Rehabilitation and the Long-Term Outcomes of Persons With Trauma-Related Amputations.

Pezzin LE, Dillingham TR, MacKenzie EJ (Departments of Emergency Medicine and Physical Medicine and Rehabilitation and the Center for Injury Research and Policy, Johns Hopkins University, Baltimore, Md), Arch Phys Med Rehabil. 2000;81:292-300.

The purpose of this retrospective cohort study was to examine the long-term physical, social, and mental health outcomes of persons who have sustained a trauma-related amputation. The researchers reviewed the medical records of 146 patients who were initially hospitalized at the University of Maryland Shock Trauma Center between 1984 and 1994 with a primary or secondary diagnosis of a trauma-related amputation.

Seventy-eight of the potential 146 subjects were interviewed by telephone, and the interviewers gathered information on the patients' general health (including activities and limitations), presence of major comorbidities and symptoms (including problems with residual and contralateral limbs), use of prosthetic devices, and health services utilization. The telephone survey items were designed to conform to standardized concepts and measures from the 36-item Short-Form Health Survey (SF-36). The scales from the SF-36 that were used to measure the health of the patient with an amputation included physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health.

The study found that, overall, about 38% of patients who underwent a lower limb traumatic amputation were discharged to inpatient rehabilitation. Those patients with a transfemoral amputation were most likely to be discharged to rehabilitation services. The results indicated that only 58% of the patients had paying jobs during the year after amputation, whereas 97.4% had worked prior to amputation. Of those patients who worked after amputation, there was a substantial change in the type of work they were doing. The physical demands of the job had decreased an average of 30% relative to the demands of prior work. The study found that inpatient rehabilitation was more likely to be used by patients who were older at the time of injury, had a premorbid illness, were not white, and had spent more days in the intensive care unit. Level of amputation and insurance status were not factors in the likelihood of being discharged to inpatient rehabilitation after acute care.

According to the study, people who were white had better long-term outcomes, a greater chance of returning to work, and less chance of reduced work hours. Although age was not found to be a factor in the SF-36 outcomes, older patients were less likely to return to work and more likely to have reduced work hours. According to the authors, analysis of the results showed that people with trauma-related amputations who received inpatient rehabilitation had significantly improved health and vocational prospects. They said that higher amounts of inpatient rehabilitation increased patients' physical functioning and vitality and reduced their bodily pain. Inpatient rehabilitation had a positive association with a return to work and a lower likelihood of reduced hours of work. The authors concluded that prospective studies are needed to confirm the findings of this study.