Long-Term Outcomes and Survival of Patients with Bilateral Transtibial Amputations After Rehabilitation

Neill, Heather L. Mac; Devlin, Michael; Pauley, Tim; Yudin, A. A.

doi:10.1097/phm.0b013e31816178cc

Cited by 24 publications

(21 citation statements)

References 15 publications

(25 reference statements)

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“…7–12 Despite growing evidence of its effectiveness, the proportion of patients who receive inpatient rehabilitation following a major dysvascular lower extremity amputation remains low, with less than one third of those patients being discharged to an inpatient rehabilitation facility. 13,14 To a large extent, papers examining the effects of post-acute care setting on outcomes have not focused on physical function or physical independence as outcomes, 6,15–18 despite evidence that improved physical functioning is correlated with increased survival. 19 In addition, with one notable exception, studies to date have been most often retrospective, relying primarily on claims data, administrative data, and chart review.…”

mentioning

confidence: 99%

Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

Sauter

Pezzin

Dillingham

2013

American Journal of Physical Medicine &Amp; Rehabilitation

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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...

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confidence: 99%

Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

Sauter

Pezzin

Dillingham

2013

American Journal of Physical Medicine &Amp; Rehabilitation

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“…Thus, they have a significant influence on psychosocial adaptation to amputation 11 and on performance in activities of daily living. 12 Therefore, since social restrictions have an impact on patients' lives, rehabilitation should be an ongoing, individualized and planned process, from before the operation until the definitive prosthesis is inserted, in order to allow patients to recover normal life and perform all their basic activities. However, dissatisfaction with and low utilization of physiotherapy and occupational Table 2.…”

Section: Discussionmentioning

confidence: 99%

Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data

et al. 2014

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CONTEXT AND OBJECTIVE: Lower-limb amputation compromises patients' independence and autonomy, and therefore they should be referred for rehabilitation in order to adapt to prostheses and regain autonomy. The aim here was to assess adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data. DESIGN AND SETTING: This was a cross-sectional study in the city of Aracaju, Brazil. METHODS:The patients were identified by primary healthcare teams. The inclusion criterion was that these should be patients who underwent major lower-limb amputations of any etiology. Associations between sociodemographic and clinical variables and the adaptation to lower-limb prostheses were assessed. RESULTS: 149 patients were examined. Adaptation to the prosthesis occurred in 40% (60/149) of them, but only 62% (37/60) were using it. Adaptation occurred more often among male patients (P = 0.017) and among those who had a higher educational level (P = 0.013), with a longer time since amputation (P = 0.049) and when the etiology was trauma (P = 0.003). The result from logistic regression analysis showed that only patients with low education (P = 0.031) were significantly associated with a lower frequency of adaptation to prostheses. CONCLUSION: It was found that patients with a low educational level became adapted to the prosthesis less frequently.RESUMO CONTEXTO E OBJETIVO: A amputação de membros inferiores compromete a independência e a autonomia dos pacientes, por isso, eles devem ser encaminhados para a reabilitação para a adaptação das próteses e assim viabilizar a recuperação da autonomia. O objetivo foi avaliar a adaptação de prótese em pacientes com amputações maiores de membros inferiores e sua associação com dados sócio-demográ-ficos e clínicos. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado na cidade de Aracaju, Brasil. MÉTODO: Os pacientes foram identificados pelas equipes de atenção primária à saúde. O critério de inclusão foi pacientes submetidos a amputações de membros inferiores principais de todas as etiologias. Foram avaliadas as associações entre variáveis sociodemográficas e clínicas e a adaptação de próteses de membros inferiores. RESULTADOS: Foram examinados 149 pacientes. A adaptação da prótese ocorreu em 40% (60/149) deles, mas apenas 62% (37/60) a utilizavam. Adaptação ocorreu mais frequentemente em pacientes do sexo masculino (P = 0,017) e naqueles que tinham maior nível de escolaridade (P = 0,013), com maior tempo de amputação (P = 0,049) e quando a etiologia (P = 0,003) foi o trauma. O resultado da análise de regressão logística mostrou que apenas a com baixa escolaridade (P = 0,031) foi significativamente associada com uma menor frequência na adaptação de próteses. CONCLUSÃO: Verificou-se que pacientes com baixa escolaridade tiveram menor frequência de ajuste para a prótese. IPhD. Adjunct Professor and Head

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“…The literature for patients with bilateral amputations has a heavy focus on elderly vascular patients, encompassing several etiologies, who may not desire a high function level postamputation [3]. Many studies used questionnaires as an outcome measure for quality of life, confident prosthetic usage, and successful rehabilitation [4,[5][6][7]. Wright et al [7] believes that high activity level and attitude pre-amputation influences the motivation and success in rehabilitation.…”

Section: Introductionmentioning

confidence: 98%

Virtual reality enhanced rehabilitation for a service member with bilateral lower extremity amputations: A case study

Kruger

Bell

Schnall

2009

2009 Virtual Rehabilitation International Conference

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To review the outcomes of rehabilitation for a service member with bilateral lower extremity amputations. A 25 yearold marine suffered a right knee disarticulation and a left transtibial amputation during military service. For two years, the patient underwent a comprehensive rehabilitation program at Walter Reed Army Medical Center. During the course of his rehabilitation, this patient took part in conventional physical therapy and at 16.5 months post-injury added clinical sessions in the Computer Assisted Rehabilitation Environment (CAREN) Laboratory to his therapy regimen for approximately six months. Gait analyses were conducted at three different points in his rehabilitation program: 5.5, 18, and 23.5 months post-injury.Temporal spatial parameters of self-selected velocities, cadence, and step length increased while his stance support time and step width decreased, becoming closer to asymptomatic populations. During the CAREN clinical sessions, the patient showed an increase in overall speed in the Road with Overhead Targets application. With the Boat application, the patient was able to improve the application time at increased levels of difficulty. The use of virtual reality as an adjunct to conventional rehabilitation for individuals with amputations provides a novel approach for maximizing function.

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Long-Term Outcomes and Survival of Patients with Bilateral Transtibial Amputations After Rehabilitation

Abstract: Patients undergoing rehabilitation for BTTA continue to do well at long-term follow-up and to survive, on average, for more than 4 yrs after discharge. Therefore, they should be given strong consideration for prosthetic fitting.

Cited by 24 publications

References 15 publications

Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

Adaptation to prostheses among patients with major lower-limb amputations and its association with sociodemographic and clinical data

Virtual reality enhanced rehabilitation for a service member with bilateral lower extremity amputations: A case study

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