Baseline PTSD and depressive symptoms predict multidimensional recovery after combat-related transtibial amputation: a prospective cohort study.

Introduction: Posttraumatic stress disorder (PTSD) is common among combat-injured service members. To date, there is insufficient evidence to determine whether the initial severity of psychiatric disorders is associated with the dynamics of motor recovery after lower limb amputation. The aim of the study was to assess whether the severity of PTSD and depressive symptoms at the time of hospitalization affect the outcomes of intensive robotic neurorehabilitation after combat-related unilateral transtibial amputation. Methods: A prospective cohort study included 45 male service members with unilateral transtibial amputations who underwent a standardized robotic neurorehabilitation program for the lower limbs. The examinations were performed at four time points: on days 0, 14, 30, and 120. 46 indicators were evaluated, including stabilometric posturography (Stabiloplatforma Alfa), instrumental gait analysis (OMEGO, STRIDE ONE, BALO), clinical functional tests (BBS, TUG, FRT, AMPPRO, FSST, 10MWT, 2MWT, 6MWT, ABC), pain intensity (VAS), as well as psychiatric scales PCL-5 and PHQ-9. Statistical analyses included longitudinal mixed-effects modeling, multivariable regression, and exploratory machine-learning approaches. Results: The study found that the level of PTSD and depression at the beginning of rehabilitation was associated with functional recovery after combat transtibial amputation. 37.8% of participants recorded a clinically significant improvement according to the combined criterion. Psychiatric scales (PCL-5 and PHQ-9) showed moderate predictive ability for rehabilitation response (AUC = 0.80). The PCL-5, PHQ-9, VAS, and baseline functional indicators (BBS and TUG) had the greatest contribution to prediction. The probability of a positive response to treatment decreased with higher PCL-5 values. Cluster analysis identified two types of patients: with high psychiatric burden and worse recovery and with lower burden and better outcomes. Conclusions: The results suggest that psychiatric status at the beginning of rehabilitation may be an important factor associated with functional recovery after amputation. Screening for PTSD and depression may help predict rehabilitation outcomes. However, these findings need to be confirmed in larger studies. It is also worthwhile to examine whether early psychiatric intervention can improve rehabilitation outcomes.