Rehabilitation and the long-term outcomes of persons with trauma-related amputations.

OBJECTIVE To examine the long-term outcomes of persons undergoing trauma-related amputations, and to explore factors affecting their physical, social, and mental health and the role of inpatient rehabilitation in improving such outcomes. DESIGN Abstracted medical records and interview data sought for a retrospective cohort of persons who had undergone a lower-limb trauma-related amputation. PARTICIPANTS Patients identified with a principal or secondary diagnosis of a trauma-related amputation to the lower extremity at the University of Maryland Shock Trauma Center between 1984 and 1994. Patients with spinal cord injury or traumatic brain injury were excluded. RESULTS Of 146 patients who had trauma-related amputations to the lower limb at the University of Maryland Shock Trauma Center during the study period, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly three quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than that of the general US population for all SF-36 scores. The differences in profiles were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to physical health, and bodily pain. About one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabilitation nights significantly improved the ability of patients with amputation to function in their physical roles, increased vitality, and reduced bodily pain. Inpatient rehabilitation was also significantly correlated with improved vocational outcomes. CONCLUSIONS These findings suggest a substantial effect of inpatient rehabilitation in improving long-term outcomes of persons with trauma-related amputations.

[1]  Ware J.E.Jr.,et al.  THE MOS 36- ITEM SHORT FORM HEALTH SURVEY (SF- 36) CONCEPTUAL FRAMEWORK AND ITEM SELECTION , 1992 .

[2]  E J MacKenzie,et al.  Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study. , 1998, Archives of physical medicine and rehabilitation.

[3]  H. Rusk,et al.  Rehabilitation of the patient with head injuries. , 1964, Clinical neurosurgery.

[4]  H. Alaranta,et al.  Lower limb amputations in Southern Finland 1984-1985 , 1988, Prosthetics and orthotics international.

[5]  G. Reiber,et al.  Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. , 1995, The Journal of trauma.

[6]  J. Delisa.  Rehabilitation Medicine: Principles and Practice , 1993 .

[7]  R. O. Pierce,et al.  The plight of the traumatic amputee. , 1993, Orthopedics.

[8]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[9]  T. Dillingham,et al.  Amputee soldiers and their return to active duty. , 1995, Military medicine.

[10]  L. Ebskov,et al.  Trauma-related major lower limb amputations: an epidemiologic study. , 1994, The Journal of trauma.

[11]  K. Sheikh,et al.  Return to work following limb injuries. , 1985, The Journal of the Society of Occupational Medicine.

[12]  John E. Ware,et al.  SF-36 physical and mental health summary scales : a user's manual , 1994 .

[13]  E M Burgess,et al.  Functional capabilities of lower extremity amputees. , 1978, Archives of physical medicine and rehabilitation.

[14]  Glattly Hw,et al.  A STATISTICAL STUDY OF 12,000 NEW AMPUTEES. , 1964 .

[15]  G A Hunter,et al.  A review of employment patterns of industrial amputees—factors influencing rehabilitation , 1985, Prosthetics and orthotics international.

[16]  G. Judge,et al.  The Theory and Practice of Econometrics , 1981 .

[17]  T. Findley,et al.  Functional outcome and comorbidity indexes in the rehabilitation of the traumatic versus the vascular unilateral lower limb amputee. , 1996, American journal of physical medicine & rehabilitation.