Comorbidity and Non-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation

M G Marquez; M Kowgier; W S Journeay

doi:10.33137/cpoj.v3i1.33916

Comorbidity and Non-prosthetic Inpatient Rehabilitation Outcomes After Dysvascular Lower Extremity Amputation

Can Prosthet Orthot J. 2020 May 16;3(1):33916. doi: 10.33137/cpoj.v3i1.33916. eCollection 2020.

Authors

M G Marquez¹, M Kowgier², W S Journeay^{3

4}

Affiliations

¹ Department of Anatomy and Cell Biology, McGill University, Montreal, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
³ Providence Healthcare - Unity Health Toronto, Toronto, ON, Canada.
⁴ Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada.

Abstract

Background: Dysvascular amputations arising from peripheral vascular disease and/or diabetes are common. Patients who undergo amputation often have additional comorbidities that may impact their recovery after surgery. Many individuals undergo post-operative inpatient rehabilitation to improve their non-prosthetic functional independence. Thus far, our characterization of comorbidity in this population and how it is associated with non-prosthetic inpatient functional recovery remains relatively unexplored.

Objective: The objective of this study was to describe comorbidities, using the Charlson Comorbidity Index (CCI), and to examine associations between comorbidity and functional outcomes in a cohort of patients with dysvascular limb loss undergoing non-prosthetic inpatient rehabilitation.

Methodology: A retrospective cohort design was used to analyze a group of 143 patients with unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation. Age, sex, amputation level, amputation side, length of stay (LOS), time since surgery, Functional Independence Measure (FIM) scores (Total and Motor at admission and discharge), and CCI scores were collected.

Findings: The data showed that neither total or specific comorbidities were associated with functional outcomes or LOS in this cohort and rehabilitation model. Multivariate analysis demonstrated an inverse relationship with age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission and discharge. Comorbidities were not associated with functional outcomes. Dementia was negatively associated with FIM scores, however this requires more study given the low number of patients with dementia in this cohort.

Conclusion: These data suggest that regardless of burden of comorbidity or specific comorbidities that patients with dysvascular limb loss may derive similar functional benefit from post-operative non-prosthetic inpatient rehabilitation.

Keywords: Amputation; Amputee; Charlson Comorbidity Index; Comorbidity; Diabetes; Dysvascular; Functional Independence Measure; Inpatient Rehabilitation; Limb Loss; Rehabilitation.