Rehabilitation outcome of post-acute lower limb geriatric amputees

Abstract

Purpose: To characterize the lower-limb elderly amputee patients admitted to a post-acute rehabilitation program, assess their 1-year survival rate, estimate rate of prosthetic fit and report rate and factors associated with 1-year post-discharge prosthetic use.

Methods: A cohort study performed in a post-acute rehabilitation department. Patients were evaluated by the Functional Independence Measure (FIM), motor FIM (mFIM), rate of prosthesis fit, length of stay (LOS), 1-year survival rate and long-term prosthetic use.

Results: One-hundred and seventeen lower limb elderly amputee patients consecutively admitted from January 2004 to June 2010 were enrolled in the study. Mean age was 74.7 ± 8.1; 56 patients (47.9%) had transtibial amputation (TTA); 46 (39.3%) transfemoral amputation (TFA) and 15 (12.8%) bilateral amputation. The main cause for amputation was diabetic foot (60.7%). Fifty-four (46.2%) patients died during first year post-admission. Twenty-seven patients (23.1%) were fitted with a prosthesis. When the bilateral amputees were considered separately, the rate of prosthetic fit among unilateral amputees was 24.5% (25/102) whereas among bilateral amputees it was 20% (3/15). Patients with prosthesis rehabilitation had a higher rate of TTA (p = 0.027), better metabolic status (p < 0.001), higher functional and cognitive levels (p < 0.001), and longer LOS (p < 0.001) compared with patients who received wheelchair rehabilitation. Twenty patients were contacted 1 year later: eight (40.0%) reported continuous functional prosthesis use, eight – partial prosthesis use and four (20%) did not use the prosthesis at all. The patient group with 1-year post-discharge prosthesis use had a significantly higher rate of TTA (p = 0.032), lower rate of congestive heart failure (CHF) (p = 0.014) and higher score changes on the FIM and mFIM (p = 0.043).

Conclusions: Rehabilitation efforts should best be targeted depending on need. Rehabilitation professionals should make an educated estimate of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission).

Implications for Rehabilitation

• Rehabilitation efforts should best be targeted depending on patients’ needs.

• Admission functional level is the most significant predictor for a successful lower limb prosthesis fit in a post-acute geriatric rehabilitation setting.

• Rehabilitation professionals should make educated estimates of outcomes at the beginning of rehabilitation based on the characteristics of the patients (level of amputation and functional level on admission).

Keywords::

• Amputees
• elderly
• lower limb
• outcomes

Acknowledgment

The corresponding author affirms that she has listed everyone who contributed significantly to the work and has obtained written consent from all contributors who are not authors and are named in the Acknowledgement section.

The authors wish to thank Ilana Gelernter, MA (Department of Statistics, Tel Aviv University) for assistance with data analysis, and Phyllis Curchack Kornspan for her editorial services.

Declaration of Interest: The authors report no declarations of interest.