title: Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss.
abstract: In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.
authors.affiliation: Health Services & Research Development, Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston, TX;
authors.forename: Sherene
authors.initials: S
authors.lastname: Sharath
authors.forename: Helene
authors.initials: H
authors.lastname: Henson
authors.forename: Stacy
authors.initials: S
authors.lastname: Flynn
authors.forename: George
authors.initials: G
authors.lastname: Pisimisis
authors.forename: Panos
authors.initials: P
authors.lastname: Kougias
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D020127:Recovery of Function; D012189:Retrospective Studies; D014481:United States; D014728:Veterans; D016138:Walking / Q000502:physiology*
keywords: Functional Independence Measure; activities of daily living; ambulation; amputations; diabetes; functional outcomes; independence; limb loss; transfemoral amputations; transtibial amputations