title: The effect of rehabilitation in a comprehensive inpatient rehabilitation unit on mobility outcome after dysvascular lower extremity amputation.
abstract: OBJECTIVE
  To (1) compare the total volume of rehabilitation therapy for patients ever attending a comprehensive inpatient rehabilitation unit (CIRU) versus never during the 12 months after amputation; (2) determine whether rehabilitation in a CIRU at any time in the first year after amputation results in greater mobility success compared with other types of rehabilitation environments of care; and (3) determine for those patients treated in a CIRU, which specific patient characteristics were associated with improved mobility outcome.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two Veterans Affairs medical centers.
  
  
  METHODS
  Patients (N=199) with peripheral vascular disease or diabetes undergoing a first unilateral major amputation were screened for participation between September 2005 and December 2008. Among these, 113 (57%) met study criteria; of these, 72 (64%) participated.
  
  
  METHODS
  Ever attending a CIRU versus never attending a CIRU in first 12 months after amputation.
  
  
  METHODS
  Number of rehabilitation therapy visits, Locomotor Capability Index scores, and mobility success.
  
  
  RESULTS
  The mean number of all therapy visits for patients ever attending a CIRU was significantly greater than that for those never attending over a 12-month period (48.6 vs 22.6; P=.001). Mean total time per any rehabilitation visit was .83±.27 hours for those ever attending and .60±.20 hours for those never attending (P<.001). Patients who ever were treated in a CIRU were 17% more likely to achieve mobility success than those who were not, controlling for amputation level, major depressive episode, alcohol use, social support, total number of rehabilitation visits, and hospital site (risk difference=.17; 95% confidence interval, .09-.25; P<.001).
  
  
  CONCLUSIONS
  Rehabilitation in a CIRU resulted in improved mobility success for veterans undergoing major lower extremity amputation secondary to peripheral vascular disease or diabetes. Among those admitted to a CIRU, younger patients with greater social support, healthy weight, and without chronic obstructive pulmonary disease had the greatest probability of mobility success.
authors.affiliation: Veterans Administration Puget Sound Health Care System, Seattle, WA, USA. dan@specri.com
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Czerniecki
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Turner
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Williams
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Hakimi
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Norvell
mesh_terms: D000367:Age Factors; D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D015992:Body Mass Index; D048909:Diabetes Complications / Q000601:surgery; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D016491:Peripheral Vascular Diseases / Q000601:surgery; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data