Articles
Interruptions to amputee rehabilitation,☆☆

Presented in part at the Ontario Association for Amputee Care's 24th Annual Conference, May 4, 2001, Kingston, Ont, Canada.
https://doi.org/10.1053/apmr.2002.33657Get rights and content

Abstract

Meikle B, Devlin M, Garfinkel S. Interruptions to amputee rehabilitation. Arch Phys Med Rehabil 2002;83:1222-8. Objectives: To determine the frequency of interruptions to inpatient amputee rehabilitation, and to identify the causes, risk factors, and consequences of these interruptions. Design: Retrospective cohort study. Setting: Inpatient amputee rehabilitation service. Patients: A total of 254 consecutive patients admitted within 90 days of amputation. Interventions: Not applicable. Main Outcome Measures: Patient age, gender, comorbid medical conditions, amputation type(s), days from amputation to admission, admission Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) score, rehabilitation length of stay (LOS), whether a prosthesis was fabricated, discharge destination, discharge Houghton Scale score, discharge 2-minute walk test, and discharge SF-36 score. Results: Interruptions occurred in 76 patients (30%). Impaired stump healing caused 46 (18%) interruptions and acute medical illness caused 26 (10%); 4 (2%) interruptions were because of other causes. Higher incidence of interruption was associated with female gender, peripheral vascular disease, and decreased days from amputation to rehabilitation. The majority of patients with interruptions (60/76, 79%) returned to complete rehabilitation. Patients with interruptions had significantly longer rehabilitation LOS (48.5 vs 37.0d, P<.001), but functional outcome measures at rehabilitation discharge were similar between those patients who returned to complete rehabilitation after interruption and those patients without interruption. Conclusions: Interruptions to amputee rehabilitation are common and result in longer rehabilitation LOS but do not adversely affect rehabilitation outcomes in those who are able to return to complete rehabilitation. No subgroup of patients with exceptionally high incidence of interruption could be identified. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Study design

A retrospective cohort design was used. Ethics approval was obtained before initiation of the study from the Research Ethics Committee at our institution.

Setting

All data were collected from an inpatient amputee rehabilitation unit located in a tertiary rehabilitation center. The unit's mandate is to accept patients from acute care hospitals as early as possible after amputation surgery and to provide all necessary amputee rehabilitation services including prosthetic fitting and multidisciplinary

Sample characteristics

Baseline demographic data for the 254 study participants are in table 1.

. Sample characteristics (N=254)

Sex, n (%)
 Male182 (72%)
 Female72 (28%)
Mean age (y)66.0±2.7
Amputation type, n (%)
 Below knee152 (60%)
 Above knee44 (17%)
 Bilateral51 (20%)
 Other7 (3%)
Mean days from amputation to admission15.6±10.9
Mean admission SF-36 score (n=190)
 Physical composite score25.8±7.1
 Mental composite score42.5±12.3
Mean no. of comorbid medical conditions2.8±1.4
Comorbid medical conditions, n (%)
 Peripheral vascular disease

Discussion

This review of 254 consecutive inpatient amputee rehabilitation patients shows that interruptions to amputee rehabilitation are very common, occurring in almost one third (29.9%). In this series, the most common causes of interruption were delayed wound healing (13%), acute medical illness (10.2%), and amputation revision surgery (5.1%). In total, 15.4% (39/254) of the patients required transfer from rehabilitation to acute care hospital because they had acute medical problems or needed

Conclusions

Interruptions to inpatient amputee rehabilitation were very common (30%), and many required transfer to acute hospital (15%), an incidence which appears similar to that reported in the general rehabilitation population. The most common causes for interruption were impaired stump healing (18%) and acute medical illness (10%). All patients were at high risk for interruption, with the only identified risk factors being female gender, fewer days from amputation to rehabilitation admission, and the

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    ☆☆

    Correspondence to Ben Meikle, MD, Ste R3-89, West Park Health Care Centre, 82 Buttonwood Ave, Toronto, Ont M6M 2J5, Canada. Reprints are not available.

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