DOS Kongressen 2014 ·
113
Factors predicting the basic amputee mobility
outcome in patients with a major non-traumatic lower
limb amputation.
Morten Tange Kristensen, Anni Østergaard Nielsen, Ulla Madsen Topp,
Peter Gebuhr
Physical Medicine and Rehabilitation Research – Copenhagen, Departments
of Physiotherapy and Orthopa, Hvidovre University Hospital; Department
og Physiotherapy, Hvidovre University Hospital; Department of Orthopaedic
Surgery, Hvidovre University Hospital
Background:
Prosthetic fitting is the long term goal for most patients following
a major lower limb amputation. However, this is not possible in every dysvascu-
lar amputee and not the primary focus of today’s acute in-patient rehabilitation
programmes. On the contrary, independence in transfers and wheelchair skills
is considered mandatory for all, but knowledge regarding who achieve this, and
factors influencing are limited.
Purpose / Aim of Study:
To examine factors predicting the basic amputee
mobility outcome in an acute orthopaedic ward following a dysvascular major
lower limb amputation.
Materials and Methods:
Ninety-one out of 103 (12 died in- hospital) con-
secutive patients (32 women and 59 men, 57 below knee and 34 above knee
or bilateral index amputations) with a mean age of 71.6 (SD, 12) years, admit-
ted from their own home. The outcome variables were independency in bed-
and bed to chair transfers, and indoor wheelchair manoeuvring.
Findings / Results:
Patients who achieved independency (n=64) stayed in the
ward a mean of 23.2 (9.3) days as compared to 30.2 (20.2) for those not
(30%). Multiple logistic regression revealed that a patient with no preamputa-
tion walking ability was 6 times more likely not to achieve independency in basic
activities during admittance, while odds increased with 8% per each additional
year a patient got older, when adjusted for gender, ASA-score, diabetes (n=39)
and the final amputation level. Correspondingly, odds was 4 times (P=0.06)
higher for patients who experienced a major revision or reamputation (n=19).
Conclusions:
The preamputation function and age were independent predic-
tors of the in- hospital amputee mobility outcome, while having a reamputation
also seem to influence. Clinicians, have the possibility to spot patients who may
benefit from more intensive training, while number of reamputations should be
reduced.
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