Physiotherapy rehabilitation for individuals with lower limb amputation: a 15-year clinical series.
OBJECTIVE
Individuals with amputations are a core group in Australian rehabilitation units that have a long index length of stay. The Repatriation General Hospital (RGH) offers general rehabilitation services to the population of Southern Adelaide (a population of 350,000) and includes an on-site prosthetic manufacturing facility. Using a physiotherapy database at the RGH, we sought to answer the following questions: What are the demographic and clinical characteristics of patients admitted for lower limb prosthetic rehabilitation over 15 years? What are the times to rehabilitation outcomes? How have these changed over 15 years with changes in service delivery?


METHODS
This paper is a retrospective observational study using a physiotherapy clinical database (1996-2010) of 531 consecutive individuals with lower limb amputation at one South Australian hospital (RGH). There were two changes in service delivery: 1) a multidisciplinary interim prosthetic programme (IPP) introduced in 1998 and 2) removable rigid dressings (RRDs) introduced in 2000. Outcome measures were patient demographics, clinical characteristics and time to rehabilitation outcome markers.


RESULTS
Mean age was 68 years (standard deviation [SD]: 15), with 69% male, 80% dysvascular and 68% transtibial. The overall median inpatient rehabilitation length of stay (RLOS) was 39 days (interquartile range [IQR]: 26-57). Individuals with amputation entering rehabilitation each year had a higher number of co-morbidities (β: 0.08; 95% confidence interval: 0.05-0.11). Introduction of the IPP was associated with a significant reduction in time to initial prosthetic casting, independent walking and inpatient RLOS. Introduction of RRDs was associated with a significant reduction in time to wound healing, initial prosthetic casting and independent walking.


CONCLUSIONS
Individuals with amputation were typically elderly dysvascular men with transtibial amputations. Introduction of the IPP and RRDs successfully reduced time to rehabilitation outcomes including independent walking, an outcome that is rarely reported but is of significance to patients and physiotherapists.
Flinders University, Faculty of Health Sciences, Adelaide, South Australia. brenton.hordacre@flinders.edu.au
Brenton
B
Hordacre
Vicki
V
Birks
Stephen
S
Quinn
Christopher
C
Barr
Benjamin L
BL
Patritti
Maria
M
Crotty
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D013021:South Australia; D013997:Time Factors; D016896:Treatment Outcome