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PM R. 2014 Dec;6(12):1128-36. doi: 10.1016/j.pmrj.2014.05.024. Epub 2014 Jun 19.

Prosthesis use and satisfaction among persons with dysvascular lower limb amputations across postacute care discharge settings.

Author information

1
Medical College of Wisconsin, Milwaukee, WI(∗).
2
Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226(†). Electronic address: lpezzin@mcw.edu.
3
Department of Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226(‡).
4
Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA(§).

Abstract

OBJECTIVE:

To test the hypotheses that patients undergoing major lower limb amputations who received postacute care at an inpatient rehabilitation facility (IRF) would experience higher prosthesis use and satisfaction and lower prosthesis-related adverse effects than those treated at a skilled nursing facility (SNF) or at home.

DESIGN:

Population-based, observational, prospective, multicenter study.

SETTING:

Hospitals and communities in 2 racially and geographically diverse states.

PARTICIPANTS:

Patients 21 years and older who were identified during the surgical acute care stay as undergoing major lower limb amputations.

MAIN OUTCOME MEASURES:

Prosthesis use; satisfaction with prosthesis' comfort, appearance, and gait; and the presence of skin irritation, pain, and wounds as a result of prosthesis use.

METHODS:

Two-stage instrumental variable models applied to data collected from medical records and patient interviews.

RESULTS:

Only 149 (50.2%) of the 297 study participants had a prosthesis at the 6-month follow-up. Regression-adjusted outcomes indicate that patients treated at IRFs used their prosthesis more hours per week (52.8 versus 36.2 h/wk or 46% higher use), were less likely to experience prosthesis-related pain (16% versus 33.7%) and were significantly more likely to be satisfied with their gait (76.1% versus 59.3%) than were patients treated at SNFs. No significant differences in outcomes were found between patients who received care at an IRF and patients who were discharged home.

CONCLUSIONS:

These results add to the growing body of literature suggesting a general pattern of better outcomes for persons with vascular-related amputations who receive postacute care at IRFs relative to SNFs.

PMID:
24953447
DOI:
10.1016/j.pmrj.2014.05.024
[Indexed for MEDLINE]

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