Perceived independence and limitations in rising and sitting down after rehabilitation for a lower-limb amputation

Objective: To study perceived independence in rising and perceived limitations in rising and sitting down in persons after a lower-limb amputation and the relationship of these perceptions with personal and clinical characteristics. Design: Cross-sectional study. Subjects/patients: Persons with a lower-limb amputation wearing a prosthesis (n=172). Methods: Perceived independence in rising was assessed with the Locomotor Capabilities Index. Limitations in rising and sitting down were assessed with the Questionnaire Rising and Sitting down. Multivariate logistic and linear regression analyses, respectively, were used to investigate the associations between independence and limitations in rising and sitting down, and personal and clinical characteristics. Results: Of the participants, 91% and 47% perceived independence in rising from a chair and rising from the floor, respectively. Older participants and women perceived less independence in rising. Participants perceived marked limitations in rising and sitting down, with those rehabilitated in a nursing home perceiving more limitations. Conclusion: After a lower-limb amputation, most persons wearing a prosthesis are able to rise independently from a chair, but many perceive decreased independence in other forms of rising, especially older participants and women. Participants, especially those rehabilitated in a nursing home, perceive considerable limitations in rising and sitting down. However, in those patients rehabilitated in a nursing home these limitations may be due to indication bias

Prevalence of comorbidity and its association with demographic and clinical characteristics in persons wearing a prosthesis after a lower-limb amputation

Objective: To describe the prevalence of comorbidity and its relationship with demographic and clinical characteristics in persons wearing a prosthesis after lower-limb amputation. Design: Cross-sectional study. Subjects/patients: Persons wearing a prosthesis after lower-limb amputation (n = 171; mean age 65 years (standard deviation 12); 72% men) at the end of outpatient rehabilitation treatment. Methods: Comorbidity was assessed with the Functional Comorbidity Index: a list of 18 items addressing the presence of specific comorbid conditions impacting on functional status. Comorbidities in medical records were assessed independently by 2 assessors. Associations with demographic and clinical characteristics were analysed using linear or logistic regression. Results: The median (interquartile range) number of comorbidities was 3 (2; 4). Three or more comorbidities were present in 103 of 171 (60%) participants. Diabetes was present in 71 (41%), cardiac disease in 60 (35%), and lumbago/degenerative disc disease in 39 (23%) participants. The prevalence of comorbidities was higher in women and those with vascular cause of amputation. Conclusion: There is a high prevalence of comorbidity at the end of outpatient rehabilitation treatment in persons wearing a prosthesis after a lower-limb amputation, especially in women and those with vascular cause of amputation

Prosthetic fitting in a patient with a transtibial amputation due to a congenital vascular malformation of the right leg

Background: The problems of prescribing a prosthesis for a young girl with severe congenital vascular malformation deformity leading to a transtibial amputation. Case description and methods: Due to the high risk of recurrent bleeding and limitations regarding full weight bearing of the stump, a normal socket fitting process was not possible. Using a multidisciplinary approach, a prosthesis was designed to enable full weight bearing in a flexed knee position with ischial tuberosity support to prevent full weight bearing on the tibial part of the stump. Findings and outcomes: After training and adjustments to the design, a definitive prosthesis with a free motion mechanical knee joint could be used. During the training with this prosthesis, no skin problems were observed, and at the end of the rehabilitation, the patient had a high level of activities of daily living and sports. Conclusion: The above prosthetic solution with an adjusted socket design proved to be successful in this case. Clinical relevance In a patient with severe congenital vascular malformation deformity leading to a transtibial amputation, fitting of a good prosthesis without full weight bearing of the stump proved to be successful

REHABILITATION IN SKILLED NURSING CENTRES FOR ELDERLY PEOPLE WITH LOWER LIMB AMPUTATIONS:A MIXED-METHODS, DESCRIPTIVE STUDY

<p>Objectives: To describe the current set-up, barriers and potential for providing rehabilitation to people with lower limb amputation in skilled nursing centres.</p><p>Design: Survey and interviews.</p><p>Subjects/participants: Elderly care physicians, physiotherapists.</p><p>Methods: In 2011, clinicians from 34 skilled nursing centres participated in a semi-structured interview covering rehabilitation and daily care, personal skills and training, team work and communication, and discharge processes.</p><p>Results: Each centre sees only a small proportion of people with amputation (a maximum of 3.6% of all admissions). This limited number of patients appears to be the main barrier in providing care, as it is difficult for clinicians to maintain knowledge, and resources are spread widely. Two main areas of improvement were suggested by participants: (i) use of guidelines in care; and (ii) collaboration with specialized team members.</p><p>Conclusion: The spread of patients across many centres makes it difficult for professionals working in skilled nursing centres to obtain the necessary skills and knowledge for care of people with amputation. A designated skilled nursing centre for amputation rehabilitation is presented as a solution, but smaller clinical changes are also suggested, including improvements in communication and training.</p>

Climbing Stairs After Outpatient Rehabilitation for a Lower-Limb Amputation

<p>Objective: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables.</p><p>Design: Cross-sectional study.</p><p>Setting: Outpatient department of a rehabilitation center.</p><p>Participants: Persons with an LLA (N=155; mean age +/- SD, 64.1 +/- 11.2y; 73% men).</p><p>Interventions: Not applicable.</p><p>Main Outcome Measures: The necessity to climb stairs was assessed with the Prosthetic Profile of the Amputee. Several indicators of the ability to climb stairs were assessed including: (1) independence in climbing stairs with a handrail and (2) without a handrail, according to the Locomotor Capabilities Index; (3) numbers of floors actually climbed, according to a rating scale; and (4) limitations in climbing stairs, according to the Climbing Stairs Questionnaire (range, 0-100, with higher scores indicating less limitations). Multivariate logistic regression analysis was used to investigate the associations between the ability to climb stairs and personal and clinical variables.</p><p>Results: Of the participants, 47% had to climb stairs. The ability to climb stairs was: (1) 62% independently climbed stairs with a handrail and (2) 21% without a handrail; (3) 32% didn't climb any stairs, 34% climbed half a floor or 1 floor, and 34% climbed >= 2 floors; (4) the median sum score (interquartile range) of the Climbing Stairs Questionnaire was 38 (19-63), indicating marked limitations. Older participants and women were less able to climb stairs with and without a handrail.</p><p>Conclusions: A considerable number of persons with an LLA have to climb stairs in their home environment. Many of them, especially older participants and women, are particularly hampered in their ability to climb stairs. Archives of Physical Medicine and Rehabilitation 2013;94:1573-9 (C) 2013 by the American Congress of Rehabilitation Medicine</p>

Lower limb amputation in Northern Netherlands: Unchanged incidence from 1991-1992 to 2003-2004

Background: Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Design: Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003-2004, in the three Northern provinces of the Netherlands. Objectives: To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003-2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992. Methods: Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts. Results: Incidence of amputation was 8.8 (all age groups) and 23.6 (>= 45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes. Conclusions: Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics