The lower limb-loss rehabilitation continuum (LLRC) – a framework for program design and implementation

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 REHABILITATION

• The 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.

Keywords:

• Amputation
• artificial limbs
• rehabilitation
• outcomes
• program development
• care continuum

Acknowledgements

This work received no funding. Some of the manuscript content was presented at a national conference. Grover P. Inpatient Rehabilitation Outcomes for Lower Extremity Limb Loss, Symposium, American Congress of Rehabilitation Medicine annual meeting, Dallas, TX, 10/2018.

Disclosure statement

No potential financial conflict of interest was reported by the author(s). Potential non-financial conflicts of interest may relate to volunteering activities, and are listed below for Prateek Grover: Member, Scientific and Medical Advisory Committee, Amputee Coalition; Chair, Limb Care Networking Group, American Congress of Rehabilitation Medicine; Member at Large, Quality, Policy, Practice and Research Committee, American Academy of Physician Medicine and Rehabilitation; Programmatic Reviewer, Orthotic and Prosthetic Outcomes Research Program, Congressionally Directed Medical Research Program.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.