Geriatric rehabilitation of lower limb amputees: a multicenter study

Abstract

Purpose: The aim of this study was to determine factors independently associated with successful rehabilitation of patients with lower limb amputation in skilled nursing facilities (SNFs). Methods: All patients admitted to one of the 11 participating SNFs were eligible. Multidisciplinary teams collected the data. Successful rehabilitation was defined as discharge to an independent living situation within 1 year after admission. Functional status at discharge, as measured with the Barthel index (BI), was a secondary outcome. Multivariate regression analyses were used to assess the independent contribution of each determinant to the two outcome measures. Results: Of 55 eligible patients, 48 were included. Mean age was 75 years. Sixty-five percent rehabilitated successfully. Multivariate analyses showed that presence of diabetes mellitus (DM) (OR 23.87, CI 2.26–252.47) and premorbid BI (OR 1.37, CI 1.10-1.70) were the most important determinants of successful rehabilitation, whereas 78% of the variance of discharge BI was explained by premorbid BI, BI on admission, and 1-leg balance. Conclusion: The presence of DM and high premorbid BI were associated with discharge to an independent living situation within 1 year after admission. Premorbid BI, admission BI, and 1-leg balance were independently associated to discharge BI.

Implications for Rehabilitation

• Geriatric patients with amputation in SNFs have a fair prognosis of being discharged to an independent living situation after rehabilitation.

• Pre-operative functional abilities of geriatric amputees are important in predicting rehabilitation outcome.

• Improving physical condition before amputation could lead to better rehabilitation outcome.

Keywords::

• elderly
• amputees
• lower limb

Acknowledgements

The authors would like to thank professor ACH Geurts, physiatrist, and H Bor, statistician, for their help on the manuscript.

Declaration of interest: This study was funded by two Dutch care organizations “Zorgboog” and “SVRZ.” They employed the primary investigators during the study period. A grant was received from the science promotion foundation for nursing homes (SWBV). The organizations that sponsored this study were not involved in the design of this study, data collection, data processing, or manuscript preparation. None of the authors have financial or personal conflicts of interest.