Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations

OBJECTIVES: To examine 12-month reamputation and mortality rates as well as acute and postacute medical care costs among a large cohort of persons with dysvascular amputations. DESIGN: Retrospective cohort study. SETTING: General community. PARTICIPANTS: Medicare beneficiaries identified from the Centers for Medicare and Medicaid Services data as undergoing a lower-limb amputation secondary to vascular disease in 1996. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Twelve-month reamputation and mortality rates, and acute and postacute medical care costs, by initial amputation level and presence or absence of diabetes. RESULTS: A total of 3565 persons, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Twenty-six percent of them required subsequent amputation procedures within 12 months, and more than one third died within 1 year of their index amputation. Acute and postacute medical care costs associated with caring for beneficiaries with a dysvascular amputation exceeded $4.3 billion yearly. There were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputees with and without a comorbidity of diabetes. Diabetic amputees were younger than those without diabetes; they were also more likely to be men, to have more comorbidities, and to have undergone their first amputation at an earlier age than persons with dysvascular amputations who did not have diabetes. Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts. Progression to a higher level of limb loss occurred most frequently (34.5%) among persons with an initial foot or ankle amputation. Diabetic amputees were more likely than nondiabetic amputees to experience progression to a higher amputation level for all initial amputation levels. CONCLUSIONS: This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels.     

Discharge destination after dysvascular lower-limb amputations

OBJECTIVE: To examine postacute care rehabilitation services use after dysvascular amputation. DESIGN: State-maintained hospital discharge data from the Maryland Health Services Cost Review Commission were analyzed. SETTING: Maryland statewide hospital discharge database. PARTICIPANTS: Persons discharged from nonfederal acute care hospitals from 1986 to 1997 with a procedure code for lower-limb amputation (ICD-9-CM code 84.12-.19), excluding toe amputations. Those persons with amputations due to trauma, bone malignancy, or congenital anomalies were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Postacute care service utilization. RESULTS: There were 16,759 discharges with an amputation procedure over this period. The average age was 69.3+/-14.3 years, and 51.9% were men. Black persons comprised 42.4% of the sample. Diabetes was present in 42.0%, and peripheral vascular disease was noted for 66.1% of amputees. Amputations were at the foot (19.4%), transtibial (38.1%), and transfemoral (42.4%) levels. The largest proportion (40.6%) of patients was discharged directly home after acute care, 37.4% went to a nursing home, 9.2% went home with home care, and 9.6% were discharged to an inpatient rehabilitation unit. From 1986 to 1997, there were downward trends in the rate of discharges directly home and corresponding upward trends in nursing home and inpatient rehabilitation dispositions. CONCLUSIONS: Inpatient rehabilitation use is infrequent after dysvascular amputation. Prospective studies are necessary to examine outcomes for persons receiving rehabilitation services in different care settings to define the optimal rehabilitation venue for functional restoration.     

Effects of physical training on straightening-up processes in patients with Parkinson's disease

Purpose: The aim of this study was to evaluate whether motor training could improve the straightening-up sequences in patients with Parkinson's disease and, consequently, could ease the capacity of the patients to change body's position. Methods: Twenty out-patients with idiopathic Parkinson's disease (12 males, 8 females; mean age 72,9; H-Y, 1, 5-3) were enrolled in a rehabilitationprogramme which included exercises for the mobility of the trunk, of upper and lower limbs and of each segment of the spine, in order to improve the coordination of movement and to avoid postural disturbances. They received 1 hour of group treatment twice a week for a 5 week consecutive period. No changes were made in the pharmacological treatment received by each patient. The patients were evaluated at the beginning and at the end of the rehabilitation training. The statistical evaluation was made using the Wilcoxon test. Results: Statistically significant differences were observed in all the motor parameters that were evaluated (supine to sitting and sitting to supine, supine rolling, standing from a chair). Conclusions: The observations demonstrate that physical training can be effective in improving motor performance related to changes in position which affects the simple daily activities of the patients.     

Joint Replacement Rehabilitation Outcomes on Discharge From Skilled Nursing Facilities and Inpatient Rehabilitation Facilities

DeJong G, Horn SD, Smout RJ, Tian W, Putman K, Gassaway J. Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities.

Objective

To compare functional outcomes at discharge across postacute settings.

Design

Prospective observational cohort study.

Setting

Eleven inpatient rehabilitation facilities (IRFs), 8 freestanding skilled nursing facilities (SNFs), and 1 hospital-based SNF from across the United States.

Participants

Consecutively enrolled patients (N=2152): patients with knee replacement (n=1401) and patients with hip replacement (n=751).

Interventions

None; examination of existing practice patterns.

Main Outcome Measure

FIM discharge motor score.

Results

Freestanding SNF patients entered with higher motor FIM scores and left with higher scores than did IRF patients. IRF patients, however, achieved larger motor FIM gains and achieved them in a shorter time. In multivariate models controlling for patient differences and onset days, IRFs were associated with better discharge motor outcomes, but the overall setting effect was not large. The largest motor FIM differences were between medium-volume IRFs and low-volume freestanding SNFs: 4.6 motor FIM points for patients with knee replacement and 7.3 motor FIM points for patients with hip replacement. Other differences between settings were much smaller. Multivariate models explained between a third and a half of the variance in outcome.

Conclusions

As a group, IRFs had better motor FIM outcomes than did SNFs, but the size of the IRF advantage was not large. Other important facility and practice characteristics also were associated with discharge outcomes after joint replacement rehabilitation. Earlier and more intensive rehabilitation was associated with better outcomes. The volume of joint replacement patients seen by a facility also plays a part: medium-volume facilities among both SNFs and IRFs had better outcomes.     

Long-Term Outcomes of Joint Replacement Rehabilitation Patients Discharged From Skilled Nursing and Inpatient Rehabilitation Facilities

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Hsieh C-H, Gassaway J, Smith P. Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient rehabilitation facilities.

Objective

To examine functional and health status outcomes of patients with joint replacement discharged from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Postdischarge follow-up interview study at 7.5 months after admission.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs.

Participants

Patients (N=856): 561 with knee replacement and 295 with hip replacement.

Interventions

None.

Main Outcome Measures

FIM and Short-Form 12-Item Health Survey (SF-12).

Results

Among patients with knee and hip replacement, IRF patients made larger motor FIM gains from admission and discharge to follow-up. IRF patients, however, were admitted with lower FIM scores and also had more to gain (especially given the ceiling effects within the FIM at follow-up). When adjusted for case mix, IRF patients made larger motor FIM gains and had higher SF-12–related scores among patients with hip replacement but not among patients with knee replacement. Multivariate regressions found modest setting effects that favored IRFs, and the setting effects explained only a modest portion of the variance in motor FIM outcomes.

Conclusions

At follow-up, patients with joint replacement discharged from IRFs had better motor FIM outcomes than those discharged from freestanding SNFs and the hospital-based SNF. Settings did not differ materially in terms of SF-12 outcomes. Findings do not favor one setting decisively over another. A sole focus on initial postacute placement overlooks the larger trajectory of postacute care that needs to be managed to achieve superior outcomes.     

Use of Rehabilitation and Other Health Care Services by Patients With Joint Replacement After Discharge From Skilled Nursing and Inpatient Rehabilitation Facilities

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P, Gassaway J, DaVanzo JE. Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities.

Objective

To compare use of rehabilitation and other health services among patients with knee and hip replacement after discharge from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Follow-up interview study at 7.5 months after discharge.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs from across the United States.

Participants

Patients (N=856): patients with knee replacement (n=561) and patients with hip replacement (n=295).

Interventions

No interventions.

Main Outcome Measures

Number of home and outpatient therapy visits, physician visits, emergency room visits, rehospitalizations, and medical complications.

Results

After discharge from postacute care, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both. Patients with knee replacement received an average of 19 home and/or outpatient rehabilitation visits; patients with hip replacement received almost 15 visits. There were no statistically significant differences in rates of emergency room use and rehospitalization except that patients with hip replacement discharged from IRFs had higher rates of rehospitalization than those discharged from freestanding SNFs (15.8% vs 3.1%). Multivariate analyses did not find any SNF/IRF effects.

Conclusions

Patients with joint replacement from both SNFs and IRFs receive considerable amounts of follow-up rehabilitation care. Study uncovered no setting effects related to rehospitalization or medical complications. Looking only at care rendered in the initial postacute setting provides an incomplete picture of all care received and how it may affect follow-up outcomes.     

Skilled nursing facility rehabilitation and discharge to home after stroke

OBJECTIVE: To determine the relation between rehabilitation therapy (RT) intensity and time to discharge home for stroke patients in skilled nursing facilities (SNFs). DESIGN: Retrospective cohort study. We used regression analyses, stratified by expected outcome, and propensity score adjustment. Setting All SNFs in Ohio, Michigan, and Ontario, Canada. PARTICIPANTS: A cohort of residents, aged 65 and over, admitted from hospitals to SNFs with a diagnosis of stroke (N=23,824). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Time to discharge home from an SNF. RESULTS: RT was given to more than 95% of residents for whom discharge was expected within 90 days and to more than 60% of residents for whom discharge was uncertain or not expected. RT increased the likelihood of discharge to the community for all groups except those expected to be discharged within 30 days. The dose-response relation was strongest for residents with either an uncertain discharge prognosis or no discharge expected. CONCLUSIONS: Postacute residents with an uncertain prognosis are an important target population for intensive RT.     

Characterizing Rehabilitation Services for Patients With Knee and Hip Replacement in Skilled Nursing Facilities and Inpatient Rehabilitation Facilities

DeJong G, Hsieh C-H, Gassaway J, Horn SD, Smout RJ, Putman K, James R, Brown M, Newman EM, Foley MP. Characterizing rehabilitation services for patients with knee and hip replacement in skilled nursing facilities and inpatient rehabilitation facilities.

Objective

To characterize rehabilitation services for patients with knee and hip replacement in 3 types of postacute facilities in the U.S.

Design

Multi-site prospective observational cohort study.

Setting

Eight freestanding skilled nursing facilities (SNFs), 1 hospital-based SNF, and 11 inpatient rehabilitation facilities (IRFs).

Participants

Patients (N=2158) with knee or hip replacement.

Interventions

No new interventions.

Main Outcome Measures

Length of stay (LOS), amount and intensity of physical therapy (PT) and occupational therapy (OT), types of therapy activities.

Results

Average LOS was about 15 days for freestanding SNF patients, and 9 to 10 days for hospital-based SNF and IRF patients. Freestanding SNFs and IRFs provide about the same number of hours of PT and OT; the hospital-based SNF provided 27% fewer hours. Freestanding SNFs and the hospital-based SNF provided fewer hours a day than did IRFs. Joint replacement patients across all 3 types of facilities spent, on average, 70% to 75% of their PT time in just 2 activities—exercise and gait and spent 56% to 66% of their OT time in 3 activities—exercise, functional mobility, and dressing lower body.

Conclusions

Both freestanding SNFs and IRFs provided similar amounts of PT with a similar emphasis on exercise and gait activities. IRFs, however, provided more OT than freestanding SNFs. IRFs had shorter LOSs and more intensive therapy services than freestanding SNFs. Study freestanding SNFs exhibited greater variation in LOS and intensity of therapy than IRFs.     

Discharge Destination's Effect on Bounce-Back Risk in Black, White, and Hispanic Acute Ischemic Stroke Patients

Kind AJH, Smith MA, Liou J-I, Pandhi N, Frytak JR, Finch MD. Discharge destination's effect on bounce-back risk in black, white, and Hispanic acute ischemic stroke patients.

Objective

To determine whether racial and ethnic effects on bounce-back risk (ie, movement to settings of higher care intensity within 30d of hospital discharge) in acute stroke patients vary depending on initial posthospital discharge destination.

Design

Retrospective analysis of administrative data.

Setting

Four hundred twenty-two hospitals, southern/eastern United States.

Participants

All Medicare beneficiaries 65 years or more with hospitalization for acute ischemic stroke within one of the 422 target hospitals during the years 1999 or 2000 (N=63,679).

Interventions

Not applicable.

Main Outcome Measures

Adjusted predicted probabilities for discharge to and for bouncing back from each initial discharge site (ie, home, home with home health care, skilled nursing facility [SNF], or rehabilitation center) by race (ie, black, white, and Hispanic). Models included sociodemographics, comorbidities, stroke severity, and length of stay.

Results

Blacks and Hispanics were significantly more likely to be discharged to home health care (blacks=21% [95% confidence interval (CI), 19.9-22.8], Hispanic=19% [17.1-21.7] vs whites=16% [15.5-16.8]) and less likely to be discharged to SNFs (blacks=26% [95% CI, 23.6-29.3], Hispanics=28% [25.4-31.6] vs whites=33% [31.8-35.1]) than whites. However, blacks and Hispanics were significantly more likely to bounce back when discharged to SNFs than whites (blacks=26% [95% CI, 24.2-28.6], Hispanics=28% [24-32.6] vs whites=21% [20.3-21.9]). Hispanics had a lower risk of bouncing back when discharged home than either blacks or whites (Hispanics=14% [95% CI, 11.3-17] vs blacks=20% [18.4-22.2], whites=18% [16.8-18.3]). Patients discharged to home health care or rehabilitation centers demonstrated no significant differences in bounce-back risk.

Conclusions

Racial/ethnic bounce-back risk differs depending on initial discharge destination. Additional research is needed to fully understand this variation in effect.     

The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities

OBJECTIVE: To examine the relation between therapy intensity, including physical therapy (PT), occupational therapy (OT), and speech and language therapy (SLT), provided in a skilled nursing facility (SNF) setting and patients' outcomes as measured by length of stay (LOS) and stage of functional independence as measured by the FIM instrument. DESIGN: A retrospective analysis of secondary data from an administrative dataset compiled and owned by SeniorMetrix Inc. SETTING: Seventy SNFs under contract with SeniorMetrix health plan clients. PARTICIPANTS: Patients with stroke, orthopedic conditions, and cardiovascular and pulmonary conditions (N=4988) covered by Medicare+Choice plans, and admitted to an SNF in 2002. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: LOS and improvement in stage of independence in the mobility, activities of daily living (ADLs), and executive control domains of function as determined by the FIM instrument. RESULTS: Higher therapy intensity was associated with shorter LOS ( P <.05). Higher PT and OT intensities were associated with greater odds of improving by at least 1 stage in mobility and ADL functional independence across each condition ( P <.05). The OT intensity was associated with an improved executive control stage for patients with stroke, and PT and OT intensities were associated with improved executive control stage for patients with cardiovascular and pulmonary conditions ( P <.05). The SLT intensity was associated with improved motor and executive control functional stages for patients with stroke ( P <.05). Therapy intensities accounted for small proportions of model variances in all outcomes. CONCLUSIONS: Higher therapy intensity was associated with better outcomes as they relate to LOS and functional improvement for patients who have stroke, orthopedic conditions, and cardiovascular and pulmonary conditions and are receiving rehabilitation in the SNF setting.     

A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery

Mallinson TR, Bateman J, Tseng H-Y, Manheim L, Almagor O, Deutsch A, Heinemann AW. A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery.

Objective

To examine differences in outcomes of patients after lower-extremity joint replacement across 3 post–acute care (PAC) rehabilitation settings.

Design

Prospective observational cohort study.

Setting

Skilled nursing facilities (SNFs; n=5), inpatient rehabilitation facilities (IRFs; n=4), and home health agencies (HHAs; n=6) from 11 states.

Participants

Patients with total knee (n=146) or total hip replacement (n=84) not related to traumatic injury.

Interventions

None.

Main Outcome Measure

Self-care and mobility status at PAC discharge measured by using the Inpatient Rehabilitation Facility Patient Assessment Instrument.

Results

Based on our study sample, HHA patients were significantly less dependent than SNF and IRF patients at admission and discharge in self-care and mobility. IRF and SNF patients had similar mobility levels at admission and discharge and similar self-care at admission, but SNF patients were more independent in self-care at discharge. After controlling for differences in patient severity and length of stay in multivariate analyses, HHA setting was not a significant predictor of self-care discharge status, suggesting that HHA patients were less medically complex than SNF and IRF patients. IRF patients were more dependent in discharge self-care even after controlling for severity. For the full discharge mobility regression model, urinary incontinence was the only significant covariate.

Conclusions

For the patients in our U.S.-based study, direct discharge to home with home care was the optimal strategy for patients after total joint replacement surgery who were healthy and had social support. For sicker patients, availability of 24-hour medical and nursing care may be needed, but intensive therapy services did not seem to provide additional improvement in functional recovery in these patients.     

Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes

OBJECTIVE: To examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective. DESIGN: Retrospective. SETTING: Skilled nursing facilities (SNFs) across the United States. PARTICIPANTS: A total of 211 SNFs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting "quite a lot" or "completely" prepared to manage their care at discharge from SNF-based rehabilitation. RESULTS: No quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator-prevalence of daily use of restraints (QI 22)-correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge. CONCLUSIONS: Patients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose.     

Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations

Sakakibara BM, Miller WC, Backman CL. Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations.

Objectives

To explore shortened response formats for use with the Activities-specific Balance Confidence (ABC) Scale and then evalute the unidimensionality of the scale, the item difficulty, the scale for redundancy and content gaps, and the item standard error of measurement (SEM) and internal consistency reliability among aging individuals with a lower-limb amputation living in the community.

Design

Secondary analysis of cross-sectional survey and chart review data.

Setting

Outpatient amputee clinics, Ontario, Canada.

Participants

Community living adults (N=448; ≥50y; mean, 68y) who have used a prosthesis for at least 6 months for a major unilateral lower-limb amputation. Of the participants, 325 (72.5%) were men.

Interventions

Not applicable.

Main Outcome Measure

ABC Scale.

Results

A 5-option response format outperformed 4- and 6-option formats. Factor analyses confirmed a unidimensional scale. The distance between response options is not the same for all items on the scale, evident by the Rasch Partial Credit Model (PCM) having a better fit to the data than the Rasch Rating Scale Model. Two items, however, did not fit the PCM within statistical reason. Revising the wording of the 2 items may resolve the misfit and improve the construct validity and lower the standard error of measurement. Overall, the difficulty of the scale's items is appropriate for use with aging individuals with lower-limb amputation, and is most reliable (Cronbach α=0.94) for use with individuals with moderately low balance confidence levels.

Conclusions

The ABC Scale with a simplified 5-option response format is a valid and reliable measure of balance confidence for use with individuals aging with a lower-limb amputation.     

Houghton Scale of prosthetic use in people with lower-extremity amputations: Reliability, validity, and responsiveness to change

OBJECTIVE: To evaluate the responsiveness to change and the floor and ceiling effects of the Houghton Scale. DESIGN: One-week and 3-month test-retest to evaluate reliability, validity, and responsiveness to change. SETTING: Amputee rehabilitation program. PARTICIPANTS: Persons (N=125) with unilateral or bilateral lower-extremity amputation who were wearing a prostheses: 1 group (n=49) for the reliability component and another group (n=76) for the responsiveness and validity component. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responsiveness to change, ceiling and floor effects, and reliability and convergent validity. RESULTS: Evaluation of responsiveness to change (n=76) showed that the total score increased from a mean +/- standard deviation of 6.14+/-2.40 at discharge to 7.70+/-2.62 (P<.001) at follow-up 3 months later. Floor and ceiling effects were not detected for the overall score but were noted for the individual subscales. The internal consistency was moderate at discharge (Cronbach alpha=.71) and follow-up (Cronbach alpha=.70). The Houghton Scale correlated significantly, although moderately, with the physical composite score of the Medical Outcomes Study 36-Item Short-Form Health Survey (r=.393, P<.01) and the 2-minute walk test at admission (r=.620, P<.01) and discharge (r=.653, P<.01). The reliability (intraclass correlation coefficient=.96) of the Houghton Scale was high (n=49). CONCLUSIONS: The Houghton Scale is appropriately responsive to change in prosthetic use in individuals with lower-limb amputation after rehabilitation.     

Dignity and its related factors among older adults in long-term care facilities: A cross-sectional study

ObjectivesThis study aimed to explore the dignity and related factors among older adults in long-term care facilities.MethodsCross-sectional data were obtained from a sample of 253 Chinese older adults dwelling in long-term care facilities. Dignity among older adults was measured using the Dignity Scale, and its potential correlates were explored using multiple linear regressions.ResultsResults showed that the total score of the Dignity Scale is 151.95 ± 11.75. From high to low, the different factors of dignity among older adults in long-term care facilities were as follows: caring factors (4.83 ± 0.33), social factors (4.73 ± 0.41), psychological factors (4.66 ± 0.71), value factors (4.56 ± 0.53), autonomous factors (4.50 ± 0.57), and physical factors (4.38 ± 0.55). A higher score of the Dignity Scale was associated with higher economic status, fewer chronic diseases, less medication, better daily living ability and long-time lived in cities.ConclusionOlder adults with low economic status, more chronic diseases, and poor daily living ability, taking more medications, or the previous residence in rural areas seem to be most at low-level dignity in long-term care facilities and thus require more attention than their peers.     

脑卒中并假性球麻痹患者吞咽障碍的康复护理

目的探讨脑卒中并假性球麻痹患者吞咽障碍康复护理的方法和效果。方法将42例患者随机分为两组,对照组20例采用传统的常规护理方法,康复组22例在此基础上采用早期系统化康复护理方法,包括吞咽功能训练、摄食训练、鼻饲。结果康复组患者吞咽功能得到不同程度的改善,与对照组相比有显著性差异(P<0·05)。结论对脑卒中并假性球麻痹患者行早期康复训练,有助于恢复吞咽功能,减少并发症,使患者的精神状态和营养状况得到改善。     

Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease

Hill K, Goldstein R, Gartner EJ, Brooks D. Daily utility and satisfaction with rollators among persons with chronic obstructive pulmonary disease.

Objective

To characterize the daily utility and satisfaction with rollators in patients with chronic obstructive pulmonary disease (COPD).

Design

Cross-sectional observational study.

Setting

Community.

Participants

COPD patients describing dyspnea during activities of living, who had been provided with a rollator by a health care professional within the preceding 5-year period.

Interventions

Not applicable.

Main Outcome Measures

Three questionnaires were administered in random order. The St. George's Respiratory Questionnaire was used to measure health-related quality of life, version 2.0 of the Quebec User Evaluation of Satisfaction with Assistive Technology was used to assess satisfaction with the rollator, and a structured questionnaire was used to obtain information regarding daily utility of the device and barriers to its use. Demographic data were obtained through patient interview. Anthropometric data, measurements of resting lung function, and 6-minute walk distance were extracted from the medical records.

Results

Twenty-seven (10 men) patients (forced expiratory volume in 1 second, 35.1%±22.3% predicted) completed the study. Sixteen (59%) patients reported daily rollator use. All patients used the rollator to assist with ambulation outdoors, but 16 (59%) patients stated that they did not use the rollator for any activity in their home. Although satisfaction with the rollator was high, women were less satisfied with the weight of the device than men (P=.008). Thirteen (48%) patients reported being embarrassed while using the device.

Conclusions

COPD patients provided with a rollator for use during daily life were most satisfied with its effectiveness and least satisfied with its weight. Daily use was generally high with over half the patients using the rollator on a daily basis. Rollators were more often used outdoors than indoors.     

The effects of added prosthetic mass on physiologic responses and stride frequency during multiple speeds of walking in persons with transtibial amputation

OBJECTIVES: To determine the effect of 3 prosthetic mass conditions on selected physiologic responses during multiple speed treadmill walking in persons with transtibial amputation. DESIGN: A repeated-measures design for 3 prosthetic mass conditions and 5 walking speeds. SETTING: University research laboratory. PARTICIPANTS: Eight ambulatory men with unilateral traumatic transtibial amputation. INTERVENTIONS: The 3 prosthetic mass conditions were 60%, 80%, and 100% of the estimated intact limb below-knee mass. The multiple-speed treadmill walking test (4min at each speed: 54, 67, 80, 94, 107m/min) was performed on an instrumented treadmill according to randomly assigned mass conditions. MAIN OUTCOME MEASURES: Oxygen consumption, gait efficiency, relative exercise intensity (percentage of age-predicted maximal heart rate), and stride frequency. RESULTS: Prosthetic mass did not significantly alter oxygen consumption or gait efficiency (P>.05). From the 60% to the 100% prosthetic mass conditions, relative exercise intensity significantly increased and stride frequency significantly decreased (P<.05). CONCLUSIONS: A heavier prosthesis (up to 100% of estimated intact limb below-knee mass) did not significantly increase the energy costs of walking for the 5 speeds examined. Further study of gait symmetry with the use of a heavier prosthesis is warranted.