The Prevalence of Osteoarthritis of the Intact Hip and Knee Among Traumatic Leg Amputees

Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees.

Objective

To determine the prevalence of osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility.

Design

Cross-sectional observational study.

Setting

Outpatient population of 2 Dutch rehabilitation centers.

Participants

Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies.

Interventions

Not applicable.

Main Outcome Measure

The prevalence of OA.

Results

The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found.

Conclusions

The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation.     

What Are the Relations Between Voluntary Postural Sway Measures and Falls-History Status in Community-Dwelling Older Adults?

Tucker MG, Kavanagh JJ, Morrison S, Barrett RS. What are the relations between voluntary postural sway measures and falls-history status in community-dwelling older adults?

Objectives

To determine whether a series of voluntary postural sway tasks could differentiate and accurately identify the falls-history status of older adults, and to examine the relations between voluntary sway measures and falls risk.

Design

Case-control study.

Setting

University biomechanics laboratory.

Participants

Healthy community-dwelling older adults (N=51) aged 65 to 94 years who were divided into nonfaller (n=36), single faller (n=10), and multiple faller (n=5) groups based on a 12-month history of falls.

Interventions

Not applicable.

Main Outcome Measures

Participants underwent a falls-risk assessment using the Physiological Profile Assessment (PPA) and then performed 6 voluntary postural sway tasks. The tasks included maximum static leans, maximum voluntary sway, continuous voluntary sway, rapid initiation of voluntary sway, rapid termination of voluntary sway, and rapid orthogonal switches of voluntary sway between the anterior-posterior and medial-lateral directions. Center of pressure amplitudes and reaction time measures were examined using analysis of covariance, Pearson's correlation, and discriminant function analyses.

Results

Multiple fallers had increased age; increased falls risk; slower initiation, termination, and orthogonal switch reaction times; and reduced center of pressure amplitude during sway initiation and continuous voluntary sway compared with nonfallers. Few differences were observed between the nonfallers and single fallers. Voluntary sway measures were significantly correlated with each other and with PPA score. Two postural reaction time measures and age identified 80% of multiple fallers and 98% of nonmultiple fallers. Similarly, PPA score and age identified 80% of multiple fallers and 100% of nonmultiple fallers.

Conclusions

The slower and less effective balance responses of multiple fallers compared with nonfallers and the comparable sensitivity and specificity of PPA score and reactive voluntary sway measures indicate that postural reaction time is a strong determinant of falls risk.     

Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators

Su P-F, Gard SA, Lipschutz RD, Kuiken TA. Differences in gait characteristics between persons with bilateral transtibial amputations, due to peripheral vascular disease and trauma, and able-bodied ambulators.

Objectives

To examine differences in gait characteristics between persons with bilateral transtibial amputations because of trauma and peripheral vascular disease (PVD); and to compare that with data from able-bodied controls that were previously collected and maintained in a laboratory database.

Design

Observational study of persons with bilateral transtibial amputations.

Setting

A motion analysis laboratory.

Participants

Nineteen bilateral transtibial amputees.

Intervention

No experimental intervention was performed. To standardize the effect of prosthetic foot type, subjects were fitted with Seattle Lightfoot II feet 2 weeks before quantitative gait analyses.

Main Outcome Measures

Temporospatial, kinematic, and kinetic gait data were recorded and analyzed.

Results

Results showed that the freely selected walking speeds of subjects with PVD and trauma were 0.69m/s and 1.11m/s, respectively, while that of able-bodied control subjects was 1.20m/s. When data were compared on the basis of freely selected walking speed, numerous differences were found in temporospatial, kinematic, and kinetic parameters between the PVD and trauma groups. However, when data from similar speeds were compared, the temporospatial, kinematic, and kinetic gait data demonstrated no statistically significant differences between the 2 amputee groups. Although not statistically significant, the PVD group displayed increased knee (P=.09) and hip (P=.06) flexion during the swing phase, whereas the trauma group displayed increased pelvic obliquity (P=.06). These actions were believed to represent different strategies to increase swing phase foot clearance. Also, the PVD group exhibited slightly greater hip power (P=.05) before toe-off.

Conclusions

Many of the differences observed in the quantitative gait data between the trauma and PVD groups appeared to be directly associated with their freely selected walking speed; the trauma group walked at significantly faster freely selected speeds than the PVD group. When their walking speeds were matched, both amputee groups displayed similar gait characteristics, with the exception that they might use slightly different strategies to increase foot clearance.     

Older fallers with poor working memory overestimate their postural limits

Liu-Ambrose T, Ahamed Y, Graf P, Feldman F, Robinovitch SN. Older fallers with poor working memory overestimate their postural limits.

Objective

To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory.

Design

Cross-sectional study.

Setting

Research laboratory.

Participants

Thirty-three community-dwelling older adults with a history of falls.

Interventions

Not applicable.

Main Outcome Measures

We measured the accuracy of perceived postural limits by using the perceived reach test in 33 fallers. The difference between the verbal digits forward test score and the verbal digits backward test score was used to provide an index of the central executive component of working memory. Participants were then allocated into 2 groups: (1) good working memory or (2) poor working memory. Comparisons of group characteristics and scores were undertaken by using Student independent-sample t tests for differences in means between those with good working memory and those with poor memory. One hierarchical linear regression model was constructed to determine the independent association of the central executive component of working memory with the accuracy of older fallers' perceived reach capacity.

Results

There was a significant difference in the mean percentage error in perceived reach between older fallers with good working memory and those with poor working memory (P=.01). The verbal digit span difference score was independently associated with the percentage error in perceived reach. The verbal digit span difference score resulted in an R² change of 18.2% and significantly improved the regression model (F_1,26 change, 7.45; P=.01).

Conclusions

Our novel results suggest that impaired executive functioning may increase falls risk by impairing older adults' judgment in motor planning for daily activities. However, future studies with larger sample sizes are needed to confirm our current results.     

A survey of physiotherapists involved in paediatric lower limb amputee rehabilitation in the British Isles

Objectives

Children require extensive rehabilitation following lower limb amputation and there are few reports describing this rehabilitation process. A survey to assess opinions, practice and caseloads amongst physiotherapists involved with paediatric amputee rehabilitation in the British Isles was therefore undertaken.

Design

A 17-item structured telephone survey was developed to include the main aspects of physiotherapy rehabilitation of children following lower limb amputation. Physiotherapists working in paediatrics and/or amputee rehabilitation in a range of acute, outpatient and community settings were surveyed.

Results

Data were collected between November 2001 and October 2002. Physiotherapists from 70 centres were contacted, and 52 treated paediatric lower limb amputees. A variety of causes of amputation were managed. All physiotherapists commented that they saw very few paediatric patients. No centre had protocols in place for any stage of management. In all geographical areas, rehabilitation was available throughout recovery for all causes of lower limb amputation. Core elements of rehabilitation were similar; however, additional elements differed between centres.

Conclusions

This survey indicates that the small population of children with lower limb amputation has access to rehabilitation throughout their recovery. However, there is variation in the provision of physiotherapy rehabilitation services throughout the British Isles. Redesigning physiotherapy rehabilitation services for paediatric lower limb amputees, and formalisation of cross-speciality links between paediatric and amputee physiotherapists may help to address these issues and better equip these children for future function.     

Adaptations to mass perturbations in transtibial amputees: kinetic or kinematic invariance?

Selles RW, Bussmann JB, Klip LM, Speet B, Van Soest AJ, Stam HJ. Adaptations to mass perturbations in transtibial amputees: kinetic or kinematic invariance? Arch Phys Med Rehabil 2004;85:2046-52.

Objective

To establish the adaptation strategy transtibial amputees use after mass perturbation of their prosthetic lower leg.

Design

We investigated whether the measured adaptations to mass perturbation of the lower leg in transtibial amputees can better be described as (1) a kinetic invariance strategy in which kinetics (joint torques) remain the same while kinematics (joint angles) change or (2) a kinematic invariance strategy in which kinematics remain the same while kinetics change.

Setting

A gait laboratory.

Participants

Ten transtibial amputees.

Interventions

Five different mass conditions.

Main outcome measures

Measured joint torques and angles during the swing phase in the different mass conditions.

Results

Mass perturbation induced more significant changes and larger effect sizes in joint torques than in joint angles.

Conclusions

Transtibial amputees adapt to mass perturbation primarily by maintaining the same kinematic pattern and adjusting their joint torques, that is, they use a kinematic invariance strategy. This implies that manipulating prosthetic inertial properties does not directly influence gait kinematics and that inertial properties should be evaluated in terms of the energetic cost of the swing phase.     

Control of a six degree of freedom prosthetic arm after targeted muscle reinnervation surgery

Miller LA, Lipschutz RD, Stubblefield KA, Lock BA, Huang H, Williams III TW, Weir RF, Kuiken TA. Control of a six degree of freedom prosthetic arm after targeted muscle reinnervation surgery.

Objectives

To fit and evaluate the control of a complex prosthesis for a shoulder disarticulation-level amputee with targeted muscle reinnervation.

Design

One participant who had targeted muscle reinnervation surgery was fitted with an advanced prosthesis and his use of this device was compared with the device that he used in the home setting.

Setting

The experiments were completed within a laboratory setting.

Participant

The first recipient of targeted muscle reinnervation: a bilateral shoulder disarticulation-level amputee.

Interventions

Two years after surgery, the subject was fitted with a 6 degree of freedom (DOF) prosthesis (shoulder flexion, humeral rotation, elbow flexion, wrist rotation, wrist flexion, and hand control). Control of this device was compared with that of his commercially available 3-DOF system (elbow, wrist rotation, and powered hook terminal device).

Main Outcome Measure

In order to assess performance, movement analysis and timed movement tasks were executed.

Results

The subject was able to independently operate all 6 arm functions with good control. He could simultaneously operate 2 DOF of several different joint combinations with relative ease. He operated up to 4 DOF simultaneously, but with poor control. Work space was markedly increased and some timed tasks were faster with the 6-DOF system.

Conclusions

This proof-of-concept study shows that advances in control of shoulder disarticulation-level prostheses can improve the quality of movement. Additional control sources may spur the development of more advanced and complex componentry for these amputees.     

A Comparison of Balance Performance: Computerized Dynamic Posturography and a Random Motion Platform

Broglio SP, Sosnoff JJ, Rosengren KS, McShane K. A comparison of balance performance: computerized dynamic posturography and a random motion platform.

Objective

To establish the clinical utility of the PROPRIO 5000 as a balance assessment device by establishing convergent validity with the NeuroCom sensory organization test (SOT).

Design

Cross-sectional.

Setting

Balance research laboratory.

Participants

Young adults (N=40; 21.1±1.4y).

Interventions

Not applicable.

Main Outcome Measures

Performance on each of the 6 NeuroCom SOT testing conditions and PROPRIO 5000 dynamic motion analysis score.

Results

Correlational analyses between output variables yielded significant relationships between the dynamic motion analysis score from the 0 to 10 second (r=−.38), 10 to 20 second (r=−.34), and 20 to 30 second (r=−.35) intervals and the SOT composite balance score.

Conclusions

The initial stages of the PROPRIO 5000 and the NeuroCom SOT battery may evaluate similar aspects of postural control. However, as the magnitude of PROPRIO perturbations increased, the relationship between the devices diverged and the complete PROPRIO assessment is not thought to pair with the SOT assessment. Differences between the 2 devices may be associated with varying degrees of test difficulty and the necessary postural control strategies involved in responding to continual balance perturbations (PROPRIO 5000) or to different sensory inputs (SOT).     

Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees

Kaufman KR, Levine JA, Brey RH, McCrady SK, Padgett DJ, Joyner MJ. Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees.

Objective

To quantify the energy efficiency of locomotion and free-living physical activity energy expenditure of transfemoral amputees using a mechanical and microprocessor-controlled prosthetic knee.

Design

Repeated-measures design to evaluate comparative functional outcomes.

Setting

Exercise physiology laboratory and community free-living environment.

Participants

Subjects (N=15; 12 men, 3 women; age, 42±9y; range, 26-57y) with transfemoral amputation.

Intervention

Research participants were long-term users of a mechanical prosthesis (20±10y as an amputee; range, 3-36y). They were fitted with a microprocessor-controlled knee prosthesis and allowed to acclimate (mean time, 18±8wk) before being retested.

Main Outcome Measures

Objective measurements of energy efficiency and total daily energy expenditure were obtained. The Prosthetic Evaluation Questionnaire was used to gather subjective feedback from the participants.

Results

Subjects demonstrated significantly increased physical activity-related energy expenditure levels in the participant's free-living environment (P=.04) after wearing the microprocessor-controlled prosthetic knee joint. There was no significant difference in the energy efficiency of walking (P=.34). When using the microprocessor-controlled knee, the subjects expressed increased satisfaction in their daily lives (P=.02).

Conclusions

People ambulating with a microprocessor-controlled knee significantly increased their physical activity during daily life, outside the laboratory setting, and expressed an increased quality of life.     

Dual Energy X-Ray Absorptiometry of the Distal Femur May Be More Reliable than the Proximal Tibia in Spinal Cord Injury

Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, Davis SA, Garshick E. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury.

Objective

To evaluate the precision of dual energy x-ray absorptiometry scanning at 2 skeletal sites at the knee (proximal femur and distal tibia) in people with SCI.

Design

Cross-sectional.

Setting

Veterans Affairs Medical Center.

Participants

Subjects (N=20) with chronic SCI.

Interventions

Not applicable.

Main Outcome Measures

Precision as determined by root mean square coefficient of variation (RMS-CV) and root mean square standard deviation (RMS-SD).

Results

At the distal femur the root RMS-CV was 3.01% and the RMS-SD was 0.025g/cm². At the proximal tibia the RMS-CV was 5.91% and the RMS-SD was 0.030g/cm².

Conclusions

Precision at the distal femur is greater than at the proximal tibia and we recommend it as the preferred site for the longitudinal assessment of bone mineral density at the knee in chronic SCI.     

Validity of a Functional Dynamic Walking Test for the Elderly

Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly.

Objective

To determine the validity of a safe, quick, and simple method of measuring dynamic balance in the elderly during gait called the parallel walk test.

Design

Control study.

Setting

Outpatient clinic, community.

Participants

Twenty-seven elderly fallers (age 82±6y) registered at a falls clinic and 34 elderly nonfallers (age 76±7y) were recruited to this study based on Mini Mental State Examination and Barthel Index scores.

Interventions

Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) in their own footwear. They were scored for foot placement on the line (1 point) or outside the lines (2 points). Participants also performed a timed 6-m tandem walk test, a 30-second tandem stance, and a 30-second parallel stance.

Main Outcome Measures

Scores and time to complete the parallel walk test and tandem walk test along with the time of standing for tandem and parallel stance. Validity coefficients were calculated for the sensitivity and specificity of the parallel walk test.

Results

All subjects completed the parallel walk test, but few attempted and completed the tandem walk test. The fallers had significantly greater scores at 20 and 30.5cm and took significantly longer to complete the 6m at all widths. The 20-cm width was most discriminatory. The parallel walk test showed a significant correlation with the tandem stance.

Conclusions

All subjects attempted and completed the parallel walk test but not the tandem walk test. The time to completion and scoring accurately measures dynamic balance during gait in elderly fallers. The parallel walk test could be a useful tool in the clinical setting for assessing balance in gait pre- and postintervention.     

Fall risk profile and quality-of-life status of older chiropractic patients

Objectives

The primary aim of this study was to estimate the prevalence of fall risk factors in older chiropractic patients. The secondary aim was to investigate the quality-of-life status of older chiropractic patients and to see whether a history of falling was related to quality-of-life status.

Methods

A cross-sectional study was conducted at 12 chiropractic practices throughout Auckland, New Zealand, and Melbourne, Australia. The study involved gaining a profile of health status, fall history, and fall risk from active chiropractic patients who were 65 years or older.

Results

One hundred ten older chiropractic patients were approached, and 101 agreed to participate in this study (response rate, 91.8%). Thirty-five percent of participants had experienced at least 1 fall in the previous 12 months. Of those that had fallen, 80% had at least a minor injury, with 37% of fallers requiring medical attention and 6% suffering a serious injury. The prevalence of most fall risk factors was consistent with published data for community-dwelling older adults. Quality of life of older chiropractic patients appeared to be good, but fallers reported a lower physical component summary score compared with nonfallers (P = .04).

Conclusions

A portion of the older chiropractic patients sampled in this study had a substantial risk of falling. This risk could be assessed on a regular basis for the presence of modifiable fall risk factors, and appropriate advice, given when fall risks are identified.     

Effects of Mirror Feedback on Upright Stance Control in Elderly Transfemoral Amputees

Hlavackova P, Fristios J, Cuisinier R, Pinsault N, Janura M, Vuillerme N. Effects of mirror feedback on upright stance control in elderly transfemoral amputees.

Objective

To investigate the effects of mirror feedback on upright stance control in elderly transfemoral amputees.

Design

Before and after intervention trials.

Setting

University medical bioengineering laboratory.

Participants

Elderly transfemoral amputees (N=12).

Interventions

Participants were asked to stand upright, as immobile as possible, in 2 Eyes-open and Mirror-feedback experimental conditions. The latter experimental condition consisted of supplying the participants with their frontal reflection by positioning a mirror in front of them.

Main Outcome Measures

Weight-bearing symmetry and the displacements of the center of foot pressure under the nonaffected limb and the prosthetic limb.

Results

Mirror feedback did not modify weight-bearing symmetry and had different effects on the center of foot pressure displacements under the nonaffected limb and prosthetic limb: a decreased center of foot pressure surface area was observed in the Mirror-feedback condition relative to the Eyes-open condition under the nonaffected limb, whereas no significant difference between the Eyes-open condition and the Mirror-feedback condition was observed under the prosthetic limb.

Conclusions

Results suggest that elderly transfemoral amputees were able to integrate augmented visual biofeedback through the use of mirror-reflected body image to improve their upright stance control. The present findings could have implications for clinical practice and rehabilitation.     

Three-dimensional motions of trunk and pelvis during transfemoral amputee gait

Goujon-Pillet H, Sapin E, Fodé P, Lavaste F. Three-dimensional motions of trunk and pelvis during transfemoral amputee gait.

Objectives

To identify characteristics of upper-body kinematics and torque transmission to the ground during locomotion in a group of patients with transfemoral amputation as compared with a group of asymptomatic subjects; and to investigate the influence of walking velocity and residual limb length on several characteristics of upper-body motion.

Design

Three-dimensional gait analysis with an optoelectronic device.

Setting

Gait laboratory.

Participants

Twenty-seven patients with transfemoral amputation and a control group of 33 nondisabled subjects.

Interventions

Not applicable.

Main Outcome Measures

Three-dimensional kinematics of the pelvis and the thorax and ground reaction force for amputees and control subjects.

Results

For subjects with transfemoral amputation, it was observed that upper-body angular ranges of motion (ROMs) increased globally as walking velocity decreased. For these subjects, specific patterns of pelvic rotation and torque transmission by the lower limbs around the vertical axis were found. The counter-rotation between the pelvic and scapular girdles was reduced. This reduction proved to be linked with the decrease of walking velocity. Walking velocity also affected all the parameters describing the motion of upper body. Pelvic ROM increased with the length of the limb decreasing.

Conclusions

The huge differences found between subjects with and without amputation suggest that the motion of the upper body must be considered to enhance gait.     

Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series

Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series.

Objective

To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation.

Design

Consecutive case series.

Setting

Outpatient physical medicine and rehabilitation clinic.

Participants

Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation.

Intervention

BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid.

Main Outcome Measure

A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections.

Results

Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment.

Conclusions

BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.     

Action Observation Treatment Improves Recovery of Postsurgical Orthopedic Patients: Evidence for a Top-Down Effect?

Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?

Objective

To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy.

Design

Randomized controlled trial.

Setting

Department of rehabilitation.

Participants

Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure.

Interventions

All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment.

Main Outcomes Measures

Changes in FIM and Tinetti scale scores, and dependence on walking aids.

Results

At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch (P=.01).

Conclusions

In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients.     

Rehabilitation setting and associated mortality and medical stability among persons with amputations

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.     

Determinants of Skin Problems of the Stump in Lower-Limb Amputees

Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU. Determinants of skin problems of the stump in lower-limb amputees.

Objective

To identify determinants of skin problems in lower-limb amputees.

Design

Survey, using a questionnaire.

Setting

Not applicable.

Participants

Lower-limb amputees (N=2039) who either obtained their prosthesis through the Orthopedische Instrument Makerij (a group of orthopedic workshops in the Netherlands) or were a member of the (Dutch) National Society of Amputees (Landelijke Vereniging van Geamputeerden) were invited to participate. In total, 872 lower-limb amputees agreed to participate.

Intervention

Amputees filled in the questionnaire to assess characteristics of the amputation and prosthesis, level of activity, stump and prosthesis hygiene, and skin problems. Stepwise backward logistic regression was performed to analyze determinants of skin problems.

Main Outcome Measure

Skin problems in the month prior to completing the questionnaire.

Results

A total of 816 questionnaires were received. Eventually 805 questionnaires were suitable for statistical analysis. Protective determinants were (in order of magnitude of association) older age, male sex, and amputation because of peripheral arterial disease and/or diabetes. Provocative determinants were (in order of magnitude of association) use of antibacterial soap, smoking, and washing the stump 4 times a week or more often. In total, 63% of the participants (95% confidence interval, 60%-67%) reported 1 or more skin problems.

Conclusions

The provocative determinants identified in this study—use of antibacterial soap, smoking, and stump washing frequency—have to be studied for their clinical relevance.