WestMARC, Queen Elizabeth University Hospital, Glasgow, UK.
WestMARC, Queen Elizabeth University Hospital, Glasgow, UK.
Physiotherapy. 2019 Dec;105(4):476-482. doi: 10.1016/j.physio.2018.11.307. Epub 2018 Dec 7.
To identify different models of care (MOC) post transtibial amputation (TTA) and relate these to achievement of rehabilitation milestones.
Retrospective analysis of rehabilitation milestone data and a survey of MOC in 10 vascular centres.
NHS Scotland vascular centres.
All unilateral TTA between January 2011 and December 2014 (n = 643).
Time (in days) to achieve the following rehabilitation milestones: compression therapy, early walking aid, casting for a prosthetic limb, prosthetic delivery, inpatient discharge and final discharge from rehabilitation. MOC were scored according to seven key aspects of service provision.
The mean age of the cohort was 67 [standard deviation (SD) 13] years, 76% were male and 63% had peripheral arterial disease and diabetes. The median number of days to achieve rehabilitation milestones varied between centres {compression therapy six [interquartile range (IQR) 0-12], early walking aid 14 (IQR 10-27), prosthetic casting 39 (IQR 27-71), prosthetic delivery 53 (IQR 36-87), inpatient discharge 53 (IQR 29-85) and final discharge from rehabilitation 141 (IQR 92-209)}. Only two centres included all seven key aspects of service provision within their MOC. Vascular centres that achieved the optimal MOC achieved the rehabilitation milestones more quickly than other vascular centres.
A positive association was found between optimal MOC and early achievement of rehabilitation milestones post TTA. Key aspects of service provision associated with a quicker time to achieve rehabilitation milestones included: use of a postoperative rigid dressing, specialist physiotherapy input in the early postoperative period, daily inpatient gym sessions and inpatient prosthetic provision. To the authors' knowledge, this is the first study to document MOC following TTA and to relate these to the achievement of rehabilitation milestones.
确定小腿截肢（TTA）后的不同护理模式（MOC），并将这些模式与康复里程碑的实现联系起来。
对康复里程碑数据进行回顾性分析，并对 10 个血管中心的 MOC 进行调查。
苏格兰国民保健署血管中心。
2011 年 1 月至 2014 年 12 月期间所有单侧 TTA（n=643）。
达到以下康复里程碑的时间（以天为单位）：压缩治疗、早期助行器、假肢铸造、假肢交付、住院出院和最终从康复中出院。MOC 根据服务提供的七个关键方面进行评分。
队列的平均年龄为 67 岁[标准差（SD）13]，76%为男性，63%患有外周动脉疾病和糖尿病。各中心达到康复里程碑的中位数天数不同{压缩治疗 6 天[四分位距（IQR）0-12]，早期助行器 14 天（IQR 10-27），假肢铸造 39 天（IQR 27-71），假肢交付 53 天（IQR 36-87），住院出院 53 天（IQR 29-85），从康复中最终出院 141 天（IQR 92-209）}。只有两家中心的 MOC 包含了服务提供的所有七个关键方面。实现最佳 MOC 的血管中心比其他血管中心更快地达到康复里程碑。与更快实现康复里程碑相关的服务提供的关键方面包括：术后使用刚性敷料、术后早期使用专业物理治疗、每日住院健身房课程和住院提供假肢。据作者所知，这是第一项记录 TTA 后 MOC 并将其与康复里程碑的实现联系起来的研究。
