The Effect of Rehabilitation in a Comprehensive Inpatient Rehabilitation Unit on Mobility Outcome After Dysvascular Lower Extremity Amputation

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 8; pp. 1384 - 1391
• Main Authors: Czerniecki, Joseph M., MD, Turner, Aaron P., PhD, Williams, Rhonda M., PhD, Hakimi, Kevin N., MD, Norvell, Daniel C., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2012; Elsevier
• Subjects: Age Factors; Aged; Amputation; Amputation - rehabilitation; Biological and medical sciences; Body Mass Index; Diabetes Complications - surgery; Diseases of the osteoarticular system; Female; Humans; Lower Extremity; Male; Medical sciences; Middle Aged; Miscellaneous; Mobility Limitation; Orthopedic surgery; Outcome assessment (health care); Peripheral Vascular Diseases - surgery; Physical Medicine and Rehabilitation; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Rehabilitation Centers - statistics & numerical data; Social Support; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; United States; United States Department of Veterans Affairs - statistics & numerical data; United States; TT; risk difference; SNF; peripheral vascular disease; VHA; Veterans Health Administration; LCI-5; transtibial; Amputation; Outcome assessment (health care); lower extremity amputation; Mobility limitation; Locomotor Capability Index (5-level ordinal scale); CI; LEA; transmetatarsal; skilled nursing facility; RD; TF; CIRU; transfemoral; comprehensive inpatient rehabilitation unit; TM; confidence interval; Rehabilitation; COPD; chronic obstructive pulmonary disease; PVD; Prognosis; Mobility; Lower extremity; Care; Reeducation; Treatment; Surgical amputation; Surgery; Limitation; Orthopedics
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2012.03.019

Abstract Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. The effect of rehabilitation in a comprehensive inpatient rehabilitation unit on mobility outcome after dysvascular lower extremity amputation. Objectives To (1) compare the total volume of rehabilitation therapy for patients ever attending a comprehensive inpatient rehabilitation unit (CIRU) versus never during the 12 months after amputation; (2) determine whether rehabilitation in a CIRU at any time in the first year after amputation results in greater mobility success compared with other types of rehabilitation environments of care; and (3) determine for those patients treated in a CIRU, which specific patient characteristics were associated with improved mobility outcome. Design Prospective cohort study. Setting Two Veterans Affairs medical centers. Participants Patients (N=199) with peripheral vascular disease or diabetes undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 113 (57%) met study criteria; of these, 72 (64%) participated. Intervention Ever attending a CIRU versus never attending a CIRU in first 12 months after amputation. Main Outcome Measures Number of rehabilitation therapy visits, Locomotor Capability Index scores, and mobility success. Results The mean number of all therapy visits for patients ever attending a CIRU was significantly greater than that for those never attending over a 12-month period (48.6 vs 22.6; P =.001). Mean total time per any rehabilitation visit was .83±.27 hours for those ever attending and .60±.20 hours for those never attending ( P <.001). Patients who ever were treated in a CIRU were 17% more likely to achieve mobility success than those who were not, controlling for amputation level, major depressive episode, alcohol use, social support, total number of rehabilitation visits, and hospital site (risk difference=.17; 95% confidence interval, .09–.25; P <.001). Conclusions Rehabilitation in a CIRU resulted in improved mobility success for veterans undergoing major lower extremity amputation secondary to peripheral vascular disease or diabetes. Among those admitted to a CIRU, younger patients with greater social support, healthy weight, and without chronic obstructive pulmonary disease had the greatest probability of mobility success.