Article

OBJECTIVES: To (1) compare the total volume of rehabilitation therapy for
patients ever attending a comprehensive inpatient rehabilitation unit (CIRU)
versus never during the 12 months after amputation ; (2) determine whether
rehabilitation in a CIRU at any time in the first year after amputation results
in greater mobility success compared with other types of rehabilitation
environments of care ; and (3) determine for those patients treated in a CIRU,
which specific patient characteristics were associated with improved mobility
outcome. DESIGN: Prospective cohort study. SETTING: Two Veterans Affairs medical
centers. PARTICIPANTS: Patients (N=199) with peripheral vascular disease or
diabetes undergoing a first unilateral major amputation were screened for
participation between September 2005 and December 2008. Among these, 113 (57%)
met study criteria; of these,
72 (64%) participated. INTERVENTION: Ever attending
a CIRU versus never attending a CIRU in first 12 months after amputation. MAIN
OUTCOME MEASURES: Number of rehabilitation therapy visits, Locomotor Capability
Index scores, and mobility success. RESULTS: The mean number of all therapy
visits for patients ever attending a CIRU was significantly greater than that for
those never attending over a 12-month period (48.6 vs 22.6; P=.001). Mean total
time per any rehabilitation visit was .83+/-.27 hours for those ever attending
and .60+/-.20 hours for those never attending (P<.001). Patients who ever were
treated in a CIRU were 17% more likely to achieve mobility success than those who
were not, controlling for amputation level, major depressive episode, alcohol
use, social support, total number of rehabilitation visits, and hospital site
(risk difference=.17; 95% confidence interval, .09-.25; P<.001). CONCLUSIONS:
Rehabilitation in a CIRU resulted in improved mobility success for veterans
undergoing major lower extremity amputation secondary to peripheral vascular
disease or diabetes. Among those admitted to a CIRU, younger patients with
greater social support, healthy weight, and without chronic obstructive pulmonary
disease had the greatest probability of mobility success.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS