title: Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes.
abstract: To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes.
  
  
  
  Retrospective medical records review.
  
  
  
  All community hospitals.
  
  
  
  Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation.
  
  
  
  Not applicable.
  
  
  
  Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient.
  
  
  
  Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation.
  
  
  
  Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
authors.forename: Kavita
authors.initials: K
authors.lastname: Venkataraman
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
authors.forename: Ngan Phoon
authors.initials: NP
authors.lastname: Fong
authors.affiliation: Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore.
authors.forename: Kin Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Medical Services, St Luke's Hospital, Singapore.
authors.forename: Boon Yeow
authors.initials: BY
authors.lastname: Tan
authors.affiliation: Medical Services, St Andrew's Community Hospital, Singapore.
authors.forename: Edward
authors.initials: E
authors.lastname: Menon
authors.affiliation: Elder Care and Health Consultancy, Singapore.
authors.forename: Chye Hua
authors.initials: CH
authors.lastname: Ee
authors.affiliation: Bright Vision Hospital, Singapore.
authors.forename: Kok Keng
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore. Electronic address: Gerald_Koh@nuhs.edu.sg.
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality / Q000534:rehabilitation*; D017028:Caregivers / Q000706:statistics & numerical data; D015897:Comorbidity; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D006304:Health Status; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Amputation; Diabetes mellitus; Outcome assessment (health care); Rehabilitation