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Guilcher SJT, Mayo AL, Swayze S, de Mestral C, Viana R, Payne MW, Dilkas S, Devlin M, MacKay C, Kayssi A, Hitzig SL. Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study. PLoS One 2024; 19:e0305381. [PMID: 38990832 PMCID: PMC11238985 DOI: 10.1371/journal.pone.0305381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology. OBJECTIVE To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits. DESIGN Retrospective cohort study using population-level administrative data. SETTING Ontario, Canada. POPULATION Adults individuals (18 years or older) with a major dysvascular LEA between April 1, 2004 and March 31, 2018. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Acute care hospitalizations and ED visits within one year post-initial discharge. RESULTS A total of 10,905 individuals with major dysvascular LEA were identified (67.7% male). There were 14,363 acute hospitalizations and 19,660 ED visits within one year post-discharge from initial amputation acute stay. The highest common risk factors across all the models included age of 65 years or older (versus less than 65 years), high comorbidity (versus low), and low and moderate continuity of care (versus high). Sex differences were identified for risk factors for hospitalizations, with differences in the types of comorbidities increasing risk and geographical setting. CONCLUSION Persons with LEA were generally more at risk for acute hospitalizations and ED visits if higher comorbidity and lower continuity of care. Clinical care efforts might focus on improving transitions from the acute setting such as coordinated and integrated care for sub-populations with LEA who are more at risk.
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Affiliation(s)
- Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda L. Mayo
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Charles de Mestral
- Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Michael W. Payne
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Steven Dilkas
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Crystal MacKay
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Ahmed Kayssi
- Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Witt M, Domazet T, Dong A, Handler C, Nella K, Dilkas S, Campbell J, Guilcher SJT, MacKay C. Understanding transitions in care for persons with limb loss: a qualitative study exploring health care providers' perspectives. Disabil Rehabil 2024:1-8. [PMID: 38205588 DOI: 10.1080/09638288.2023.2301477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To explore health care providers' (HCP) experiences related to transitions in care from inpatient rehabilitation to the community for patients with limb loss. MATERIALS AND METHODS A qualitative study was conducted using semi-structured interviews. Participants were eligible if they were HCPs currently working in amputation rehabilitation at a rehabilitation hospital in Ontario, Canada, with at least 1-year experience in this setting, and could speak and understand English. Data were analyzed thematically using the six-step process of the DEPICT model dynamic reading, engaged codebook development, participatory coding, inclusive reviewing and summarizing of categories, collaborative analyzing and translating. RESULTS Fourteen HCPs from a variety of health care professions participated in this study. Five key themes describe participants' perspectives on the factors impacting patients' transition in care following limb loss. Specifically, participants emphasized patient preparedness, HCP follow-up, finances and funding, patient self-management skills, and psychosocial support as factors that could influence the transition in care. CONCLUSION This study identified challenges to transitions in care for people with limb loss. Future research is needed to evaluate solutions to address these challenges in transitions in care.
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Affiliation(s)
- Micah Witt
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Teah Domazet
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Dong
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Carly Handler
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Katrina Nella
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Steve Dilkas
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Janet Campbell
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
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Yildirim Şahan T, Erbahçeci F. Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study. Games Health J 2023; 12:459-467. [PMID: 37934289 DOI: 10.1089/g4h.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Purpose: Virtual reality is widely used in patients with chronic musculoskeletal problems. However, the short-term effects on individuals with transtibial (TT) amputation during this process remain unclear. This study aimed at investigating the effects of virtual reality on rehabilitation outcomes in TT amputees. Methods: The study included 20 TT amputees who were using TT prostheses. The participants were divided into two groups randomly as follows: physiotherapy (PT) and virtual reality (VR). Participants were treated 3 days a week, for 4 weeks, and evaluations were made before and after treatment; a 6-minute walk test was used for performance, a single-leg balance test for balance, Trinity Amputation Prosthesis Experience Scale for prosthesis satisfaction, a 10-meter walking test for gait speed, and a wearable smart t-shirt to determine cadence. Results: It was found that there was a statistically significant difference in performance, balance, prosthesis satisfaction, cadence, and gait speed before and after PT (P < 0.05). There were differences in terms of performance, prosthesis satisfaction, balance, cadence, and gait speed before and after VR (P < 0.05). There was no statistically significant difference between PT and VR (P > 0.05). Conclusion: The 4 weeks of VR training improved performance, prosthesis satisfaction, balance, cadence, and gait speed in TT amputation rehabilitation similar to physiotherapy methods. The addition of VR training to amputation rehabilitation will bring improvements since it is a fun and safe intervention. Clinical Trial Registration: The trial is registered at Clinical Trials.gov, Trial No: NCT03872193.
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Affiliation(s)
- Tezel Yildirim Şahan
- University of Health Science Turkey, Gulhane Faculty of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Fatih Erbahçeci
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Department of Musculoskeletal Physiotherapy and Rehabilitation, Ankara, Turkey
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Mayo AL, Fung V, Hitzig SL, Gould S, Posa S, Summers deLuca L, Kayssi A. Exploring the psychosocial needs of persons with lower extremity amputation and feasibility of internet cognitive behavioural therapy: a qualitative study. Disabil Rehabil 2023; 45:4025-4034. [PMID: 36377342 DOI: 10.1080/09638288.2022.2144492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. METHODS Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). RESULTS Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. CONCLUSIONS Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content.IMPLICATIONS FOR REHABILITATIONFollowing lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression.Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population.The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.
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Affiliation(s)
- Amanda L Mayo
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vera Fung
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Gould
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Posa
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Leslie Summers deLuca
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Ahmed Kayssi
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Vascular Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Cimino SR, Vijayakumar A, MacKay C, Mayo AL, Hitzig SL, Guilcher SJT. Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review. Disabil Rehabil 2022; 44:6899-6925. [PMID: 34546799 DOI: 10.1080/09638288.2021.1974106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA). METHODS A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis. RESULTS One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations. CONCLUSION Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.
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Affiliation(s)
- Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Crystal MacKay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,West Park Health Care Centre, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- St. John's Rehabilitation Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,St. John's Rehabilitation Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
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Miller TA, Wurdeman S, Paul R, Forthofer M. The Value of Health Economics and Outcomes Research in Prosthetics and Orthotics. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2021; 4:35959. [PMID: 37615002 PMCID: PMC10443510 DOI: 10.33137/cpoj.v4i2.35959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The demand has increased for evidence regarding the effectiveness and value of prosthetic and orthotic rehabilitation interventions. Clinicians and managers are under pressure to provide treatment recommendations and demonstrate effectiveness through outcomes. It is often assumed that rehabilitation interventions, including the provision of custom-made and custom-fit orthotic and prosthetic devices, are beneficial to patients. Assessing the value of orthotic and prosthetic services has become more critical to continue to ensure equitable access to needed services. Health economics and outcomes research methods serve as tools to gauge the value of prosthetic and orthotic rehabilitation interventions. The purpose of this article is to provide an overview of the current need of health economics and outcomes research in orthotics and prosthetics, to introduce common economic methods that assist to generate real-world evidence, and to discusses the potential value of economic methods for clinicians and clinical practice.
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Affiliation(s)
- TA Miller
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
- College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - S Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
- Department of Biomechanics, The University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - R Paul
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
| | - M Forthofer
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, Texas, USA
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Collins KL, Linassi AG, Zucker-Levin A. A Focus Group- and Patient-Driven Study to Understand Patients' and Health Care Providers' Perspectives on Services for People with Amputation. Physiother Can 2021; 73:244-251. [PMID: 34456441 DOI: 10.3138/ptc-2019-0054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study investigates patients' and health care providers' perspectives on the services provided for people with amputation in Saskatoon. Method: We used a qualitative approach, following the Delphi method. A patient-oriented research team designed five questions and presented them to two focus groups. The discussions focused on what worked well in the health care system and what could be improved, what could be improved in the community, future research, and ways to improve specific knowledge translation regarding care of people with amputation to therapists. Results: The two focus groups consisted of 48 panellists, all community members and health care professionals. The themes that emerged included positive experiences with prosthetic care and the individual people responsible for amputee care and improvements needed to streamline the pathways of care, community support, education, and research into all aspects of amputation. Conclusions: Amputation is not just a one-time medical procedure; people with amputation need lifelong support from health care providers and the community. Clear pathways of care, access to immediate support, amputee-specific education for health care providers, better patient education, increased physical therapy, and enhanced resources and care were identified as areas in need of improvement. This study will, we hope, form the basis of future research to continually improve the quality of care and support for people living with amputation.
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Affiliation(s)
- Kassondra L Collins
- Health Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - A Gary Linassi
- Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Mealy A, Tierney S, Sorensen J. Lower extremity amputations in Ireland: a registry-based study. Ir J Med Sci 2021; 191:839-844. [PMID: 33755918 DOI: 10.1007/s11845-021-02536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To analyse the current provision of lower extremity amputations (LEA) in Irish public hospitals by patient characteristics and assess the potential savings for reducing numbers if a national multi-disciplinary foot protection clinic (MDFPC) was established nation-wide. DESIGN AND DATA SOURCES Patient characteristics of LEA conducted during 2016-2019 were analysed based on discharge data from the national hospital inpatient enquiry system. Reported consequences from existing literature were used to extrapolate national consequences. RESULTS Public hospitals registered 3104 hospital admissions with LEA during 2016-2019. 68% (n = 2099) of these were minor amputations. About 76% (n = 1592) of minor amputations and 52% (n = 525) of major amputations were performed on patients with a diagnosis of diabetes. If the implementation of a national MDFPC programmed could reduce the number of diabetic amputations by 20%, 80 minor and 26 major amputations could be avoided annually. This would avoid nearly 3000 hospital bed days and correspond to a potential annual saving of €3 M. CONCLUSION LEA has severe impact on patients' lives and hospital resources. Potential savings from effective prevention strategies may offer both health improvements and cost-savings.
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Affiliation(s)
| | - Sean Tierney
- Tallaght University Hospital, Dublin, Republic of Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre, RCSI, Dublin, Republic of Ireland
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Chislett M, Ploughman M, McCarthy J. Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation. Arch Rehabil Res Clin Transl 2020; 2:100084. [PMID: 33543107 PMCID: PMC7853323 DOI: 10.1016/j.arrct.2020.100084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To identify variables associated with rehabilitation length of stay (LOS) and prosthetic fitting success for people with lower limb amputation (LLA). Design Retrospective analysis of clinically collected cohort. Setting Canadian inpatient rehabilitation hospital. Participants Consecutive individuals with LLA (N=103) admitted for prosthetic fitting (mean age, 65.3±10.6y). Interventions Not applicable. Main Outcome Measures Independent variables included the Lower Limb Amputee Measurement Scale (LLAMS), which is a 31-question tool to predict LOS with items in medical, cognitive, social, physical, activities of daily living, and other subsections; admission FIM; age; sex; level of amputation (below- or above-knee); and time from surgery to admission. LOS was measured as days from admission to discharge. Successful prosthetic fitting was defined as the ability to use a prosthesis on discharge. Results The mean LOS was 63.6 ± 33.3 days, and 21.4% of patients failed prosthetic fitting. Higher LLAMS, lower FIM, and above-knee amputation were significantly associated with longer LOS (P<.001, R2=0.36). Age, sex, and time from surgery were not significantly associated with LOS or prosthetic fitting. Higher LLAMS was significantly associated with unsuccessful prosthetic fitting (P=.032). Of the 31 items in the LLAMS, 5 were associated with prolonged LOS and 5 were associated with failed prosthetic fitting (P<.10). Conclusions The LLAMS, level of amputation, and admission FIM can be used to predict LOS in lower limb amputees admitted for prosthetic fitting. The LLAMS was weak in identifying patients who failed prosthetic fitting. Future research should consider shortening the LLAMS.
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Affiliation(s)
- Michael Chislett
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jason McCarthy
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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Hitzig SL, Mayo AL, Kayssi A, Viana R, MacKay C, Devlin M, Dilkas S, Domingo A, Hebert JS, Miller WC, Andrysek J, Azhari F, Baltzer HL, de Mestral C, Dittmer DK, Dudek NL, Grad S, Guilcher SJT, Habra N, Hunter SW, Journeay WS, Katz J, King S, Payne MW, Underwood HA, Zariffa J, Aternali A, Atkinson SL, Brooks SG, Cimino SR, Rios J. Identifying priorities and developing strategies for building capacity in amputation research in Canada. Disabil Rehabil 2020; 43:2779-2789. [PMID: 32036731 DOI: 10.1080/09638288.2020.1720831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Compared to other patient population groups, the field of amputation research in Canada lacks cohesion largely due to limited funding sources, lack of connection among research scientists, and loose ties among geographically dispersed healthcare centres, research institutes and advocacy groups. As a result, advances in clinical care are hampered and ultimately negatively influence outcomes of persons living with limb loss. OBJECTIVE To stimulate a national strategy on advancing amputation research in Canada, a consensus-workshop was organized with an expert panel of stakeholders to identify key research priorities and potential strategies to build researcher and funding capacity in the field. METHODS A modified Delphi approach was used to gain consensus on identifying and selecting an initial set of priorities for building research capacity in the field of amputation. This included an anonymous pre-meeting survey (N = 31 respondents) followed by an in-person consensus-workshop meeting that hosted 38 stakeholders (researchers, physiatrists, surgeons, prosthetists, occupational and physical therapists, community advocates, and people with limb loss). RESULTS The top three identified research priorities were: (1) developing a national dataset; (2) obtaining health economic data to illustrate the burden of amputation to the healthcare system and to patients; and (3) improving strategies related to outcome measurement in patients with limb loss (e.g. identifying, validating, and/or developing outcome measures). Strategies for moving these priorities into action were also developed. CONCLUSIONS The consensus-workshop provided an initial roadmap for limb loss research in Canada, and the event served as an important catalyst for stakeholders to initiate collaborations for moving identified priorities into action. Given the increasing number of people undergoing an amputation, there needs to be a stronger Canadian collaborative approach to generate the necessary research to enhance evidence-based clinical care and policy decision-making.IMPLICATIONS FOR REHABILITATIONLimb loss is a growing concern across North America, with lower-extremity amputations occurring due to complications arising from diabetes being a major cause.To advance knowledge about limb loss and to improve clinical care for this population, stronger connections are needed across the continuum of care (acute, rehabilitation, community) and across sectors (clinical, advocacy, industry and research).There are new surgical techniques, technologies, and rehabilitation approaches being explored to improve the health, mobility and community participation of people with limb loss, but further research evidence is needed to demonstrate efficacy and to better integrate them into standard clinical care.
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Affiliation(s)
- Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amanda L Mayo
- Physical Medicine and Rehabilitation, St. John's Rehab Hospital, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ahmed Kayssi
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ricardo Viana
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | | | | | | | - Jacqueline S Hebert
- Department of Medicine, Faculty of Medicine and Dentistry, Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, Canada
| | - William C Miller
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jan Andrysek
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, Canada
| | - Fae Azhari
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Heather L Baltzer
- Division of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles de Mestral
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Douglas K Dittmer
- Physical Medicine & Rehabilitation, Grand River Hospital, Kitchener, Canada
| | - Nancy L Dudek
- Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, Canada
| | - Sharon Grad
- Department of Physical Medicine and Rehabilitation, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Natalie Habra
- Division of Physical Medicine and Rehabilitation, Gingras-Lindsay Montreal Rehabilitation Institute, University of Montreal, Montreal, Canada
| | - Susan W Hunter
- School of Physical Therapy, Western University, London, Canada
| | | | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, Canada
| | - Sheena King
- G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Michael W Payne
- Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Heather A Underwood
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - José Zariffa
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Andrea Aternali
- Department of Psychology, Faculty of Health, York University, Toronto, Canada
| | - Samantha L Atkinson
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephanie G Brooks
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephanie R Cimino
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jorge Rios
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
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Hitzig SL, Mayo AL. Clinician's Commentary on Imam et al. Physiother Can 2019; 71:22-23. [PMID: 30787495 DOI: 10.3138/ptc.2017-39-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sander L Hitzig
- Scientist, St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto;
| | - Amanda L Mayo
- Physiatrist - Amputee and Cardiac Rehabilitation, St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto;
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Ciufo DJ, Thirukumaran CP, Marchese R, Oh I. Risk factors for reoperation, readmission, and early complications after below knee amputation. Injury 2019; 50:462-466. [PMID: 30396770 DOI: 10.1016/j.injury.2018.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/16/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many patients undergoing below knee amputations (BKA) return for subsequent unplanned operations, hospital readmission, or postoperative complications. This unplanned medical management negatively impacts both patient outcomes and our healthcare system. This study primarily investigates the risk factors for unplanned reoperation following BKA. METHODS Below knee amputations from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from the years 2012-2014 were identified by CPT code 27880 for amputation through the tibia and fibula. Our query identified 4631 BKA cases, including 30 day complications. Multivariate logistic regression modeling was performed on several patient demographic and disease factors to assess for independent predictors of unplanned reoperation. Secondary outcomes of unplanned and related readmissions (related to the procedure), major complications, minor complications, and mortality were also included in the analysis. RESULTS Of 4631 BKAs identified, 9.63% (446/4631) underwent unplanned reoperations and 8.75% (405/4631) had unplanned and related readmissions. Major complications were experienced by 12.8% (593/4631) and minor complications by 8.7% (401/4631). Thirty day mortality rate was 5.14% (238/4631). The most common procedures for unplanned operations were thigh amputations (128/446, 28.7%), debridement/secondary closure (114/446, 25.6%), and revision leg amputations (46/446, 10.32%). Factors associated with an increased risk of unplanned reoperation included patients transferred from another facility (Adjusted Odds Ratio [AOR] = 1.28; p = .04), recent smokers (AOR = 1.34; p = .02), bleeding disorder (AOR = 1.30; p = .02), and preoperative ventilator use (AOR = 2.38; p = .01). CONCLUSION Patients that were ongoing/recent smokers, had diagnosed bleeding disorders, required preoperative ventilator use, or were transferred in from another facility were associated with the highest risks of reoperation following BKA. This patient population experiences high rates of reoperation, readmission, complication, and mortality.
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Affiliation(s)
- David J Ciufo
- University of Rochester, Department of Orthopaedics and Rehabilitation, United States.
| | | | | | - Irvin Oh
- University of Rochester, Department of Orthopaedics and Rehabilitation, United States
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Syed MH, Hussain MA, Khoshhal Z, Salata K, Altuwaijri B, Hughes B, Alsaif N, de Mestral C, Verma S, Al-Omran M. Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study. Can J Surg 2018; 61:257-263. [PMID: 30067184 PMCID: PMC6066379 DOI: 10.1503/cjs.012417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Rates of hospital readmission following surgery can serve as a marker for quality of care. The aim of this study was to establish the rates and causes of readmission and emergency department visits after vascular surgery and to understand how these patients are managed. METHODS We conducted a prospective observational cohort study including all inpatients who underwent major vascular surgery between September 2015 and June 2016 at a tertiary vascular care centre in Toronto. Patients were followed at 30 days after discharge via telephone interview. RESULTS We enrolled 133 patients (94 men [70.7%] and 39 women [29.3%] with a mean age of 65.3 years). The most common index admission diagnosis was peripheral artery disease (67 patients [50.4%]). At 30 days, 19 patients (14.8%) had been readmitted or had visited the emergency department, most commonly after lower extremity revascularization (19.4%). Ten patients were readmitted a mean of 16.8 days following discharge; surgical site infection was the most common cause for readmission (3 patients). The most common treatment was antimicrobial therapy (4 patients). The mean hospital length of stay was 14.4 days. Nine patients presented to the emergency department a mean of 10.6 days after discharge; 6 reported a wound issue, and most (6 of 9) were managed with oral antibiotic treatment. CONCLUSION Early readmission/emergency department visits after lower extremity revascularization surgery in patients with peripheral artery disease are common and are often due to surgical site infection or wound-related issues. Follow-up within 7-10 days and a specialized wound care team may help reduce the occurrence of these events.
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Affiliation(s)
- Muzammil H Syed
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Mohamad A Hussain
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Zeyad Khoshhal
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Konrad Salata
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Beidaa Altuwaijri
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Bertha Hughes
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Norah Alsaif
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Charles de Mestral
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Subodh Verma
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
| | - Mohammed Al-Omran
- From the Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ont. (Syed, Hussain, Khoshhal, Salata, Altuwaijri, Hughes, Alsaif, de Mestral, Al-Omran); the Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Ont. (Verma); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont. (de Mestral, Verma, Al-Omran); the Faculty of Science, McMaster University, Hamilton, Ont. (Syed); the Department of Surgery, University of Toronto, Toronto, Ont. (Hussain, Khoshhal, Salata, de Mestral, Verma, Al-Omran); the King Saud University-Li Ka Shing Knowledge Institute Collaborative Research Program, St. Michael's Hospital, Toronto, Ont. (Verma, Al-Omran); the Department of Surgery, Taibah University, Madinah, Kingdom of Saudi Arabia (Khoshhal); and the Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia (Al-Omran)
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