Functional Outcome and Comorbidity Indexes in the Rehabilitation of the Traumatic Versus the Vascular Unilateral Lower Limb Amputee1

Abstract

This study compared the Functional Independence Measure (FIM) scores of traumatic (n=12) and vascular (n=12) unilateral lower limb amputees at admission and discharge from a rehabilitation facility. FIM scores that were measured were amputation FIM subscores and total FIM scores. Comorbidity indexes were developed to weight the stump condition and comorbidities seen in both groups. The vascular group was significantly (P<0.01) greater stump comorbidity, but there was no significant difference with respect to length of stay, medical comorbidity score, and amputation and total FIM scores both at admission and discharge between the two groups. Medical comorbidity was significantly (P<0.05) correlated with amputation and total FIM scores at discharge for traumatic amputees with r = -0.64 and r = -0.66, respectively. Stump comorbidity was significantly (P<0.05) correlated with total FIM at discharge with r = -0.64 for vascular amputees. Medical comorbidity was a good predictor of discharge FIM scores for traumatic amputees, whereas stump comorbidity predicted discharge FIM scores for vascular amputees, although not as well. In conclusion, inpatient traumatic amputees may be younger than vascular amputees, but traumatic amputees may not necessarily be healthier or do better functionally at discharge than vascular amputees.

Physical capacity and walking ability after lower limb amputation: a systematic review

“…The interaction between these different parameters is unknown. For example, Melchiorre et al 45 stated that vascular amputees had significantly more stump comorbidities than traumatic amputees. Geertzen et al 6 and Waters and Mulroy 8 stated that vascular amputees had more walking problems than traumatic amputees.…”

“…44,45 However, when the numbers of walkers in the different studies were compared, higher levels of walking ability seemed to be reached for traumatic amputees than for vascular amputees.…”

Rehabilitation Programs monitored by Functional Independence Measure: An Observational Study

“…It has been indicated that discharge FIM score for traumatic amputees is well predicted by medical comorbidity and for vascular amputees by stump comorbidity (an inverse relationship in both). 25 Rush et al 26 pointed out that the admission FIM score does not predict successful prosthetic rehabilitation in lower extremity amputee patients as it does not correlate with the Houghton Scale for prosthetic use. Morrison et al 27 maintain that FIM may not be useful in detecting changes in follow up measure for early lower limb amputees but that it is suitable for measuring changes during the inpatient stage of rehabilitation.…”

Care of the Elderly Patient with Lower Extremity Amputation

“…2 Traumatic amputee patients tend to be younger and healthier than vascular amputee patients. 12 Benign or malignant tumors are responsible for the remaining 5% of amputations among older patients. 2 …”