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Functional Outcomes of Patients with Amputation Receiving Chronic Dialysis for End-Stage Renal Disease

Arneja, Amarjit S. MD; Tamiji, Javaneh MD; Hiebert, Brett M. BSc, MSc; Tappia, Paramjit S. PhD; Galimova, Lena MD

American Journal of Physical Medicine & Rehabilitation: April 2015 - Volume 94 - Issue 4 - p 257–268
doi: 10.1097/PHM.0000000000000259
Original Research Articles: CME Article . 2015 Series . Number 4
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Objective The aim of this study was to compare the rehabilitation length of stay and functional outcome of patients with amputation on chronic dialysis with a similar group of patients not on dialysis.

Design This was a retrospective cohort study. Twenty-five patients with amputations on chronic dialysis and 25 nonrenal controls with amputation were included in the two groups. Primary outcome measures were Functional Independence Measure scores through discharge and follow-up, the percentage of patients fitted with a prosthesis, the number of patients able to ambulate independently indoors or outdoors or operate a wheelchair, and acute and rehabilitation length of stay for inpatients. Comorbidities and complications in end-stage renal disease (ESRD) patients with amputation on chronic dialysis vs. those without renal disease were also evaluated.

Results Eleven women and 14 men were included in each group. The study group patients were younger than non-ESRD controls (54 ± 12 and 61 ± 11 yrs, respectively; P = 0.05). No significant differences were found between the groups in sex, race, amputation etiology, or comorbidities, except minor amputations of toes and fingers, which were performed more often in the ESRD group compared with the non-ESRD group (14 and 2, respectively; P = 0.0003). Functional Independence Measure score was higher in the non-ESRD group on discharge (112.1 ± 7.6 vs. 107.5 ± 7.7; P = 0.04) and follow-up (111.3 ± 10.7 vs. 104.4 ± 8.7; P = 0.02). The number of patients able to ambulate indoors and outdoors or operate wheelchair independently on discharge was not statistically different between the groups. Length of stay was higher in the ESRD group (153 ± 67 vs. 105 ± 42 days; P = 0.04).

Conclusions Patients with limb amputations on chronic dialysis had significantly longer length of stay and lower Functional Independence Measure scores compared with the non-ESRD group. It is suggested that current practices may need to be adjusted to accommodate the complex rehabilitation needs of the ESRD patient population.

From the Department of Internal Medicine, Section of Rehabilitation Medicine, Faculty of Medicine, University of Manitoba (ASA, JT, LG); and St Boniface Hospital Research, Asper Clinical Research Institute, Winnipeg, Canada (BMH, PST).

All correspondence and requests for reprints should be addressed to: Paramjit S. Tappia, PhD, Asper Clinical Research Institute, St Boniface Hospital Research & Office of Clinical Research, CR3129-369 Tache Avenue, Winnipeg, Manitoba, Canada R2H 2A6.

Supported by the St. Boniface Hospital Research Foundation (infrastructural support).

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.

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