Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations Effect of Postacute Rehabilitation Setting

Sauter CN, Pezzin LE, Dillingham TR: Functional outcomes of persons who underwent dysvascular lower extremity amputations: effect of postacute rehabilitation setting. Am J Phys Med Rehabil 2013;92:287-296. Objective: The aim of this study was to examine the effect of postacute rehabilitation setting on functional outcomes among patients who underwent major dysvascular lower extremity amputations. Design: This is a population-based prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization after amputation and at 6 mos after the acute care discharge were analyzed using multivariate models and instrumental variable techniques. Results: A total of 297 patients were analyzed on the basis of postacute care rehabilitation setting: acute inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home. The majority (43.4%) received care in an IRF; 32%, in an SNF; and 24.6%, at home. On the Short Form-36 subscales, significantly improved outcomes were observed for the patients receiving postacute care at an IRF relative to those cared for at an SNF in physical function, role physical, and physical component summary score. Patients receiving postacute care in IRFs also experienced better role physical and physical component summary score outcomes compared with those discharged directly home. In addition, patients receiving postacute care in an IRF were significantly more likely to score in the top quartile for general health in IRF compared with SNF or home and less likely to score in the lowest quartile for physical function, role physical, and physical component summary score in IRF compared with SNF. Lower activity of daily living impairment was observed in IRF compared with SNF. Conclusions: Among this large and diverse cohort of patients who underwent major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services in an IRF yielded improved functional outcomes 6 mos after amputation relative to care received in SNFs or at home.