Diabetes and lower extremity amputation -rehabilitation pathways and outcomes at a regional hospital

Abstract

BACKGROUND: Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes METHODS: Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes RESULTS: From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52-68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and crutches (7; 7.7%), and wheelchair-bound (4; 4.4% CONCLUSION: Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways Keywords: prevalence, diabetes mellitus, lower extremity amputations, rehabilitation, physiotherapy

Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study

“…This variable considered total diet score (=17), total exercise score (=17), total medication score (=12), total testing score (=12), footcare (=7), smoking (=1), alcohol (=1), doctor (=5), and self-care (=5), giving a total self-management score = 77. Assessed self-management was categorised as poor (0-37), fair (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57), and good (58-77).…”

“…In Table 4, the combined scores of self-management activities and compliance were assessed over the last eight weeks using DSMQ. The assessed self-care management activities are presented as means ± SD, frequencies, and proportions, and categorised as poor (0-37), fair (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57), and good (58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77). The results showed that only 10% had a good total diet, 10% were good with exercise, 75% had a good total medication score, and only 3% had a good total self-testing score.…”

“…Additionally, it is important to bear in mind that challenges to the management of diabetes revolve around optimal care, diabetes self-management education, medication adherence, reducing barriers, and improving health delivery [44]. There has been minimal research conducted on contextual factors regarding diabetes self-management in the country, particularly the practice of foot-care, which is vital to prevent limb amputation; one of the most common complications (71.8%) of diabetes in South Africa [45].…”