Article

OBJECTIVES: To determine patient, treatment, or facility characteristics that
influence decisions to initiate a rehabilitation assessment before transtibial or
transfemoral amputation within the Veterans Affairs (VA) health care system.
DESIGN: Retrospective database study. SETTING: VA medical centers. PARTICIPANTS:
A total of 4226 veterans with lower extremity amputations discharged from a VA
medical center between October 1, 2002, and September 30, 2004. OUTCOME: Evidence
of a preoperative rehabilitation assessment after the index surgical stay
admission but before the surgical date. RESULTS: Evidence was found that 343 of
4226 veterans (8.12%) with lower extremity amputations received preoperative
rehabilitation assessments. Veterans receiving preoperative rehabilitation were
more likely to be older, admitted from home, or transferred from another
hospital. Patients who underwent surgical amputation at smaller-sized hospitals
or in the South Central or Mountain Pacific regions were more likely to receive
preoperative rehabilitation compared with patients in mid-sized hospitals or in
the Northeast, Southeast, or Midwest regions. Patients with evidence of
paralysis, patients treated in facilities with programs accredited by the
Commission on Accreditation of Rehabilitation Facilities (P < .01), and patients
in the second data wave were less likely to receive preoperative rehabilitation.
After accounting for patient-, treatment-, and facility-level structural
characteristics, we found that older patients were more likely to receive
preoperative rehabilitation services (odds ratio [OR] 1.01, 95% confidence
interval [CI] 1.01-1.02). Patients with a contributing amputation etiology of a
previous amputation complication were more likely to receive preoperative
consultation rehabilitation services (OR 1.50, 95% CI 1.02-2.19) compared with
patients who did not have this etiology. Compared with patients treated in the
Southeast region of the United States, those treated in the South Central region
(OR 2.52, 95% CI 1.82-3.48) or Mountain Pacific region (OR 1.62, 95% CI
1.11-2.37) were more likely to receive preoperative consultation rehabilitation
services. Patients with evidence of paralysis were less likely to receive
preoperative rehabilitative services compared with patients who did not have this
condition (OR 0.29, 95% CI 0.09-0.93), and patients treated in mid-sized
hospitals also were less likely to receive preoperative rehabilitative services
compared with patients treated in smaller-sized facilities (OR 0.38, 95% CI
0.27-0.53). Veterans in the second data year were less likely to receive services
compared with patients in the first year (OR 0.74, 95% CI 0.58-0.94).
CONCLUSIONS: Rehabilitation assessment before lower extremity amputation surgery
is a rare occurrence in the VA health care system. Practice patterns appear to be
driven by location and not by patient characteristics.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS