Rehabilitation of the older vascular amputee: A review of the literature

Abstract

The aim was to review the literature on factors affecting prosthetic rehabilitation of older vascular lower extremity amputees. A search of the literature was carried out using the MEDLINE, EMBASE and CINAHL databases up to September 2010. Only original English language articles were accepted. Relevant studies were reviewed and selected based on prespecified inclusion criteria namely: age more than 65 years; vascular cause for the amputation; amputation level of below knee, through-the-knee or above knee; and discussed factors affecting rehabilitation. Age alone is not an absolute contraindication to prosthetic limb prescription; however, it does influence the potential success of gait retraining. Other factors influencing prosthetic fitting and use include comorbidities, premorbid function, level of amputation, status of the remaining limb and patient motivation. Prosthetic gait retraining is not possible in every older dysvascular amputee; however, almost all amputees will benefit from a rehabilitation program to increase independence in transfers and learn wheelchair skills. The MESH key words were: "aged" "diabetes complications" "peripheral vascular diseases" "amputees" "amputation" "rehabilitation" and "artificial limbs".

Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation

“…Rightfully, critics might question the need for a new outcome measure for use in amputee patients, as several already exist . However, as reviewed, they commonly also include evaluation of walking and prosthetic use, and are not specifically focused on independence in basic transfer and wheelchair mobility skills, which is considered an important target for many dysvascular amputees …”

“…Thus, prosthetic fitting is associated with improved quality of life, and is the long‐term goal for most patients after a LEA, although early postural control seems extremely limited . However, prosthetic fitting is not possible in every patient after a major LEA, and particularly not in every dysvascular amputee, and not the primary focus of today's acute in‐hospital rehabilitation programs . On the contrary, independence in transfers and wheelchair skills is considered mandatory for all patients, for independent daily functioning, and especially for those returning to live in their home.…”

Assessment of quality of life in patients after lower limb amputation

“…It is very likely that the ability to move has the greatest impact on a group of variables related to physical health component. We must bear in mind that a large number of factors affect these people's ability to move, as well as their overall quality of life [8,15,16]. Patients with lower extremity amputations usually have associated chronic diseases, such as diabetes and cardiovascular disease.…”

Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation

“…(51) The perception that they are “ready” for a prosthesis and the therapy needed to be a successful prosthetic limb user can bolster a patient’s confidence and sense of wellbeing. There needs to be emphasis on the role of social and psychological factors when evaluating and tailoring interventions to enable the optimal use of the prosthetic limb so that patients experience positive outcomes, such as increased social participation and community reintegration, higher quality of life, and reduce burden on the family and community.…”