Article

The aim of this study was to examine the effect of postacute
rehabilitation setting on functional outcomes among patients who underwent major
dysvascular lower extremity amputations. DESIGN: This is a population-based
prospective cohort study conducted in Maryland and Wisconsin. Data collected from
medical records and patient interviews conducted during acute hospitalization
after amputation and at 6 mos after the acute care discharge were analyzed using
multivariate models and instrumental variable techniques. RESULTS: A total of 297
patients were analyzed on the basis of postacute care rehabilitation setting:
acute inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or
home. The majority (43.4%) received care in an IRF; 32%, in an SNF; and 24.6%, at
home. On the Short Form-36 subscales, significantly improved outcomes were
observed for the patients receiving postacute care at an IRF relative to those
cared for at an SNF in physical function, role physical, and physical component
summary score. Patients receiving postacute care in IRFs also experienced better
role physical and physical component summary score outcomes compared with those
discharged directly home. In addition, patients receiving postacute care in an
IRF were significantly more likely to score in the top quartile for general
health in IRF compared with SNF or home and less likely to score in the lowest
quartile for physical function, role physical, and physical component summary
score in IRF compared with SNF. Lower activity of daily living impairment was
observed in IRF compared with SNF. CONCLUSIONS: Among this large and diverse
cohort of patients who underwent major dysvascular lower limb amputations,
receipt of interdisciplinary rehabilitation services in an IRF yielded improved
functional outcomes 6 mos after amputation relative to care received in SNFs or
at home.

Langue : ANGLAIS