Gender differences in amputation outcome

Purpose.?To assess the influence of gender on the success of limb-fitting after amputation.

Methods.?One-hundred and five successive in-patients admitted to an amputee rehabilitation ward were followed to assess the success of limb-fitting at discharge. The influence of demographic, clinical and social factors on the success of lower limb-fitting was assessed using linear regression analysis and group comparisons.

Results.?There were 35 (33%) women in a cohort of 105 successive admissions. Men and women were comparable in terms of age, length of stay, medical comorbidity and level of amputation. Women were less likely to be successfully fitted with a prosthetic limb at discharge than men (42.9% vs 68.6%, p = 0.011), and more women lived alone (57.1% vs 38.6%, p = 0.021). Linear regression revealed that gender was an independent significant factor in the success of limb-fitting; age, level and cause of amputation, co-morbidity and length of stay were not significant factors.

Conclusions.?Women were less likely to be successfully fitted with a lower limb prosthesis after amputation.     

Partial hand amputation and work

Purpose. To determine whether or not subjects who had had a partial hand amputation were able to return to the same job and whether or not they used their silicone finger prosthesis for work.

Method. Medical records of all the patients who had undergone a traumatic partial hand amputation and who had been treated in the Upper Limb Prosthetic Clinic at the Institute for Rehabilitation in Ljubljana were reviewed. Questionnaires were sent to 112 patients. Forty-eight questionnaires which were returned and had been correctly answered were analysed.

Results. The study found that less than half the patients who had had a partial hand amputation were able to do the same work as before the amputation. Less than one-third wore their silicone prosthesis at work regularly. The subjects who did not have manual jobs and who had an amputation of only one or two fingers were able to keep the same job more easily after the amputation. Only a few subjects found their silicone prosthesis useful at work.

Conclusion. It can be concluded that partial hand amputation may present a great problem in keeping the same job after amputation. An aesthetic (cosmetic) silicone prosthesis is helpful particularly for subjects with higher education whose work involves personal contacts and for whom aesthetics is important. They use the prosthesis for certain activities, such as typing.     

Partial hand amputation and work

Purpose. To determine whether or not subjects who had had a partial hand amputation were able to return to the same job and whether or not they used their silicone finger prosthesis for work.

Method. Medical records of all the patients who had undergone a traumatic partial hand amputation and who had been treated in the Upper Limb Prosthetic Clinic at the Institute for Rehabilitation in Ljubljana were reviewed. Questionnaires were sent to 112 patients. Forty-eight questionnaires which were returned and had been correctly answered were analysed.

Results. The study found that less than half the patients who had had a partial hand amputation were able to do the same work as before the amputation. Less than one-third wore their silicone prosthesis at work regularly. The subjects who did not have manual jobs and who had an amputation of only one or two fingers were able to keep the same job more easily after the amputation. Only a few subjects found their silicone prosthesis useful at work.

Conclusion. It can be concluded that partial hand amputation may present a great problem in keeping the same job after amputation. An aesthetic (cosmetic) silicone prosthesis is helpful particularly for subjects with higher education whose work involves personal contacts and for whom aesthetics is important. They use the prosthesis for certain activities, such as typing.     

Selection of outcome measures in lower extremity amputation rehabilitation: ICF activities

Purpose. To identify and evaluate the lower extremity amputee (LEA) rehabilitation outcome measurement instruments that quantify those outcomes that have been classified within the ICF category of activities. This was done to assist the clinicians in the selection of the most appropriate instrument based upon four determinants of successful LEA rehabilitation and outcome measurement.

Method. A systematic review of the literature associated with outcome measurement in LEA rehabilitation was conducted. Only articles containing data related to metric properties (reliability, validity or responsiveness) for an instrument were included. Articles were identified by electronic and hand-searching techniques and were subsequently classified first according to the ICF and then by their clinical use.

Results. Seventeen instruments were identified that were classified into one of (A) walk tests, (B) mobility grades and (C) indices (generic and amputee-specific). Evidence about metric properties and clinical utility was summarised in tables which formed the basis for conclusions and recommendations pertaining to LEA rehabilitation.

Conclusions. All instruments examined have the potential for some use within the initial rehabilitation trial following amputation. There is a universal absence of quality evidence demonstrating responsiveness and most instruments would benefit from further investigation to better define their optimal use.     

Outcome measures in amputation rehabilitation: ICF body functions

Purpose. To identify and evaluate the lower limb amputation rehabilitation outcome measurement instruments that quantify those outcomes classified within the International classification of functioning, disability and health (ICF) category of body function or structure. This was done to summarise the current evidence base for the most commonly used outcome measurement tools and to provide clinicians with recommendations on how specific tools might be selected for use.

Method. A systematic review of the literature associated with outcome measurement in lower limb amputation rehabilitation was conducted. Only articles containing data related to metric properties (reliability, validity or responsiveness) for an instrument were included. Articles were identified by electronic and hand-searching techniques and were subsequently classified according to the ICF.

Results. Sixteen instruments were identified that were classified into one of Global mental function (12), Sensory and pain (1), Cardiovascular and respiratory (1) and Neuromusculoskeletal and movement (2). Evidence about metric properties and clinical utility was summarised in tables, which formed the basis for conclusions.

Conclusions. Few well-validated body function tools exist in the amputee literature, which may explain their lack of widespread use. For all scales, responsiveness to intervention has not been well established and should be the focus of future studies along with continued establishment of validity and reliability.     

Sex differences in injury severity and outcome measures after traumatic brain injury

OBJECTIVE: To investigate the effect of a patient's sex on various measures of injury severity and outcome after rehabilitation in a matched sample of patients with traumatic brain injury (TBI). DESIGN: Retrospective data were retrieved from a database that contains information routinely collected on all patients admitted for inpatient rehabilitation. SETTING: Inpatient rehabilitation unit of major teaching hospital in Australia. PARTICIPANTS: Fifty-four women with TBI after a motor vehicle crash (MVC) were identified from the Brain Injury Rehabilitation Database. An equal number of men were then matched for age and years of education. All subjects met the study admission criteria of having being involved in a high-speed MVC. Exclusion criteria included history of a previous head injury, chronic amnesia, psychiatric disturbance, and significant alcohol and/or substance abuse. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Differences, by sex, in patient scores on measures of injury severity and outcome after TBI. RESULTS: Men had significantly greater levels of injury severity as indicated by the Glasgow Coma Scale scores (U=994.0, P=.002) and length of posttraumatic amnesia (U=880.0, P=.016) when compared with women. No significant sex differences existed in the outcome measures or in injuries not associated with the central nervous system. CONCLUSIONS: Few investigations exist on the effect of patient sex on measures of injury severity and outcome after a TBI. In the present study, men's levels of injury severity were greater than women's despite the same admission criteria (high-speed MVC) being applied to both sexes.     

截肢术后的康复医疗特点

截肢后安装假肢是重建肢体功能的重要手段,及时正确的康复训练有助于充分发挥假肢的代偿作用,让患者尽早回归社会。文章就截肢康复的重要性、我国截肢康复的现状、现代截肢康复的特点及主要方法等作一综述。     

Mobility of persons after traumatic lower limb amputation

The objective of this study was to determine the influence of time span since amputation on mobility of persons experiencing traumatic lower limb amputation. A special questionnaire was sent to such persons and responses were analysed statistically. The subjects comprised 223 persons after traumatic lower limb amputation, residents of Slovenia. We discovered that 186 (74.2%) are using their prosthesis for more than 7 hours per day, 109 (52.2%) are able to walk outdoors without crutches, and 129 (57.8%) climb more than 20 stairs per day. In addition, those who are walking without crutches, walking longer distances, still cycling and driving a car are, on average, 5–10 years younger than the others. However, around one-third of persons who were young at the time of amputation face limitations of mobility later in life. A total of 76 (35.3%) are able to walk only up to 500 m out of doors, 38 (18.2%) can walk only with a pair of crutches, 62 (29.7%) need a cane or one crutch, and 37 (16.6%) cannot climb stairs. We conclude that successful fitting and usage of a prosthesis by persons after lower limb amputation promotes independent walking and mobility in everyday life. The level of independence achieved is related to time span since amputation.     

截肢病人的心理护理

通过对32例高位截肢病人的护理,针对病人入院初期、术后住院治疗期、出院前康复期等不同时期的心理异常,分别开展不同的心理辅导,结果发现心理护理对病人正视现实、安心积极配合治疗、回归社会重新生活具有重要意义.     

截肢病人的心理护理

通过对32例高位截肢病人的护理，针对病人入院初期、术后住院治疗期、出院前康复期等不同时期的心理异常，分别开展不同的心理辅导，结果发现心理护理对病人正视现实、安心积极配合治疗、回归社会重新生活具有重要意义。     

Return to work after lower limb amputation

Purpose. To review the literature on return to work after lower limb amputation.

Method. A comprehensive review of literature on return to work after lower limb amputation was carried out, searching MEDLINE and PubMED.

Results. Most authors found return-to-work rate to be about 66%. Between 22 and 67% of the subjects retained the same occupation, while the remainder had to change occupation. Post-amputation jobs were generally more complex with a requirement for a higher level of general educational development and were physically less demanding. The return to work depends on: general factors, such as age, gender and educational level; factors related to impairments and disabilities due to amputation (amputation level, multiple amputations, comorbidity, reason for amputation, persistent stump problems, the time from the injury to obtaining a permanent prosthesis, wearing comfort of the prosthesis, walking distance and restrictions in mobility); and factors related to work and policies (salary, higher job involvement, good support from the implementing body and the employer and social support network).

Conclusions. Subjects have problems returning to work after lower limb amputation. Many have to change their work and/or work only part-time. Vocational rehabilitation and counselling should become a part of rehabilitation programme for all subjects who are of working age after lower limb amputation. Better cooperation between professionals, such as rehabilitation team members, implementing bodies, company doctors and the employers, is necessary.     

Return to work after lower limb amputation

Purpose. To review the literature on return to work after lower limb amputation.

Method. A comprehensive review of literature on return to work after lower limb amputation was carried out, searching MEDLINE and PubMED.

Results. Most authors found return-to-work rate to be about 66%. Between 22 and 67% of the subjects retained the same occupation, while the remainder had to change occupation. Post-amputation jobs were generally more complex with a requirement for a higher level of general educational development and were physically less demanding. The return to work depends on: general factors, such as age, gender and educational level; factors related to impairments and disabilities due to amputation (amputation level, multiple amputations, comorbidity, reason for amputation, persistent stump problems, the time from the injury to obtaining a permanent prosthesis, wearing comfort of the prosthesis, walking distance and restrictions in mobility); and factors related to work and policies (salary, higher job involvement, good support from the implementing body and the employer and social support network).

Conclusions. Subjects have problems returning to work after lower limb amputation. Many have to change their work and/or work only part-time. Vocational rehabilitation and counselling should become a part of rehabilitation programme for all subjects who are of working age after lower limb amputation. Better cooperation between professionals, such as rehabilitation team members, implementing bodies, company doctors and the employers, is necessary.     

Gender differences in outcomes of a multimodal pain management program

Although gender differences in pain and analgesia are well known, it still remains unclear whether men and women vary in response to multimodal pain treatment. This study was conducted to investigate whether men and women exhibited different outcomes after an intensive multimodal pain treatment program. The daily outpatient program consisted of individual treatment as well as group therapy, with a total amount of therapy of 117.5 h per patient. Overall, 496 patients (254 women) completed the multimodal program. Pretreatment parameters for pain, disability due to pain, pain duration, and pain chronicity stage, as well as age or psychiatric comorbidities, did not differ between genders. The average pain, measured with a Numeric Rating Scale, decreased after treatment of −1.54 (±1.96) with a large effect size (ES) of .911 for the total sample. However, there were considerable differences in the benefit for women (−1.83 ± 2.12; ES 1.045) compared with men (−1.23 ± 1.74; ES .758). Consistently, women (ES .694) improved more in pain-related disabilities in daily life than men (ES .436). These distinctions are not due to differences in pain duration, received medication, psychiatric comorbidities, pain chronicity stage, or application for a disability pension. Therefore, gender differences not only refer to chronic pain prevalence, pain perception, or experimental pain measurement, but also seem to have a clinically relevant impact on the response to pain therapy.     

A systematic literature review of physiotherapy and rehabilitation approaches to lower-limb amputation

Background: Successful use of prostheses after lower-limb amputation (LLA) depends on undergoing physiotherapy and rehabilitation both physically and psychologically. The aim of this systematic literature review is to systematically review the scientific evidence regarding prosthetic rehabilitation and physiotherapy after LLA. Methods: A systematic literature search was conducted using PubMed, Web of Science, Cochrane, CINAHL, EMBASE, SCOPUS, and EMB Reviews databases on December 31, 2015. Studies with the search keywords were identified and independently assessed by reviewers. The search yielded 403 potentially relevant articles after the removal of duplicates. Of these, only nine articles met the inclusion criteria. All studies were original articles, one of which was a randomized controlled study. Different measurement methods were used and positive results in terms of functional status, weight-lifting capacity with prosthesis, walking and balance ability, and acute care process were gained with a physiotherapy program. Conventional methods still possess high importance; however, it is safe to say that virtual reality and software-based programs for rehabilitation are increasingly being developed and getting more and more support. Discussion: LLA rehabilitation is a topic that requires the focus of current and future studies; evidence-based studies are required on the approaches to rehabilitation for specific LLA groups.     

现代截肢观念及现代截肢术后康复

截肢康复是指从截肢手术到术后处理、康复训练、临时与正式假肢的安装和使用,直到重返家庭与社会的全过程。文章重点论述了截肢部位的选择,现代截肢手术的改进,儿童截肢的特点,大腿截肢手术特点以及影响假肢穿戴的非理想残肢的康复。     

Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation

Purpose.?Post-amputation rehabilitation is physically and cognitively demanding. Understanding which specific cognitive domains mediate outcome is critical to the development of interventions.

Method.?A cohort undergoing post-amputation rehabilitation was assessed before limb fitting and followed up at 6 months (n = 34). The average age was 60.69 years (SD = 13.98). 82.4% of the sample was male. 79.4% had amputations because of peripheral arterial disease. Memory, visuospatial function, executive function, praxis, emotion and language were assessed at Time 1 (first prosthetic clinic attendance). Time 1 data were also gathered on aetiology, level of amputation, comorbidities, pain and demographics. Six month outcomes were the locomotor capability index (LCI), the special interest group in amputee medicine (SIGAM) mobility grades and self reported hours of use.

Results.?The LCI at 6 months was significantly predicted in regression analyses by a measure of visual memory (figure recall) (adjusted R² = 24.8%, df = 32, zβ = 0.52, p = 0.002. Hours of use were predicted by the verbal fluency test total (adjusted R² = 17.1%, df = 26, zβ = 0.45, p = 0.017). SIGAM mobility grades were predicted by a combination of immediate verbal memory (story recall), age, level of amputation and presence of pain (adjusted R² = 58.2, df = 30, zβ = 0.52, p = 0.000).

Conclusions.?Neuropsychological and clinical variables predict a large amount of 6 month outcome variance. Cognitive difficulties may be considered mediators of poor outcome.     

Measuring rehabilitation outcome in post-acute hip fractured patients

Abstract

Purpose: To present our experience in measuring rehabilitation achievements of post-acute hip fractured patients with the FIM instrument; assess its appropriateness as to the patients’ various disability levels and describe our experience with other measuring tools in patients less sensitive to changes in the FIM instrument. Methods: A retrospective study performed in a post-acute geriatric rehabilitation center. Three hundred and eighty-seven hip fractured patients admitted from January 2010 to May 2012 were included in this study. Patients were evaluated by the Functional Independence Measure (FIM), the Timed Get Up and Go (TUG) test and “bed to chair” transfer FIM parameter. The study population was divided into three disability groups according to their admission disability level: high (admission FIM score <40), moderate (FIM 40–79) and low (FIM?≥?80). The Mann–Whitney U, ANOVA and Chi square tests analyzed the data. Results: The FIM instrument was found most sensitive in identifying functional change in patients with moderate disability. Low disability patients received more physio- and occupational-therapy treatment time, yet achieved a lower mean FIM score change compared to moderately disabled patients. The smallest real difference (SRD?=?13) for the FIM score was achieved by 60% of patients with moderate disability. When assessed by the TUG test, most patients (94%) improved their score. The SRD% of 31% was achieved by 71.7% of the patients. Nineteen patients (35.9%) achieved a discharge score of <20?s. The high disability group achieved the lowest mean FIM score change. On admission, 52/64 (81%) patients required considerable help in transferring from bed to chair (FIM 1–2), however, upon discharge, the majority (69.2%) improved to the level of a one man transfer (FIM?≥?3). Forty-one (64.1%) patients were discharged home. Conclusion: Post-acute hip fracture patients exhibit variable functional ability. Assessing rehabilitation achievements with a disability measure is limited; therefore, it is advisable to use an instrument most suitable to the patients’ disability level.

• Implication for Rehabilitation

• Post-acute hip fracture patients exhibit variable functional ability.

• Assessing rehabilitation achievements with a disability measure is limited.

• It is advisable to use an instrument most suitable to the patients’ disability level.

     

运动疗法对大腿截肢患者的疗效探讨

目的：研究运动疗法对大腿截肢患者康复的疗效，方法：对50例大腿截肢患者于运动疗法前后利用FIM评测表进行评定，结果：大腱截肢患者运动疗法训练后FIM评分与训练前相比有显著性差异（P＜0．05），结论：运动疗法对大腿截肢患者有确切的康复疗效。     

Early planning of care and rehabilitation after amputation for vascular disease by means of Katz Index of Activities of Daily Living

The aim of the study was to investigate whether the Swedish version of the Katz Index of ADL (Activities of Daily Living), on days 5-7 after amputation for vascular disease, had predictive value regarding length of hospital stay, discharge to the patient's own home or death within 1 month. Patients who had recently undergone primary unilateral trans-tibial amputation, living in their own homes before the amputation, were included. Fifty-two patients with a median age of 78 years (60-92) were assessed with the Katz Index of ADL. Results revealed that of the 10 (20%) patients discharged to their own homes within 1 month, only 2 belonged to grades A-C, that is, were independent in the majority of functions in personal ADL. Within 6 months 62% were discharged to their own homes. Eighty-four percent of the patients in grades D-G, i.e. most dependent on others, were still at the hospital or dead 1 month post-operatively. All the patients who belonged to grades A-F survived the first month post-operatively. The Katz Index of ADL had predictive value regarding early outcome in terms of length of hospital stay, discharge to the patient's own home or death within 1 month, and positive predictive value regarding survival the first month post-operatively.     

儿童下肢截肢及其功能康复的流行病学与临床特征

目的 分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况。方法 选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性。结果 创伤性截肢占58.82%,主要原因为交通事故(70%);疾病性截肢占41.18%,主要原因为先天性肢体畸形(80.95%)。创伤性截肢后发生残端并发症的可能性较预期更高(P <0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P <0.05)。结论 交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的。先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局。