Article

OBJECTIVE: To examine the effect of postacute rehabilitation settings on
depression and emotional and social functioning among patients undergoing major
lower extremity dysvascular amputations. DESIGN: A population-based, prospective
cohort study. SETTING: Two racially diverse metropolitan areas (Baltimore,
Maryland, and Milwaukee, Wisconsin). PATIENTS: Persons undergoing major
amputation. METHODS: Data were collected from medical records and patient
interviews during acute hospitalization, and 6-month postamputation data were
analyzed with use of multivariate regression techniques. MAIN OUTCOME MEASURES:
Multivariate regressions were used to examine the independent effect of postacute
rehabilitation setting on the probability of experiencing depression, low mental
health, low social functioning, and low emotional role functioning 6 months
postindex amputation, while controlling for preamputation functioning and an
array of potential confounders, including pre-existing medical conditions,
sociodemographic characteristics, baseline health, and functional status
described previously. RESULTS: Of the 297 patients participating in the study,
43.4% received most of their inpatient postacute care at an inpatient
rehabilitation facility (IRF), 32% at a skilled nursing facility (SNF), and 24.6%
were discharged home with no inpatient rehabilitation. Even after we adjusted for
preamputation characteristics and potential selection bias into the postacute
care setting, patients receiving postacute care at an IRF were significantly less
likely than those receiving postacute care at an SNF or home to experience
depressive symptoms. Patients receiving care at IRFs were also less likely to
report low emotional functioning than their counterparts receiving postamputation
care at home or in an SNF. Patients in IRFs also reported better social
functioning than did those who received postacute care in SNFs. CONCLUSIONS: This
study showed an association between reduction in depressive symptoms and
emotional suffering and management after lower limb amputation on an inpatient
rehabilitation unit. These results add to the growing body of literature
suggesting better outcomes for persons with vascular-related amputations who
receive care at an IRF relative to other postacute care settings.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS