Article

OBJECTIVE: To identify factors associated with functional gain, discharge
destination, and long-term survival after inpatient rehabilitation in patients
with lower extremity amputation and diabetes. DESIGN: Retrospective medical
records review. SETTING:
All community hospitals. PARTICIPANTS: Patients with
diabetes (N=256) admitted for inpatient rehabilitation after lower extremity
amputation. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Absolute
functional gain (AFG) using the Shah-modified Barthel Index, discharge
destination, and long-term survival for each patient. RESULTS: Length of stay
(B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional
status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with
AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39;
95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse:
OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1
(OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs >/=4), and younger age (OR, .96; 95% CI,
.93-.99; P=.02) were significantly associated with being discharged home.
Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001),
AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs >/=4:
HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI,
1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI,
1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity
(Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival
postamputation. CONCLUSIONS: Admission functional status predicted both
functional gain during rehabilitation and survival in 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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
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