Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

Abstract

Objective-To examine the effect of post-acute rehabilitation setting on functional outcomes among patients undergoing major lower extremity dysvascular amputations.Design-A population-based, prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization following amputation and at six-month following the acute care discharge were analyzed using multivariate models and instrumental variable techniques.Results-A total of 297 patients were analyzed based on post-acute care rehabilitation setting: acute inpatient rehabilitation (IRF), skilled nursing facility (SNF) or home. The majority (43.4%) received care in IRF, 32% in SNF, and 24.6% at home. On SF-36 subscales, significantly improved outcomes were observed for patients receiving post-acute care at an IRF relative to those cared for at a SNF in physical function (PF), role physical (RF) and physical component score (PCS). Patients receiving post-acute care in IRFs also experienced better RF and PCS outcomes compared to those discharged directly home. In addition, patients receiving post-acute care at an IRF were significantly more likely to score in the top quartile for general health in IRF compared to SNF or home, and less likely to score in the lowest quartile for PF, RF and PCS in IRF compared to SNF. Lower ADL impairment was observed in IRF compared to SNF.Conclusions-Among this large and diverse cohort of patients undergoing major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services at an IRF yielded improved functional outcomes six months after amputation relative to care received at SNFs or home.Correspondence: Timothy R. Dillingham, MD, MS, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard Street, First Floor, Philadelphia, PA 19046. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclosures:Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. NIH Public Access Author ManuscriptAm J Phys Med Rehabil. Author manuscript; available in PMC 2014 April 01. Currently, the incidence of limb loss secondary to dysvascular etiology accounts for the majority (82%) of amputations in the United States 1 and the incidence of such amputations is expected to rise with climbing rates of co-morbid diseases such as peripheral vascular disease and diabetes. 2 The prevalence of dysvascular lower extremity amputations (i.e. nontr...

Role of balance ability and confidence in prosthetic use for mobility of people with lower-limb loss

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The effect of social integration on outcomes after major lower extremity amputation

“…Many different features have been identified as impacting how amputees adapt to life after their amputations. These include specialized rehabilitation, 22,23 age, comorbidities, 24,25 level of amputation, 26 employment status and use of a prosthesis. 3 In terms of the role social factors play, data are mixed.…”

Gait Training Interventions for Lower Extremity Amputees: A Systematic Literature Review

“…An individual with LE amputation may face increased mortality and morbidity rates, decreased quality of life, and impaired function (5). Impaired function may include gait problems such as movement asymmetry (6).…”

“…Moreover, the TFA gait pattern may also include vaulting to assure prosthetic limb clearance during swing phase. The abnormalities of lateral trunk flexion and forces from vaulting may be contributing factors in the development of back pain, osteoarthritis, or other chronic overuse conditions (5,6,12,13). As previously mentioned, LE amputee gait impairments also include significantly increased ambulatory energy requirements, which may impact overall activity and participation (8,12,14).…”