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Pelzl CE, Rosenkrantz AB, Rula EY, Christensen EW. The Neiman Imaging Comorbidity Index: Development and Validation in a National Commercial Claims Database. J Am Coll Radiol 2024; 21:869-877. [PMID: 38276924 DOI: 10.1016/j.jacr.2023.12.003] [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: 08/30/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To build the Neiman Imaging Comorbidity Index (NICI), based on variables available in claims datasets, which provides good discrimination of an individual's chance of receiving advanced imaging (CT, MR, PET), and thus, utility as a control variable in research. METHODS This retrospective study used national commercial claims data from Optum's deidentified Clinformatics Data Mart database from the period January 1, 2018 to December 31, 2019. Individuals with continuous enrollment during this 2-year study period were included. Lasso (least absolute shrinkage and selection operator) regression was used to predict the chance of receiving advanced imaging in 2019 based on the presence of comorbidities in 2018. A numerical index was created in a development cohort (70% of the total dataset) using weights assigned to each comorbidity, based on regression β coefficients. Internal validation of assigned scores was performed in the remaining 30% of claims, with comparison to the commonly used Charlson Comorbidity Index. RESULTS The final sample (development and validation cohorts) included 10,532,734 beneficiaries, of whom 2,116,348 (20.1%) received advanced imaging. After model development, the NICI included nine comorbidities. In the internal validation set, the NICI achieved good discrimination of receipt of advanced imaging with a C statistic of 0.709 (95% confidence interval [CI] 0.708-0.709), which predicted advanced imaging better than the CCI (C 0.692, 95% CI 0.691-0.692). Controlling for age and sex yielded better discrimination (C 0.748, 95% CI 0.748-0.749). DISCUSSION The NICI is an easily calculated measure of comorbidity burden that can be used to adjust for patients' chances of receiving advanced imaging. Future work should explore external validation of the NICI.
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Affiliation(s)
- Casey E Pelzl
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia.
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University (NYU) Grossman School of Medicine, New York, New York; and Editor-in-Chief, American Journal of Roentgenology
| | - Elizabeth Y Rula
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia; Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Eric W Christensen
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia; Health Services Management, University of Minnesota, St. Paul, Minnesota; Director of Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, Virginia
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Ghai S, Hitzig SL, Eberlin L, Melo J, Mayo AL, Blanchette V, Habra N, Zucker-Levin A, Zidarov D. Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review. Arch Phys Med Rehabil 2024; 105:1158-1170. [PMID: 37708929 DOI: 10.1016/j.apmr.2023.08.028] [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: 03/09/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA). DATA SOURCES The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022. STUDY SELECTION To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting. DATA EXTRACTION The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer. DATA SYNTHESIS Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported. CONCLUSION The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.
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Affiliation(s)
- Shashank Ghai
- Department of Political, Historical, Religious and Cultural Studies, Karlstads Universitet, Karlstad, Sweden; Centre for Societal Risk Research, Karlstads Universitet, Karlstad, Sweden; Psychology of Learning and Instruction, Department of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany; Centre for Tactile Internet with Human-in-the-loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Sander L Hitzig
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lindsay Eberlin
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Joshua Melo
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Québec, Canada; Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Natalie Habra
- Faculté de Médecine, Université de Montréal, Montréal, Canada; Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada
| | - Audrey Zucker-Levin
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| | - Diana Zidarov
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada; École de readaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
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Grover P, Karuppan CM. The lower limb-loss rehabilitation continuum (LLRC) - a framework for program design and implementation. Disabil Rehabil 2024; 46:1652-1661. [PMID: 37147928 DOI: 10.1080/09638288.2023.2207221] [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: 09/18/2022] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
Purpose: The multistep journey to prosthetic device-enabled functioning following amputation requires a structured approach for optimal care delivery, but such program structures and outcomes are inadequately characterized. The study is responsive by describing an implementation framework for lower limb loss rehabilitation and evaluating its utility.Materials and methods: The lower limb loss rehabilitation continuum framework (LLRC) was developed using literature-based continuum of care and amputation phase concepts as well as input from limb loss rehabilitation stakeholders. LLRC structure includes five sequential steps (Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), Prosthetic Rehabilitation (PR)) between six touchpoints of patient-healthcare interaction (Surgery, Preprosthetic Rehabilitation Admission and Discharge, Functioning Evaluation and Prescription, Prosthetic Rehabilitation Admission and Discharge). The utility of this framework was evaluated through LLRC program implementation in a semiurban US setting and program functioning and process outcomes assessment from an IRB-approved, retrospective observational study about patients with unilateral lower-limb amputations completing this program.Results: Program functional (FIM gain; efficiency) scores were greater for PPR(32.6(8);3.1) compared with PR(24.3(8.5);3.8). Program completion duration was 149.7(63.4) days. LHM(75.8(58.5) days) and PF(51.4(24.3) days) were the longest steps. PR duration was significantly longer(p = 0.033) for the transfemoral level.Conclusion: The LLRC framework is useful for the design and implementation of structured limb loss rehabilitation programs.IMPLICATIONS FOR REHABILITATIONThe lower limb-loss rehabilitation continuum (LLRC) is a novel implementation framework with a five-step structure from limb loss to completion of prosthetic rehabilitation between six touchpoints of patient-healthcare interaction, with standardized terminology and baseline and outcome metrics. The utility of the program was demonstrated by successful program development in a suburban health setting and actionable process outcomes and superior functioning outcomes compared with literature.The LLRC can be adapted by health systems, institutions, and care providers for program development. Programs can expect high FIM gains and efficiency for Preprosthetic rehabilitation and Prosthetic rehabilitation steps. With an LLRC completion time of 5 months, long Limb healing and maturation and Prosthetic fitting steps present areas of opportunity for improvement.
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Affiliation(s)
- Prateek Grover
- Mercy Clinics and Mercy Rehabilitation Hospital, Springfield, MO, USA
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Premnath S, Cox M, Hostalery A, Kuhan G, Rowlands T, Quarmby J, Singh S. Preoperative factors influencing functional rehabilitation after major lower limb amputation and validation of a preoperative scoring tool. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_159_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
BACKGROUND Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. OBJECTIVES The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. STUDY DESIGN Cross-sectional study. METHODS Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. RESULTS Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension (β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. CONCLUSION These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. CLINICAL RELEVANCE Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.
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Affiliation(s)
- Shannon L Mathis
- Department of Kinesiology, College of Education, The University of Alabama in Huntsville, Huntsville, AL, USA
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Gailey R, Clemens S, Sorensen J, Kirk-Sanchez N, Gaunaurd I, Raya M, Klute G, Pasquina P. Variables that Influence Basic Prosthetic Mobility in People With Non-Vascular Lower Limb Amputation. PM R 2019; 12:130-139. [PMID: 31329356 DOI: 10.1002/pmrj.12223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 07/11/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. OBJECTIVE To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self-reported balance and mobility are predictive of Component timed-up-and-go (cTUG) performance. DESIGN Cross-sectional study of a convenience sample. SETTING National conference. PARTICIPANTS People (N=68) with non-vascular causes of unilateral LLA. METHODS Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. MAIN OUTCOME MEASURE Timed performance of the cTUG. RESULTS The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities-specific Balance Confidence scale score, all variables easily collected in a waiting room. CONCLUSION Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Robert Gailey
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Sheila Clemens
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL.,Physical Therapy Department, Nicole Wertheim College of Nursing and Health Professions, Florida International University, FL Research Department, Miami Veterans Administration Healthcare System, Miami, FL.,Research Department, Miami Veterans Administration Healthcare System, Miami, FL
| | - Jeffrey Sorensen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Neva Kirk-Sanchez
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Ignacio Gaunaurd
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL.,Research Department, Miami Veterans Administration Healthcare System, Miami, FL
| | - Michele Raya
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, FL
| | - Glenn Klute
- Department of Mechanical Engineering, University of Washington, Seattle, WA.,Rehabilitation Research and Development, VA Puget Sound Health Care System, Seattle, WA
| | - Paul Pasquina
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.,Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD
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Major MJ, Fey NP. Considering passive mechanical properties and patient user motor performance in lower limb prosthesis design optimization to enhance rehabilitation outcomes. PHYSICAL THERAPY REVIEWS 2017; 22:1-15. [PMID: 29170616 DOI: 10.1080/10833196.2017.1346033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background Selection of prosthesis mechanical characteristics to restore function of persons with lower-limb loss can be framed as an optimization problem to satisfy a given performance objective. However, the choice of a particular objective is critical, and considering only device and generalizable outcomes across users without accounting for inherent motor performance likely restricts a given patient from fully realizing the benefits of a prosthetic intervention. Objectives This review presents methods for optimizing passive below-knee prosthesis designs to maximize rehabilitation outcomes and how considerations on patient motor performance may enhance these outcomes. Major Findings Available literature supports that considering patient-specific variables pertaining to motor performance permits a multidimensional landscape relating device characteristics and user function, which may yield more accurate predictions of rehabilitation outcomes for individual patients. Moreover, the addition of targeted physical therapeutic interventions that encourage user self-organization may further improve these outcomes. We note the potential of existing paradigms to address these additional dimensions, and we encourage investigators to consider the many different performance objectives available for prosthesis optimization. Conclusions By considering user motor performance in combination with prosthesis mechanical characteristics, a staged optimization approach can be formulated which acknowledges that device modifications may only improve outcomes to a certain extent and user self-organization is a critical component to complete rehabilitation. An iterative process that can be integrated within existing rehabilitative practices accounts for changes in patient status through combined targeted prosthetic solutions and physical therapeutic techniques, and embodies the concept of personalized intervention for patients with lower limb-loss.
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Affiliation(s)
- Matthew J Major
- Jesse Brown VA Medical Center, Chicago IL, USA.,Northwestern University Prosthetics Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago IL, USA
| | - Nicholas P Fey
- University of Texas at Dallas, Departments of Bioengineering and Mechanical Engineering, Richardson TX, USA.,UT Southwestern Medical Center, Department of Physical Medicine and Rehabilitation, Dallas TX, USA
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van Velzen JM, van Bennekom CAM, Polomski W, Slootman JR, van der Woude LHV, Houdijk H. Physical capacity and walking ability after lower limb amputation: a systematic review. Clin Rehabil 2016; 20:999-1016. [PMID: 17065543 DOI: 10.1177/0269215506070700] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To review the influence of physical capacity on regaining walking ability and the development of walking ability after lower limb amputation. Design: A systematic search of literature was performed. The quality of all relevant studies was evaluated according to a checklist for statistical review of general papers. Subjects: Lower limb amputees. Main measures: Physical capacity (expressed by aerobic capacity, anaerobic capacity, muscle force, flexibility and balance) and walking ability (expressed by the walking velocity and symmetry). Results: A total of 48 studies that complied with the inclusion criteria were selected. From these studies there is strong evidence for deterioration of two aspects of physical capacity (muscle strength and balance) and of two aspects of walking ability (walking velocity and symmetry) after lower limb amputation. Strong evidence was found for a relation between balance and walking ability. Conclusion: Strong evidence was only found for a relation between balance and walking ability. Evidence about a relation between other elements of physical capacity and walking ability was insufficient. Training of physical capacity as well as walking ability during rehabilitation following lower limb amputation should not be discouraged since several parameters have been shown to be reduced after amputation, although their relation to regaining walking ability and to the development of walking ability remains unclear.
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Affiliation(s)
- J M van Velzen
- Heliomare Research and Development, Wijk aan Zee, Amsterdam, The Netherlands.
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The effect of amputation level and age on outcome: an analysis of 135 amputees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 26:107-12. [PMID: 26449785 DOI: 10.1007/s00590-015-1709-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In this retrospective study, the impact of age, amputation level and the cause of amputation were examined using the Hospital Anxiety and Depression Scale (HADS) and Medicare K scores of amputees with unilateral lower-limb amputation. MATERIALS AND METHODS In total, 135 patients with unilateral transfemoral (TF) or (TT) transtibial amputations were examined. All data were collected using questionnaires that were either self-administered or administered during an interview. The HADS was developed as a self-reporting questionnaire to detect adverse anxiety and depressive status. K code is used to describe the functional abilities of amputees. RESULTS The mean age at the time of surgery was 52.79 ± 13.08 years. The mean time since amputation was 59.20 ± 24.41 months for TT, and 60.89 ± 22.09 months for TF amputation. The HADS-A scores of the transfemoral amputation group were determined as significantly high compared to those of the transtibial group (p < 0.05). The K index of the group aged 35 years and below was significantly higher than that of the other groups (p 0.002, p 0.001, p < 0.01). CONCLUSION The data show higher HADS-A scores with traumatic transfemoral amputation. Therefore, adequate psychiatric evaluation and rehabilitation should be applied to all amputees, especially in cases of young, traumatic, transfemoral amputations. LEVEL OF EVIDENCE Level 3, retrospective comparative cohort study.
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Batten HR, Kuys SS, McPhail SM, Varghese PN, Nitz JC. Demographics and discharge outcomes of dysvascular and non-vascular lower limb amputees at a subacute rehabilitation unit: a 7-year series. AUST HEALTH REV 2015; 39:76-84. [DOI: 10.1071/ah14042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/21/2014] [Indexed: 11/23/2022]
Abstract
Objective To examine personal and social demographics, and rehabilitation discharge outcomes of dysvascular and non-vascular lower limb amputees. Methods In total, 425 lower limb amputation inpatient rehabilitation admissions (335 individuals) from 2005 to 2011 were examined. Admission and discharge descriptive statistics (frequency, percentages) were calculated and compared by aetiology. Results Participants were male (74%), aged 65 years (s.d. 14), born in Australia (72%), had predominantly dysvascular aetiology (80%) and a median length of stay 48 days (interquartile range (IQR): 25–76). Following amputation, 56% received prostheses for mobility, 21% (n = 89) changed residence and 28% (n = 116) required community services. Dysvascular amputees were older (mean 67 years, s.d. 12 vs 54 years, s.d. 16; P < 0.001) and recorded lower functional independence measure – motor scores at admission (z = 3.61, P < 0.001) and discharge (z = 4.52, P < 0.001). More non-vascular amputees worked before amputation (43% vs 11%; P < 0.001), were prescribed a prosthesis by discharge (73% vs 52%; P < 0.001) and had a shorter length of stay (7 days, 95% confidence interval: –3 to 17), although this was not statistically significant. Conclusions Differences exist in social and demographic outcomes between dysvascular and non-vascular lower limb amputees. What is known about the topic? Lower limb amputation occurs due to various aetiologies. What does this paper add? Lower limb amputee rehabilitation over 7 years was investigated, comprising 425 admissions, 80% due to dysvascular aetiology. Personal and social demographics, and discharge outcomes are compared by aetiology. What are the implications for practitioners? Demographic and discharge outcome differences exist between dysvascular and non-vascular lower limb amputees. Twenty-one percent were required to change residence and 28% required additional social supports. Discharge planning should begin as soon as possible to limit time spent waiting for new accommodation or major modifications for current homes. Lower limb amputees are not homogeneous, so care should be taken if extrapolating from combined amputee aetiologies or from one aetiology to another.
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Chan TC, Luk JKH, Chu LW, Chan FHW. Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults. Geriatr Gerontol Int 2013; 14:452-7. [PMID: 24020396 DOI: 10.1111/ggi.12129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Tuen-Ching Chan
- Department of Medicine and Geriatrics; Fung Yiu King Hospital; Hong Kong SAR China
- Division of Geriatric Medicine; Department of Medicine; Queen Mary Hospital, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - James Ka-Hay Luk
- Department of Medicine and Geriatrics; Fung Yiu King Hospital; Hong Kong SAR China
| | - Leung-Wing Chu
- Division of Geriatric Medicine; Department of Medicine; Queen Mary Hospital, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Felix Hon-Wai Chan
- Department of Medicine and Geriatrics; Fung Yiu King Hospital; Hong Kong SAR China
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Kark L, Simmons A. Patient satisfaction following lower-limb amputation: the role of gait deviation. Prosthet Orthot Int 2011; 35:225-33. [PMID: 21558305 DOI: 10.1177/0309364611406169] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients. OBJECTIVES This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription. STUDY DESIGN A cross-sectional study was done. METHODS Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfaction-related questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS). RESULTS Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (-0.35 ≤ r ≤ 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden (r ≥ 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (-0.45 ≤ r ≤ 0.43), and the GPS did not correlate with any satisfaction measures (-0.23 ≤ r ≤ 0.15). CONCLUSIONS In this study of high functioning amputees, gait deviation was unimportant to the amputee, while self-reported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation. CLINICAL RELEVANCE For the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. RESULTS suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.
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Affiliation(s)
- Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, NSW, Australia
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Hermodsson Y, Ekdahl C. Assessing Functional Ability in Patients with Unilateral Trans-tibial Amputation for Vascular Disease. Scand J Occup Ther 2009. [DOI: 10.3109/11038129809035742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stineman MG, Kurichi JE, Kwong PL, Maislin G, Reker DM, Vogel WB, Prvu-Bettger JA, Bidelspach DE, Bates BE. Survival analysis in amputees based on physical independence grade achievement. ACTA ACUST UNITED AC 2009; 144:543-51; discussion 552. [PMID: 19528388 DOI: 10.1001/archsurg.2009.37] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Survival implications of achieving different grades of physical independence after lower extremity amputation are unknown. OBJECTIVES To identify thresholds of physical independence achievement associated with improved 6-month survival and to identify and compare other risk factors after removing the influence of the grade achieved. DESIGN Data were combined from 8 administrative databases. Grade was measured on the basis of 13 individual self-care and mobility activities measured at inpatient rehabilitation discharge. SETTING Ninety-nine US Department of Veterans Affairs Medical Centers. PATIENTS Retrospective longitudinal cohort study of 2616 veterans who underwent lower extremity amputation and subsequent inpatient rehabilitation between October 1, 2002, and September 30, 2004. MAIN OUTCOME MEASURE Cumulative 6-month survival after rehabilitation discharge. RESULTS The 6-month survival rate (95% confidence interval [CI]) for those at grade 1 (total assistance) was 73.5% (70.5%-76.2%). The achievement of grade 2 (maximal assistance) led to the largest incremental improvement in prognosis with survival increasing to 91.1% (95% CI, 85.6%-94.5%). In amputees who remained at grade 1, the 30-day hazards ratio for survival compared with grade 6 (independent) was 43.9 (95% CI, 10.8-278.2), sharply decreasing with time. Whereas metastatic cancer and hemodialysis remained significantly associated with reduced survival (both P < or = .001), anatomical amputation level was not significant when rehabilitation discharge grade and other diagnostic conditions were considered. CONCLUSIONS Even a small improvement to grade 2 in the most severely impaired amputees resulted in better 6-month survival. Health care systems must plan appropriate interdisciplinary treatment strategies for both medical and functional issues after amputation.
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Affiliation(s)
- Margaret G Stineman
- Department of Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
PURPOSE To assess the influence of gender on the success of limb-fitting after amputation. METHODS One-hundred and five successive in-patients admitted to an amputee rehabilitation ward were followed to assess the success of limb-fitting at discharge. The influence of demographic, clinical and social factors on the success of lower limb-fitting was assessed using linear regression analysis and group comparisons. RESULTS There were 35 (33%) women in a cohort of 105 successive admissions. Men and women were comparable in terms of age, length of stay, medical comorbidity and level of amputation. Women were less likely to be successfully fitted with a prosthetic limb at discharge than men (42.9% vs. 68.6%, p = 0.011), and more women lived alone (57.1% vs. 38.6%, p = 0.021). Linear regression revealed that gender was an independent significant factor in the success of limb-fitting; age, level and cause of amputation, co-morbidity and length of stay were not significant factors. CONCLUSIONS Women were less likely to be successfully fitted with a lower limb prosthesis after amputation.
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Affiliation(s)
- Rajiv Singh
- Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, UK.
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16
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Roberts TL, Pasquina PF, Nelson VS, Flood KM, Bryant PR, Huang ME. Limb deficiency and prosthetic management. 4. Comorbidities associated with limb loss. Arch Phys Med Rehabil 2006; 87:S21-7. [PMID: 16500190 DOI: 10.1016/j.apmr.2005.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Accepted: 11/22/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED This self-directed learning module highlights common comorbidities found in people with amputations and their impact on functional outcome. It is part of the study guide on limb deficiency and vascular rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on prosthetic considerations, functional outcome, and potential complications for a woman with the comorbidities of stroke and diabetes who experiences a dysvascular amputation. Formulation of the differential diagnosis, management of limb pain, and evaluation of the potential psychosocial issues arising after amputation are also discussed. OVERALL ARTICLE OBJECTIVE To analyze common comorbidities of people with amputations and to delineate their impact on functional outcome.
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Affiliation(s)
- Toni L Roberts
- Physical Medicine and Rehabilitation Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA.
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MacKenzie EJ, Bosse MJ, Castillo RC, Smith DG, Webb LX, Kellam JF, Burgess AR, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, Travison TG, McCarthy ML. Functional outcomes following trauma-related lower-extremity amputation. J Bone Joint Surg Am 2004; 86:1636-45. [PMID: 15292410 DOI: 10.2106/00004623-200408000-00006] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The principal aims of this study were to examine functional outcomes following trauma-related lower-extremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-the-knee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. METHODS A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; self-selected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates. RESULTS There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-the-knee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-the-knee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome. CONCLUSIONS Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.
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Affiliation(s)
- Ellen J MacKenzie
- Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 554, Baltimore, MD 21205, USA.
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Tashjian RZ, Henn RF, Kang L, Green A. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear. J Bone Joint Surg Am 2004; 86:355-62. [PMID: 14960682 DOI: 10.2106/00004623-200402000-00020] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The results of preoperative assessment of factors that might affect the outcome of orthopaedic surgery have rarely been studied. In this study, we evaluated the relationship between the number of medical comorbidities and the preoperative performance on outcome assessment tools in patients with a chronic rotator cuff tear. METHODS One-hundred and ninety-nine patients (206 shoulders) with a chronic rotator cuff tear who were treated with surgery were evaluated preoperatively with a detailed history (including medical comorbidities), physical examination, and the following outcome instruments: (1) the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, (2) the Simple Shoulder Test, (3) visual analog scales (pain, function, and quality of life), and (4) the Short Form-36 (SF-36). RESULTS The patients had a mean of 2.07 comorbidities (range, zero to seven comorbidities). With use of univariate regression analysis, a greater number of comorbidities was associated with worse function (DASH [p = 0.0064], Simple Shoulder Test [p = 0.0001 for the best-case scenario and p = 0.0009 for the worst-case scenario], and visual analog scale for function [p = 0.0003] and increased pain [p = 0.05]) and with worse general health status (physical function [p < 0.0001], role-physical [p = 0.0286], general health [p < 0.0001], vitality [p = 0.0014], social function [p = 0.0004], role-emotional [p = 0.0003], and visual analog scale for quality of life [p = 0.0102]). These results were confirmed with significant associations (p < 0.05) between the number of comorbidities and the scores on the Simple Shoulder Test; DASH questionnaire; visual analog scales for function, pain, and quality of life; and seven of the eight items (all but mental health) on the SF-36 in a multivariate regression analysis, which included age, gender, Workers' Compensation status, number of previous operations, smoking history, size of the tear, duration of symptoms, and average patient expectations as possible confounding variables. CONCLUSIONS Medical comorbidities have a negative impact on patient-reported preoperative baseline pain, function, and general health status associated with chronic rotator cuff tears. We postulate that this effect may ultimately influence the evaluation of the results of surgical treatment of rotator cuff tears and should be considered when treating patients and analyzing outcomes.
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Affiliation(s)
- Robert Z Tashjian
- University Orthopedics, Inc., 2 Dudley Street, Suite 200, Providence, RI 02905, USA
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20
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Gailey RS, Roach KE, Applegate E, Cho B, Cunniffe B, Licht S, Maguire M, Nash MS. The Amputee Mobility Predictor: An instrument to assess determinants of the lower-limb amputee's ability to ambulate. Arch Phys Med Rehabil 2002; 83:613-27. [PMID: 11994800 DOI: 10.1053/apmr.2002.32309] [Citation(s) in RCA: 265] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe the development of the Amputee Mobility Predictor (AMP) instrument designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis, and to test its reliability and validity. DESIGN Measurement study using known groups method and concurrence with existing measures. SETTING Academic medical center. PARTICIPANTS A convenience sample of 191 lower-limb amputee subjects who had completed prosthetic training, 24 in the reliability study (mean age +/- standard deviation, 68.3+/-17.9y, range, 28-99y) and 167 in the validity study (mean age, 54.8+/-18.6y; range, 18-100y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Intra- and interrater reliability; construct validity by known groups method; concurrent validity by comparisons with 6-minute walk test, Comorbidity Index, age, and time since amputation; predictive validity by comparison with 6-minute walk test after controlling for other factors. RESULTS Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97. Both the AMPnoPRO (P<.0001) and the AMPPRO scores (P<.0001) distinguished among the 4 Medicare functional classification levels. The AMP correlated strongly with 6-minute walk scores (AMPnoPRO r=.69, P<.0001; AMPPRO r=.82, P<.0001) and the amputee activity survey (AMPnoPRO r=.67, P<.0001; AMPPRO r=.77, P<.0001), and negatively correlated with age (AMPnoPRO r=-.69, P<.0001; AMPPRO r=.56, P<.0001) and comorbidity (AMPnoPRO r=-.43, P<.0001; AMPPRO r=.38, P<.0001). CONCLUSION The AMP with and without a prosthesis are reliable and valid measures for the assessment of functional ambulation in lower-limb amputee subjects.
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21
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Abstract
OBJECTIVE To investigate in a pilot study the use of extended walking times as an objective method of distinguishing differences in outcome in lower limb amputees. SETTING Sixteen lower limb amputees attending the prosthetic clinic. METHOD Patients were asked to walk 100 m, turning every 20 m, using their usual walking aids and prostheses at their chosen walking speed. Demographic details and modified Stanmore/Harold Wood mobility grades, walking aids used and discomfort were recorded. Time to walk each 20 m up to 100 m was recorded. Statistical analysis was carried out using the Spearman rank order correlation coefficient. RESULTS There was a wide age range and differing causes of amputation. Five out of 16 subjects failed to complete 100 m and these had the slowest 20- and 40-m times. The mean time to walk 40 m was 41 seconds for those who were able to complete 100 m and 144 seconds for those who could not complete 100 m. All those with modified Stanmore/Harold Wood mobility grades less than four failed to complete 100 m. There was a high correlation between 20-, 40-, 60-, 80- and 100-m times and mobility grades, which was statistically significant, and between 20-, 40-, 60-, 80- and 100-m times. CONCLUSION Forty-metre walking time can differentiate between those of mobility grades 4b-6 and those with lower mobility grades who are unable to walk significantly outside.
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Affiliation(s)
- Alison G Hatfield
- Disablement Services Centre, St Mary's Hospital, Portsmouth, Hants, UK
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Calmels P, Béthoux F, Le-Quang B, Chagnon PY, Rigal F. [Functional assessment scales and lower limb amputation]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2001; 44:499-507. [PMID: 11788112 DOI: 10.1016/s0168-6054(01)00147-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This paper is a review of the literature on assessment tools in lower limb amputees. MATERIAL AND METHODS The authors have research on Medline(R) data base the different tools with keys words "lower limb amputee or amputation, functional evaluation or outcome assessment tools, activity of daily living", and have completed the research with the references of papers. RESULTS A comprehensive approach of the consequences of an amputation and of the outcome of prosthetic care should include an evaluation of gait, use of the prosthesis in activities of daily life, acceptability and satisfaction with the device. DISCUSSION Functional assessment tools that are validated are recent, and most of them were developed in English. They take into account the use and the acceptance of the device, but there is no study using them for an important sample population. CONCLUSION It is now necessary to translate the recent tools into French, and to confirm their validity and sensitivity to change.
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Affiliation(s)
- P Calmels
- Service de médecine physique et réadaptation et GIP Exercice, université Jean-Monnet, CHU, 42055, Saint-Etienne, France.
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Abstract
Annually, roughly 80,000 to 100,000 amputations are performed with a total cost of greater than $50,000 per patient. Amputations in general and TTAs in particular are worthy of investigation to provide a cost-effective functional outcome that provides high patient satisfaction. The process of prosthetic selection, functional outcome, and avoidance of common complications begins with preoperative education of the patient and communication with the rehabilitation team. Determining an individual patient's perceptions of the process and his or her desired functional needs can help establish a baseline for prosthetic prescription and patient education. With the apparent difficulty in predicting who will be functional with a prosthesis, it seems prudent to initiate prosthetic training and fitting with all patients who have a moderate potential for use. Because many patients undergoing this operation have significant illness, as judged by the high mortality rate at follow-up, it is important to begin this process early to promote the highest recovery of functional independence. With the continual improvement in prosthetic components and postoperative management, it seems possible for the ill, elderly patient to regain near preoperative functional independence with the use of a prosthesis.
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Affiliation(s)
- G V Green
- Division of Orthopaedic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Matsen SL, Malchow D, Matsen FA. Correlations with patients' perspectives of the result of lower-extremity amputation. J Bone Joint Surg Am 2000; 82:1089-95. [PMID: 10954097 DOI: 10.2106/00004623-200008000-00004] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients' perceptions of the result of lower-extremity amputation vary widely, yet the factors associated with this variability are not well understood. Our objective was to identify important correlations with the perceived result that may help to indicate the factors that deserve particular emphasis in the management of patients who have had an amputation. METHODS In this retrospective study, 148 patients who had had a major lower-extremity amputation completed a standardized questionnaire designed to assess the demographic characteristics, comorbidities, amputation characteristics, prosthetic function, and social function at a mean of seven years after surgery. We correlated each of these variables with four result metrics: general satisfaction, quality of life, freedom from frustration, and walking distance. RESULTS The four result metrics were significantly and strongly correlated with (1) the comfort of the residual limb; (2) the condition of the contralateral limb; (3) the comfort, function, and appearance of the prosthesis; (4) social factors; and (5) the ability to exercise recreationally (p < 0.0001). Interestingly, the level and laterality of the amputation were not significantly correlated with the patients' perceived result. CONCLUSIONS The perceived result of amputation is not associated with the amount of the limb that was amputated but rather with factors that may be optimized by surgical, prosthetic, and social management.
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Affiliation(s)
- S L Matsen
- Department of Orthopaedics, University of Washington, Seattle 98195-6500, USA
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Pezzin LE, Dillingham TR, MacKenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Arch Phys Med Rehabil 2000; 81:292-300. [PMID: 10724073 DOI: 10.1016/s0003-9993(00)90074-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the long-term outcomes of persons undergoing trauma-related amputations, and to explore factors affecting their physical, social, and mental health and the role of inpatient rehabilitation in improving such outcomes. DESIGN Abstracted medical records and interview data sought for a retrospective cohort of persons who had undergone a lower-limb trauma-related amputation. PARTICIPANTS Patients identified with a principal or secondary diagnosis of a trauma-related amputation to the lower extremity at the University of Maryland Shock Trauma Center between 1984 and 1994. Patients with spinal cord injury or traumatic brain injury were excluded. RESULTS Of 146 patients who had trauma-related amputations to the lower limb at the University of Maryland Shock Trauma Center during the study period, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly three quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than that of the general US population for all SF-36 scores. The differences in profiles were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to physical health, and bodily pain. About one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabilitation nights significantly improved the ability of patients with amputation to function in their physical roles, increased vitality, and reduced bodily pain. Inpatient rehabilitation was also significantly correlated with improved vocational outcomes. CONCLUSIONS These findings suggest a substantial effect of inpatient rehabilitation in improving long-term outcomes of persons with trauma-related amputations.
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Affiliation(s)
- L E Pezzin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
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Kosasih JB, Borca HH, Wenninger WJ, Duthie E. Nursing home rehabilitation after acute rehabilitation: predictors and outcomes. Arch Phys Med Rehabil 1998; 79:670-3. [PMID: 9630147 DOI: 10.1016/s0003-9993(98)90042-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the predictive factors and functional outcomes of patients who were discharged from an acute rehabilitation unit to a nursing home care unit (NHCU) at a Veterans Affairs (VA) hospital. DESIGN Cohort descriptive study. SETTING An academically affiliated urban VA Medical Center. PATIENTS All patients (n = 81, median age 68 years) admitted to a VA rehabilitation unit over a 1-year period. OUTCOME MEASURES Discharge locations, predictors for NHCU transfer, and functional status as determined by Functional Independence Measure (FIM) scores. RESULTS Patients discharged to the NHCU (17%) were compared with those discharged to the community (80%). Multiple logistic regression analysis showed that acute rehabilitation length of stay (LOS), admission, and discharge FIM scores were the only independent variables that predicted discharge to the VA NHCU. Although overall FIM gains in both groups during acute rehabilitation were similar, the NHCU group had significantly lower admission FIM scores and lower LOS efficiency because of longer acute rehabilitation LOS. Postacute NHCU rehabilitation resulted in significant gains in FIM scores at a slower rate. Sixty-four percent of these nursing home patients eventually returned to the community. CONCLUSION Nursing home rehabilitation can result in favorable functional and community outcomes for selected patients.
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Affiliation(s)
- J B Kosasih
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee 53295, USA
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Steinau HU, Hebebrand D, Vogt P. Amputation alternatives preserving bipedal ambulation. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1071-0949(97)80026-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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