Comprehensive inpatient rehabilitation improves mobility in lower extremity amputation
MedWire News: Rehabilitation in a comprehensive inpatient rehabilitation unit (CIRU) may help improve mobility in patients who have a major lower extremity amputation (LEA) due to diabetes or peripheral vascular disease (PVD).
To date, there have been few comprehensive studies on which rehabilitation environment has the most beneficial effect on patient functional outcomes following an LEA. The majority of patients with an LEA are discharged from the hospital to their home (without home care) or a skilled nursing facility, with only about 10% going to a CIRU. Results from earlier large database studies indicate that the CIRU environment, with individualized therapy and specific patient treatment goals, may facilitate positive short-term outcomes.
Daniel Norvell (Spectrum Research, Inc., Tacoma, Washington, USA) and colleagues conducted a study to determine the relationship between rehabilitation environment of care and mobility outcome over a 12-month period following an LEA.
Norvell and colleagues enrolled 72 patients who had undergone an LEA due to complications from diabetes or PVD during a 39-month period. Mobility, postsurgery degree of support, presence of a major depressive episode, and patients' rehabilitation environment experience in the 12 months after surgery were assessed.
Writing in the Archives of Physical Medicine and Rehabilitation, the team reports that patients who attended a CIRU were younger and more likely to have been smokers and/or diagnosed with a major depressive disorder than those who did not. Patients in a CIRU had a greater number of physical therapy, rehabilitation psychology, and total therapy visits, as well as longer duration of all rehab visits.
In total, 33% of all patients achieved mobility success after 12 months. More patients who were treated in a CIRU had mobility success than patients who did not, although the difference was not significant.
In a multivariate model, those in a CIRU were 17% more likely to attain mobility success. Likelihood of success was linked to greater social support, less alcohol use, and not having had a major depressive episode. The authors note that determining whether patient characteristics are connected to a likelihood of success may be beneficial to the rehabilitation team in deciding which environment of care would be the most optimal for the patient.
The authors recognize that this study was limited to a fairly narrow patient population. However, they conclude that based on the data, "the CIRU environment appears to add a dimension to care that results in enhanced mobility outcome that is not captured by rehabilitation therapy volume alone."
By Stephanie Leveene