A DEPICTION OF REHABILITATION PATIENTS 65 YEARS AND YOUNGER WITH DYSVASCULAR LOWER EXTREMITY AMPUTATION
Authors: Mayo Amanda Lee , Hitzig Sander , Cimino Stephanie 
Published: February 2019

BACKGROUND: The majority of lower limb amputations (LLA) in Canada are dysvascular due to complications of diabetes and/or vascular disease. Traditionally dysvascular amputations have occurred in the elderly. With younger onset of adult diabetes, amputations are now occurring in non-geriatric populations. An understanding of younger patients with dysvascular LLA is needed to determine their risk factors, and unique health and psychosocial challenges.

OBJECTIVES: To obtain a depiction of the key demographic and impairment characteristics of adults 65 years and younger with dysvascular LLA undergoing inpatient rehabilitation.

METHODOLOGY: A retrospective chart review was completed on inpatient adult amputation rehabilitation patients over a five year period. Data extracted included socio-demographics, Functional Independence Measure (FIM) scores, co-morbidities, and discharge outcomes.

FINDINGS: One hundred and forty-three patients who were 65 years and younger were included, which represented almost a quarter of all admissions. Most patients were male (79%) with an average age of 55 years old (SD=8). The majority (72%) were unemployed. The mean number of co-morbidities was 5.2 (SD=8.2). Individuals discharged home (n=122) had higher (p<0.05) FIM scores than those readmitted to acute care or discharged to long-term care (n=20).

CONCLUSIONS: Similar to the literature on older dysvascular LLA patients, our study found high rates of disability and co-morbidities in younger patients with dysvascular LLA, which might impact their ability to work. Given these challenges, better amputation prevention strategies and targeted rehabilitation programming for this population are needed.

LAYMAN’S ABSTRACT:

The rates of people with diabetes and peripheral vascular disease are increasing, which might be leading to a higher rate of adults losing their lower limbs earlier than typically seen (65 years and younger). As a result, we need to better understand if the health and physical function outcomes of this younger group are similar to geriatric populations (over 65 years old). This study used electronic chart data collected on 143 patients with lower limb loss from complications of diabetes and/or vascular disease who received care at a rehabilitation hospital over a five-year period. The average age of the group was 55 years old, with the youngest being 21 years old. The majority of the patients were men and 72% were unemployed at hospital admission. Those who had higher functional abilities were more likely to return to home whereas those with lower functional abilities (20 patients)  went to another hospital or a long-term care setting. Overall, our study showed that patients who were 65 years and younger were showing similar types and rates of co-morbidities (e.g. heart disease, pressure ulcers, etc.) typically seen in older patients with lower limb loss. However, younger patients might need higher levels of support to help them resume key social roles, such as employment.

Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/31950/24770

How to Cite: Mayo A.L, Cimino S.R, Hitzig S.L. A depiction of rehabilitation patients 65 years and younger with dysvascular lower extremity amputation. Canadian Prosthetics & Orthotics Journal. 2019; Volume2, Issue1, No.1. https://doi.org/10.33137/cpoj.v2i1.31950

CORRESPONDING AUTHORDr. Amanda L. Mayo, MD, MHSc, FRCPC1) Physiatrist: St. John’s Rehab, 285 Cummer Avenue, Toronto, ON, Canada M2M 2G1 2) Assistant Professor, Faculty of Medicine, University of Toronto, Toronto, Canada.Email: amanda.mayo@sunnybrook.ca