Prosthetic rehabilitation following below-knee amputation in elderly persons

Amputation of lower limbs is, in the majority of cases, the consequence of obstructive peripheral vascular disease with or without diabetes mellitus. The disease is markedly age-related and the incidence of amputations is rising because of population ageing. Ninety per cent of such amputations are undertaken in patients aged 65 Ž . and over Pernot et al., 1997 . Life expectancy in survivors of amputations is shorter than that of persons of the same age in the general Ž . population Custon and Bongiorni, 1996 . Mortality during the first year following amputation ranges from 26% in the USA to 39% in Finland, and within four years after the operation from 23% in Denmark to 75% in Ž . Britain Pernot et al., 1997 . Elderly persons with obstructive vascular disease have significant co-morbidity, i.e. cerebrovascular, cardiovascular, renal or visual complications of diabetes mellitus, that severely interfere Ž with prosthetic rehabilitation Pohjolainen and Alaranta, . 1998 ; therefore not all elderly lower limb amputees can be rehabilitated with a prosthesis. The goal of successful rehabilitation with a prosthesis is to enable independence in mobility and other activities Ž . of daily living Kent, 1999 . A frequently used measure of outcome of successful rehabilitation is the extent of use of the prosthesis in mobility and activities of daily Ž . living Datta et al., 1992 . The proportion of individuals who use their prosthesis ranging from 47% to 96% and the time elapsed between completion of rehabilitation and the assessment of use varies between studies Ž . Pernot et al., 1997 . In a study performed in Israel 5 years after prosthetic rehabilitation, 65% of survivors Ž were using their prosthesis most of the time Hahn et al., . 1999 . Prosthetic rehabilitation can be undertaken in a rehabilitation institution or in the person’s home. A study was conducted to compare the two settings as to effecŽ tiveness of rehabilitation assessed from the extent of use of the prosthesis and from the level of performance . of activities of daily living and as to the quality of Ž rehabilitation care provided assessed as the degree of