Rehabilitation outcomes after inpatient rehabilitation for lower extremity amputations in patients with diabetes

Publication date: Available online 11 May 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Kavita Venkataraman, Ngan Phoon Fong, Kin Ming Chan, Boon Yeow Tan, Edward Menon, Chye Hua Ee, Kok Keng Lee, Gerald Choon-Huat Koh
ObjectiveTo identify factors associated with functional gain, discharge destination and long-term survival following inpatient rehabilitation in patients with lower extremity amputation and diabetes.DesignRetrospective medical records reviewSettingAll community hospitals in Singapore (n=4) between 1996 and 2005Participants256 patients with diabetes, admitted for inpatient rehabilitation following lower extremity amputation.InterventionsNoneMain outcomes measuresAbsolute functional gain (AFG) using Shah-modified Barthel Index, discharge destination and long-term survival for each patientResultsLength of stay (B=0.15, 95%confidence interval (CI):0.08–0.21, p<0.001) and admission functional status (B=-0.09, 95%CI:-0.18─-0.01, p=0.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker odds ratio (OR)=16.39, 95%CI:4.65-57.78, p<0.001; child OR=3.82, 95%CI:1.31-11.12, p=0.014; spouse OR=2.82; 95%CI:1.07-7.46, p=0.037 versus none), Charlson Comorbidity Index score of 1(OR=4.32; 95%CI:1.34-13.93, p=0.014 versus 4 or more), and younger age (OR for age=0.96; 95%CI:0.93-0.99, p=0.02) were significantly associated with being discharged home. Admission functional status(hazard ratio (HR)=0.98; 95%CI:0.97-0.99, p<0.001), AFG(0.99; 95%CI:0.97-1.00, p=0.058), Charlson Comorbidity Index score(1 versus 4 or more, HR=0.42; 95%CI:0.24-0.77, p=0.004, ischaemic heart disease (HR=2.25; 95%CI:1.27-4.0, p=0.006), discharge destination (other versus home, HR=1.82; 95%CI:1.02-3.23, p=0.041) age (HR=1.02; 95%CI:1.00-1.03, p=0.082) and ethnicity (Malay versus Chinese HR=0.37; 95%CI:0.16-0.87, p=0.022) predicted survival post-amputation.ConclusionsAdmission functional status predicted both functional gain during rehabilitation as well as survival among 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.



from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/21VTNnt
via IFTTT