Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes

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• 作者：Kavita Venkataraman ; MBBS ; PhD^a ; Ngan Phoon Fong ; MBBS ; MSc^a ; Kin Ming Chan ; MMed^b ; Boon Yeow Tan ; MMed^c ; Edward Menon ; MMed^d ; Chye Hua Ee ; MMed^e ; Kok Keng Lee ; MBBS^f ; Gerald Choon-Huat Koh ; MBBS ; MMed(FM) ; FCFP ; FAMS ; GDGM ; MGer ; PhD(FM)^a ; ^{Gerald_Koh@nuhs.edu.sg" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Amputation ; Diabetes mellitus ; Outcome assessment (health care) ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：97
• 期：9
• 页码：1473-1480
• 全文大小：222 K

文摘

To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes.

Design

Retrospective medical records review.

Setting

All community hospitals.

Participants

Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation.

Interventions

Not applicable.

Main Outcomes Measures

Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient.

Results

Length of stay (B=.15; 95% confidence interval [CI], .08–.21; P<.001) and admission functional status (B=−.09; 95% CI, −.18 to −.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65–57.78; P<.001; child: OR, 3.82; 95% CI, 1.31–11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07–7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34–13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93–.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97–.99; P<.001), AFG (HR, .99; 95% CI, 0.97–1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24–.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27–4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02–3.23; P=.041), age (HR, 1.02; 95% CI, 1.00–1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16–.87; P=.022) predicted survival postamputation.

Conclusions

Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.