Lower-limb amputee rehabilitation in Australia: analysis of a national data set 2004-10
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Objective: Examine demographics, clinical characteristics and rehabilitation outcomes of lower-limb amputees using the Australasian Rehabilitation Outcomes Centre (AROC) database. Methods: Lower-limb amputee rehabilitation episodes completed between 2004 and 2010 were identified from the AROC database using AROC impairment codes 5.3-5.7.1 Analysis was conducted by year, impairment code, Australian National Sub-acute and Non-Acute Patient (AN-SNAP) classification (S2-224, FIMTM motor score 72-91; S2-225, FIMTM motor score 14-71) and States of Australia. Results: Mean length of stay (LOS) for all lower-limb amputee episodes was 36.1 days (95%CI: 35.4-36.9). Majority of episodes were unilateral below knee (63.6%), males (71.8%) with a mean age of 67.9 years (95% CI: 67.6-68.3). Year-on-year analysis revealed that LOS was not decreasing. Analysis by impairment code demonstrated no significant difference in rehabilitation outcomes. Analysis by AN-SNAP found that LOS was 16.2 days longer for S2-225 than S2-224 (95% CI: 14.7-17.8, p<0.001), whilst FIMTM (mot) change was 12.0 points higher for S2-225 than S2-224 (95% CI: 11.5-12.6, p<0.001). Analysis by states revealed significant variation in LOS, FIMTM (Mot) change and FIMTM (Mot) efficiency which were associated with variations in organisation of rehabilitation services across States. Conclusion: Whilst amputees represented a comparatively small proportion of all rehabilitation episodes in Australia, their LOS was significant. Unlike many other rehabilitation conditions, there was no evidence of decreasing LOS over time. AN-SNAP classes were effective in distinguishing rehabilitation outcomes, and could potentially be used more effectively in planning rehabilitation programs. Key words: Amputees, Functional Independence Measure, FIM Motor, Rehabilitation, Rehabilitation Centres, Rehabilitation Outcome, AN-SNAP class.
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