EXPLORATION OF FACTORS ASSOCIATED WITH FUNCTIONAL IMPROVEMENT IN LOWER LIMB AMPUTATION PATIENTS AFTER ACUTE INPATIENT REHABILITATION IN A FREE STANDING REHABILITATION HOSPITAL
Nagar, Vittal Ramachandra
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Functional changes, mainly motor and cognitive challenges, are commonly observed with unilateral Lower Limb Amputation (LLA) and these changes may persist even after the post-surgical stage. Therefore, rehabilitation efforts are needed to detect and improve functional deficits in unilateral LLA patients. Additionally, LLA can produce secondary medical and functional consequences. Because LLA patients are dependent upon prosthetics, they may exhibit biomechanical and pathological changes in different body parts. Acute in-patient rehabilitation (AIR), involving physical, occupational and (as needed) speech therapy may influence functional improvement, which may improve quality of life. Study-1 examined differences of AIR in a Free Standing Rehabilitation Hospital (FSRH) on total Functional Independent Measure (TFIM), cognitive FIM (CFIM) and motor FIM (MFIM) scores in individuals with different etiologies (dysvascular, traumatic or osteomyelitis) and phases (pre-prosthetic and prosthetic) for unilateral above knee amputations (AKA). Study-2 examined the differences of AIR in an FSRH on TFIM, CFIM and MFIM scores in individuals with different etiologies (dysvascular, traumatic or osteomyelitis) and phases (pre-prosthetic and prosthetic) for unilateral transtibial amputations (TTA). Study-3 examined TFIM, CFIM and MFIM scores in individuals with LLA with Phantom Limb Pain (Yes-PLP) when compared to those with no PLP (No-PLP). Study consisted of 121 patients (91 dysvascular, 13 traumatic and 17 osteomyelitis) patients with a primary diagnosis of AKA. Among 121 AKA patients, 72 were admitted for the pre-prosthetic phase and 49 for the prosthetic phase. Study 2 consisted of 126 patients (79 dysvascular, 13 traumatic and 34 osteomyelitis) with a primary TTA diagnosis. Among 126 TTA patients, 102 were admitted for the pre-prosthetic phase and 24 for the prosthetic phase. Study 3 consisted of 247 unilateral LLA patients among which 176 had No-PLP, whereas 71 had Yes-PLP. All patients were admitted over a 35-month period between June 2012 and May 2015 to a FSRH for AIR and all were between the ages of 18 and 90 years. In all three studies Length of Stay (LOS), time since surgery, age, Charlson comorbidity index and discharge disposition were measured. Study-1 found that in the AKA patients there were statistical and clinical differences in admission and discharge scores. Dysvascular TFIM, MFIM, CFIM scores were lower than in traumatic. Admission and the discharge pre-prosthetic phase TFIM, MFIM, CFIM scores were lower than in the prosthetic phase. Study-2 found that admission and discharge dysvascular CFIM scores were lower than traumatic. Furthermore, admission and discharge pre-prosthetic phase TFIM, MFIM, CFIM scores were lower than prosthetic phase. In Study-3, admission and discharge of PLP patient’s TFIM, MFIM, and CFIM scores were not lower than in non-PLP patients. Finally, around 95% patients were discharged to-home.