Hordacre Brenton, Birks Vicki, Quinn Stephen, Barr Christopher, Patritti Benjamin L, Crotty Maria
Flinders University, Faculty of Health Sciences, Adelaide, South Australia.
Physiother Res Int. 2013 Jun;18(2):70-80. doi: 10.1002/pri.1529. Epub 2012 Jun 6.
Individuals with amputations are a core group in Australian rehabilitation units that have a long index length of stay. The Repatriation General Hospital (RGH) offers general rehabilitation services to the population of Southern Adelaide (a population of 350,000) and includes an on-site prosthetic manufacturing facility. Using a physiotherapy database at the RGH, we sought to answer the following questions: What are the demographic and clinical characteristics of patients admitted for lower limb prosthetic rehabilitation over 15 years? What are the times to rehabilitation outcomes? How have these changed over 15 years with changes in service delivery?
This paper is a retrospective observational study using a physiotherapy clinical database (1996-2010) of 531 consecutive individuals with lower limb amputation at one South Australian hospital (RGH). There were two changes in service delivery: 1) a multidisciplinary interim prosthetic programme (IPP) introduced in 1998 and 2) removable rigid dressings (RRDs) introduced in 2000. Outcome measures were patient demographics, clinical characteristics and time to rehabilitation outcome markers.
Mean age was 68 years (standard deviation [SD]: 15), with 69% male, 80% dysvascular and 68% transtibial. The overall median inpatient rehabilitation length of stay (RLOS) was 39 days (interquartile range [IQR]: 26-57). Individuals with amputation entering rehabilitation each year had a higher number of co-morbidities (β: 0.08; 95% confidence interval: 0.05-0.11). Introduction of the IPP was associated with a significant reduction in time to initial prosthetic casting, independent walking and inpatient RLOS. Introduction of RRDs was associated with a significant reduction in time to wound healing, initial prosthetic casting and independent walking.
Individuals with amputation were typically elderly dysvascular men with transtibial amputations. Introduction of the IPP and RRDs successfully reduced time to rehabilitation outcomes including independent walking, an outcome that is rarely reported but is of significance to patients and physiotherapists.
截肢患者是澳大利亚康复机构中的核心群体，住院时间较长。遣返总医院（RGH）为阿德莱德南部地区（人口35万）的居民提供综合康复服务，其中包括一个现场假肢制造设施。利用RGH的物理治疗数据库，我们试图回答以下问题：15年间接受下肢假肢康复治疗的患者的人口统计学和临床特征是什么？康复结果所需时间是多少？随着服务提供方式的改变，这些情况在15年间发生了怎样的变化？
本文是一项回顾性观察研究，使用了南澳大利亚一家医院（RGH）物理治疗临床数据库（1996 - 2010年）中531例连续的下肢截肢患者的数据。服务提供方式有两项改变：1）1998年引入多学科临时假肢项目（IPP）；2）2000年引入可移除刚性敷料（RRD）。结果指标包括患者人口统计学、临床特征以及康复结果指标所需时间。
平均年龄为68岁（标准差[SD]：15），男性占69%，血管性疾病导致截肢的占80%，经胫骨截肢的占68%。总体住院康复中位时长（RLOS）为39天（四分位间距[IQR]：26 - 57）。每年进入康复治疗的截肢患者共病数量更多（β：0.08；95%置信区间：0.05 - 0.11）。IPP的引入与初次假肢石膏固定时间、独立行走时间以及住院RLOS的显著缩短相关。RRD的引入与伤口愈合时间、初次假肢石膏固定时间和独立行走时间的显著缩短相关。
截肢患者通常是患有血管性疾病的老年男性，经胫骨截肢。IPP和RRD的引入成功缩短了包括独立行走在内的康复结果所需时间，独立行走这一结果虽很少被报道，但对患者和物理治疗师具有重要意义。
