Rehabilitation and the long-term outcomes of persons with trauma-related amputations

Objective: To examine the long-term outcomes of persons undergoing trauma-r elated amputations, and to explore factors affecting their physical, social , and mental health and the role of inpatient rehabilitation in improving s uch outcomes. Design: Abstracted medical records and interview data sought for a retrospe ctive cohort of persons who had undergone a lower-limb trauma-related amput ation. Participants: Patients identified with a principal or secondary diagnosis o f a trauma-related amputation to the lower extremity at the University of M aryland Shock Trauma Center between 1984 and 1994. Patients with spinal cor d injury or traumatic brain injury were excluded. Results: Of 146 patients who had trauma-related amputations to the lower li mb at the University of Maryland Shock Trauma Center during the study perio d, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly th ree quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than tha t of the general US population for all SF-36 scores. The differences in pro files were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to p hysical health, and bodily pain. About one fourth of persons with a trauma- related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabil itation nights significantly improved the ability of patients with amputati on to function in their physical roles, increased vitality, and reduced bod ily pain. Inpatient rehabilitation was also significantly correlated with i mproved vocational outcomes, Conclusions: These findings suggest a substantial effect of inpatient rehab ilitation in improving long-term outcomes of persons with trauma-related am putations.