability, and was the only scale tested that could discriminate between people with transfemoral and transtibial amputations.

Reliability

Devlin et al[1] found the reliability of the Houghton Scale to be high .Intraclass correlation coefficient = 0.96 n=49

Validity

Internal consistency moderate at discharge (Cronbach α=.71) and follow-up (Cronbach α=.70)[1]

Significant but moderate correlation between the Houghton Scale and the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r =.393, P <.01) and the 2-minute walk test at admission (r= .620, P <.01) and discharge (r =.653, P <.01)

Responsiveness

Significantly increased scores at 3 months follow up (P<.001 ) [1]

Mean ± standard deviation of 6.14±2.40 at discharge to 7.70±2.62 at 3 months follow up

References

  1. 1.0 1.1 1.2 1.3 Devlin, M., T. Pauley, K. Head, and S. Garfinkel. 2004. Houghton Scale of prosthetic use in people with lower extremity amputations: Reliability, validity, and responsiveness to change. Archives of Physical Medicine and Rehabilitation 85 (8):1339-44.
  2. Wong, C. K., W. Gibbs, and E. S. Chen. 2016. Use of the Houghton scale to classify community and household walking ability in people with lower-limb amputation: Criterion-related validity. Archives of Physical Medicine and Rehabilitation 97 (7):1130-6.
  3. Houghton AD, Taylor PR, Thurlow S, Rootes E, McColl I. Success rates for rehabilitation of vascular amputees: implications for preoperative assessment and amputation level. Br J Surg 1992;79:753-5
  4. Miller WC, Deathe AB, Speechley M. Lower extremity prosthetic mobility: a comparison of 3 self-report scales. Arch Phys Med Rehabil 2001;84:1432-40.