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Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations: Effect of Postacute Rehabilitation Setting

Sauter, Carley N. MD; Pezzin, Liliana E. PhD, JD; Dillingham, Timothy R. MD, MS

American Journal of Physical Medicine & Rehabilitation: April 2013 - Volume 92 - Issue 4 - p 287–296
doi: 10.1097/PHM.0b013e31827d620d
Original Research Articles
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Objective The aim of this study was to examine the effect of postacute rehabilitation setting on functional outcomes among patients who underwent major dysvascular lower extremity amputations.

Design This is a population-based prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization after amputation and at 6 mos after the acute care discharge were analyzed using multivariate models and instrumental variable techniques.

Results A total of 297 patients were analyzed on the basis of postacute care rehabilitation setting: acute inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home. The majority (43.4%) received care in an IRF; 32%, in an SNF; and 24.6%, at home. On the Short Form–36 subscales, significantly improved outcomes were observed for the patients receiving postacute care at an IRF relative to those cared for at an SNF in physical function, role physical, and physical component summary score. Patients receiving postacute care in IRFs also experienced better role physical and physical component summary score outcomes compared with those discharged directly home. In addition, patients receiving postacute care in an IRF were significantly more likely to score in the top quartile for general health in IRF compared with SNF or home and less likely to score in the lowest quartile for physical function, role physical, and physical component summary score in IRF compared with SNF. Lower activity of daily living impairment was observed in IRF compared with SNF.

Conclusions Among this large and diverse cohort of patients who underwent major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services in an IRF yielded improved functional outcomes 6 mos after amputation relative to care received in SNFs or at home.

From the Department of Physical Medicine and Rehabilitation (CNS, TRD) and Department of Medicine and Center for Patient Care and Outcomes Research (LEP), Medical College of Wisconsin, Milwaukee.

All correspondence and requests for reprints should be addressed to: Timothy R. Dillingham, MD, MS, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, First Floor, Philadelphia, PA 19046.

Dr Dillingham is now with the Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia.

Supported by the NIH/NICHHD/NCMRR under grants R29HD36414 and R01HD36414.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2013 Lippincott Williams & Wilkins, Inc.