Objective-To determine if the presence of specialized rehabilitation units (SRUs) within Veterans Affairs medical centers (VAMC) influences access to rehabilitation services.
Design-Retrospective cohort analysis.Setting-Two types of VAMCs: those with and without SRUs. October 1, 2002, and September 30, 2003. There were a total of 2375 veterans with amputations: 99% were men; and 60% had transtibial, 40% had transfemoral, and less than 1% had hip disarticulation amputations. Nine hundred sixty-six patients (41%) were seen at a VAMC with an SRU.
Participants-Veterans with lower-extremity amputations discharged from VAMCs between
Interventions-Not applicable.Main Outcome Measure-Level of service provided expressed as: no evidence of rehabilitation during the hospitalization, generalized rehabilitation through consultation only, or admission to an SRU.Results-There were no differences between patients treated at facilities with SRUs and those treated in a facility without SRU beds with respect to age, sex, marital status, source of hospital admission, or level of amputation (all P<.05). Patients with lower initial FIM instrument scores were more likely to be treated in facilities with SRUs, and to have longer lengths of acute hospitalization (P<.01). Patients at facilities with an SRU compared with those without an SRU Reprints are not available from the author.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
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NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript had comparable likelihoods of being seen for an initial rehabilitation consultation (75% vs 74%, P=.56), but were more likely to be admitted for high intensity specialty rehabilitation services (26% vs 11%, P<.01).Conclusions-Although the majority of patients were seen in consultation, structural differences in service availability among clinically similar populations appear to be causing access disparities to specialized rehabilitation among amputees in the VAMC setting. The implication of these differences with regard to patient outcomes will need to be determined.
KeywordsAmputation; Leg; Rehabilitation; Veterans Amputation of the lower limb can result in permanent impairment and disability, reducing the capacity for productive activities among people of all ages, but especially in the elderly. Lower-limb amputations in the United States can be expected to double from 28,000 to 58,000 per year by 2030 because of the disproportionate shifts in the oldest segments of our population, 1 making cost-effective rehabilitation strategies to help elderly patients achieve independence and home discharge increasingly essential in the upcoming decades.Rehabilitation immediately after the onset of any new impairment (including lowerextremity amputation) can be provided in a variety of ways that could be considered a continuum ranging from no rehab...