Nov 19, 2025
VCU Researcher Expands Understanding of Mobility after Amputation with NIH-Funded Study
Understanding how individuals with lower-limb amputations navigate their communities – and why many remain dissatisfied with their mobility, even after successful rehabilitation – is the focus of a new research project led by Paul Kline, DPT, Ph.D., assistant professor in VCU’s Department of Physical Therapy.
The two-year study, supported by a career development award through the Clinical & Translational Science Award (CTSA) to VCU from the National Institutes of Health, builds directly on Kline’s earlier work, which focused on how well and how much individuals move after amputation. This new research adds a vital third dimension: where that movement happens.
While movement amount and frequency are important, “they don’t really provide the full picture,” he said. “This new award focuses on where people are moving and how they get there.”
Kline’s study will use a combination of GPS monitors and accelerometers to track both the location and type of movement among 50 participants. By synchronizing those two data streams, his team will be able to distinguish, for example, when walking activity occurs at home versus in the workplace, or how far an individual travels from their “home base” over a given period.
“Instead of just saying ‘you took 5,000 steps today,’” Kline said, “we can look at how far you actually went: how far away from your main base you traveled and what kinds of places you went to. This provides a clearer understanding of mobility in a way that captures the locations that are important to that individual.”
Participants will wear the devices for two weeks and log their destinations in an activity journal, noting the reason for each trip. This descriptive approach is designed to capture a realistic picture of how people move through and sometimes even limit their environments.
Beyond Steps: Understanding Dissatisfaction
Kline’s past research revealed a puzzling disconnect. Patients who could walk well in a clinic often struggled to stay mobile in their daily lives. Many became discouraged and reduced their community engagement, even though they had the physical ability to walk.
“The main concern, in my opinion, is that people with amputation are dissatisfied with their ability to be mobile and go to the places they want to go,” Kline said. “Even though they participate in rehab, learn how to walk with a prosthetic limb and walk well, they find that they’re still dissatisfied once they return home.”
This dissatisfaction often stems not from physical inability but from environmental or contextual barriers. Tasks that seem routine – such as navigating crowded grocery-store aisles or a hilly neighborhood park – can pose challenges that limit independence.
“Many people can walk fine at home, but when they go out, they might use their scooter or wheelchair,” he said. “And over time, some people may just decide it’s too hard to go at all. Their world narrows to only a handful of places.”
Mapping the Path to Better Outcomes
The study will run through April 2027 and aims to create the first dataset quantifying both the extent and geography of community mobility after amputation. These findings could shape future interventions from tailored rehabilitation programs to new strategies that help patients decide on walking, wheelchair use or other modes of mobility for specific activities or locations.
“We don’t want people to always rely on walking or always rely on their wheelchair,” Kline said. “We want them to use the capabilities they have, but in a complementary way that lets them go where they want to go and do what they want to do.”
Ultimately, Kline hopes the project will bridge a critical gap between clinical success and real-world satisfaction. “This study is the first step,” he said, “in helping people with amputations truly get back to living the lives they want – socially, occupationally and in their communities.”