Losing a Limb, Regaining Independence: A Systematic Review of Occupational Therapy Interventions for Lower Extremity Amputations

Primary Focus: Rehab, Disability & Participation Learning Objectives: Describe lower extremity residual limb care interventions within the scope of occupational therapy Explain the prevalence of individuals who sustain a lower extremity amputation and understand the impact on the U.S. health-care system Identify lower extremity residual limb care interventions to maximize occupational performance Abstract: The purpose of this presentation is to report findings of a systematic review regarding residual limb care interventions supporting increased occupational performance in adults post lower extremity amputation. A systematic review was completed utilizing PubMed, CINHAL, and OTseeker. Inclusion criteria included articles with a sample of adults (mean age of 18-64 years old) with all levels of lower extremity amputations resulting from various etiologies. In addition, these articles were published within the past 10 years and in the English language. Exclusion criteria included articles that contained interventions outside of the scope of occupational therapy practice, systematic reviews, and meta-analyses. Two million people in the U.S. are currently living with limb loss. Hospital costs associated with amputees in 2009 totaled 8.3 billion dollars. Approximately half of individuals with amputations due to vascular disease will require an additional amputation within 2-3 years (Amputee Coalition, 2016). Although there is evidence on surgical techniques and physical therapy’s role in rehabilitation of lower extremity amputations, there is limited evidence to support occupational therapy’s unique role (Robinson, Sansam, Hirst, & Neumann, 2010). However, occupational therapists can provide valuable interventions to improve participation in all activities of daily living (Klarich & Brueckner, 2014). Critical appraisals of eligible articles were performed to identify themes and clinical implications utilizing quantitative and qualitative critical review forms. Four themes concluded from the literature associated with residual limb care interventions and their impact on occupational performance included education, health-care costs, pain, and skin integrity. These findings present implications for occupational therapy research, education, and practice in regards to advocating for occupational therapy’s role in the continuum of care for individuals with lower extremity amputation, and the implementation of interventions to increase occupational performance and decrease health-care costs. This presentation material is of intermediate level and targeted for an audience of occupational therapists and occupational therapy assistants with experience working with individuals with lower limb amputations. References: Amputee Coalition. (2016). Limb loss statistics. Retrieved from http://www.amputee-coalition/limb-loss-resource-center/resources-by-topic/limb-loss-statistics/limb-loss-statistics/ Robinson, V., Sansam, K., Hirst, L., & Neumann, V. (2010). Major lower limb amputation -- what, why and how to achieve the best results. Orthopaedics & Trauma, 24(4), 276-285 10p. doi:10.1016/j.mporth.2010.03.017 Klarich, J., & Brueckner, I. (2014). Amputee rehabilitation and preprosthetic care. Physical Medicine and Rehabilitation Clinics of North America, 25(1), 75-91. doi:10.1016/j.pmr.2013.09.005 Presentation: 31:5

Parents\u27 Goals: An Analysis of Therapist Reasoning

Purpose: Illustrate the use of DDDM to develop parent-identified goals for occupational therapy and to identify underlying sensory integration factors hypothesized to be impacting participation

An Interprofessional, Tailored Behavioral Intervention for Sleep Problems in Autism: Use of Sensory Data to Inform Intervention

Purpose: The purpose of this poster is to demonstrate how Sensory Profile data informed occupational therapy sleep interventions for two participants as part of an Interprofessional Tailored Behavioral Intervention study

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially