Factors Associated with Late Specialized Rehabilitation Among Veterans with Lower Extremity Amputation Who Underwent Immediate Postoperative Rehabilitation

Abstract

Objective To determine what patient- and facility-level characteristics drive late specialized rehabilitation among veterans who already received immediate postoperative services. Design Data were obtained from 8 administrative databases for 2,453 patients who underwent lower extremity amputation in Veterans Affairs Medical Centers in 2002-2004. A Cox proportional hazards model was used to determine the hazards ratios and 95% confidence intervals of the factors associated with days to readmission for late services after discharge from the surgical hospitalization. Results There were 2,304 patients who received only immediate postoperative services, while 152 also received late specialized rehabilitation. After adjustment, veterans who were less disabled physically, residing in the South Central compared to the Southeast region, and had their surgeries in CARF accredited facilities were all more likely to receive late services. The hazards ratios for type of immediate postoperative rehabilitation were not constant over time. At hospital discharge, there was no difference in receipt, however, after 3 months, those who received early specialized rehabilitation were significantly less likely to receive late services. Conclusion The factors associated with late specialized rehabilitation were due mainly to facility-level characteristics and care process variables. Knowledge of these factors may help with decision-making policies regarding CARF accredited units.

Factors Associated With Home Discharge After Rehabilitation Among Male Veterans With Lower Extremity Amputation

“…Clinicians will be inclined to believe that patients with higher motor FIM scores are at a functional level acceptable for returning home, as they gain enough functional ability to be able to move around their homes with decreasing levels of assistance. We previously found that veterans with lower extremity amputations who had higher discharge motor FIM scores were more likely to be admitted to late rehabilitation [19]. Once these patients have returned home, presumably at a more functional level, they are better able to re‐gain strength and endurance, facilitating readiness for prosthetic training during late rehabilitation.…”

Competências do profissional da saúde para o cuidado da pessoa com amputação

“…Nesta direção, diversas ações de reabilitação podem ser iniciadas e a atuação da equipe de saúde neste período, abrange avaliação física detalhada, explanação sobre o prognóstico funcional, esclarecimentos sobre dor fantasma e discussões sobre as metas de reabilitação de curto, médio e longo prazo. 1,18,19,20,21 Finalmente, quanto à competência sociopolítica dos profissionais de saúde, notouse que os mesmos estão engajados com o princípio de que o indivíduo com amputação insere-se em uma comunidade e possui uma realidade social. Assim, para desenvolver um plano de cuidado integral é imprescindível conhecer as necessidades e com quais redes de apoio as pessoas com amputação podem contar e estar disposto a reformular este planejamento sempre que necessário.…”