Article

OBJECTIVES: To describe changes in ambulation among individuals with
lower-extremity amputation secondary to peripheral artery disease and /or diabetes
prior to surgery through 12 months after surgery. To compare differences in
ambulation by amputation level and to examine risk factors for change in
ambulation over time. DESIGN: Prospective cohort study. SETTING: Two Veterans
Affairs medical centers, 1 university hospital, and a level I trauma center.
PARTICIPANTS: Patients with peripheral artery disease or diabetes (N=239)
undergoing a first unilateral major amputation were screened for participation
between September 2005 and December 2008. Among these, 57% (n=136) met study
criteria, and of these, 64% (n=87) participated. INTERVENTIONS: Standard of care
at each facility. MAIN OUTCOME MEASURES: Ambulatory function measured using the
Locomotor Capability Index-5. RESULTS: Seventy-five of the 87 (86%) subjects
enrolled finished their 12-month follow-up interview. Ambulatory mobility
declined during the period immediately prior to surgery (premorbid) and remained
low at 6 weeks postsurgery.
On average, ambulation improved after surgery but did
not return to premorbid levels. In the final multivariate model, age and history
of lower-extremity arterial reconstruction were significantly associated with a
poorer ambulatory trajectory over time, while other factors, such as amputation
level, prior alcohol use, and length of disability prior to amputation, were not.
CONCLUSIONS: The findings highlight the importance of considering premorbid
ambulatory function. Informing providers and patients about the trajectory and
time course of changes in ambulation can enhance patient education, patient
expectations, and treatment planning.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS