Study Suggests Better Outcomes for Veteran Amputees Receiving Specialized Rehabilitation Compared to Consultative Services
It is generally believed that rehabilitation, by enhancing functional recovery, can improve quality of life and reduce the economic burden associated with major limb loss. Yet, there is ongoing concern that healthcare professionals have little evidence of the value of many treatment alternatives, including rehabilitation. Consequently, the current Federal Administration strongly endorses comparative effectiveness research as a way to address how patients with a particular medical condition react to alternative approaches to care. This observational study compared the recovery of mobility and self-care functions among Veteran amputees according to the timing and type of rehabilitation services they received. Using VA data from inpatient specialized rehabilitation units (SRUs) and consultative services within 95 VAMCs, investigators identified 1,502 Veteran amputees, with a new lower extremity amputation, who received early or late consultative or specialized rehabilitation during FY03 and FY04. In specialized rehabilitation, patients are discharged from medical or surgical services and transferred to SRUs for inpatient rehabilitation. Consultative rehabilitation services involve Physical Medicine and Rehabilitation professionals seeing patients while they remain on other acute hospital services, and medical and surgical care remain the primary focus.
Results show that Veterans who receive specialized rehabilitation can be expected to make comparatively higher gains than Veterans who receive consultative services, regardless of timing and clinical complexity. Of the 1,502 Veterans in this study, 79.1% received consultative services, while 20.9% were admitted to a SRU for specialized rehabilitation. Patients who received specialized compared to consultative services were younger, and were more likely to be living at home before hospitalization. Advanced age, trans-femoral amputation, paralysis, serious nutritional compromise, and psychosis were associated with lower gains in physical function. Most Veterans (89.1%) received early rehabilitation occurring directly after surgery vs. late rehabilitation beginning during a separate hospitalization after discharge from the index surgical stay. Authors suggest that clinicians consider adjusting prognostic expectations to both clinical severity and the type of rehabilitation patients receive.
Stineman M, Kwong P, Xie D, Kurichi J, Cowper Ripley D, et al. Prognostic differences for functional recovery after major lower limb amputation: Effects of the timing and type of inpatient rehabilitation services. PM&R April 2010;2(4):232-43.
Dr. Cowper Ripley is Co-Director of HSR&D/RR&D’s Rehabilitation Outcomes Research Center for Veterans with Neurological Impairment, Gainesville, FL.