Mid- to long-term factors influencing functional status of people affected by lower-limb amputation associated with hemiparesis due to stroke.
OBJECTIVE
In people with lower-limb amputation and hemiparesis, prognostic factors of rehabilitation outcomes were investigated at hospital discharge. This study aims to identify which factors influence functional outcomes at mid- to long-term follow-up.


METHODS
Follow-up observational study on forty-four people (68 ± 9 years old) with unilateral amputation for vascular disease, temporally preceding or following hemiparesis due to stroke (26 patients prior amputation; 18 patients prior stroke), was performed. Barthel Index (BI) and Locomotor Capabilities Index (LCI) scores were recorded at discharge from the rehabilitation hospital and 3.4 years later. Use of the prosthesis was also recorded.


RESULTS
At the follow-up, BI and LCI scores had significantly decreased (10 and 13%, respectively). Contralaterality of the impairment was the main prognostic factor for reduced functional status (p = 0.025) and prosthesis abandonment (p = 0.028, OR = 4.4), especially for women (OR = 8). Severity of hemiparesis affected the BI score (p < 0.01) and level of amputation the LCI score (p < 0.01).


CONCLUSIONS
At the light of the observed decrement of functional status after discharge, particular attention should be paid to the patients more exposed to the risk of worsening and/or prosthesis abandon, such as women with contralateral impairment. The results of this study may assist rehabilitation teams in performing a more specific and effective long-term rehabilitative interventions.
Fondazione Santa Lucia, I.R.C.C.S., Rome, Italy. s.brunelli@hsantalucia.it
Stefano
S
Brunelli
Augusto
A
Fusco
Marco
M
Iosa
Anna Sofia
AS
Delussu
Stefano
S
Paolucci
Marco
M
Traballesi
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000704:Analysis of Variance; D001186:Artificial Limbs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010291:Paresis / Q000209:etiology* / Q000534:rehabilitation; D016491:Peripheral Vascular Diseases / Q000534:rehabilitation / Q000601:surgery; D020127:Recovery of Function; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome