Do amputees benefit from comprehensive rehabilitation services?

University Of Pennsylvania, Philadelphia PA

Investigators

Abstract

The project is yielding tools for identifying the patients post trans-tibial and trans-femoral amputation who are most likely to benefit from alternative levels of rehabilitation services. Taking advantage of a series of linkable patient information systems available within the Veterans Health Administration (VHA), multiple sources of data were merged on all amputees discharged from all VHA Medical Centers from 2002 through 2004 (total n=4727). Findings to date provide empirical evidence supporting the benefits of acute postoperative rehabilitation following amputation. After propensity adjustment, the adjusted odds of survival to 1 year were 1.8 times larger (95% Cl=1.4 to 2.3; p<.0001) among those who received any form of rehabilitation in the acute postoperative period. Odds of the more immediate benefit of home discharge were increased 2.4 fold (95% Cl=1.9 to 3.1; p<.0001), and increased even further to 3.1 fold among those who received high compared to low intensity rehabilitation. During the next project period, we propose to add an additional data wave, expand follow-up from 1 to 3 years, add outpatient and home care rehabilitation services, and incorporate Medicare data. This will allow the study of a broader array of rehabilitation care patterns, longer-term health outcomes, and the effects of dual private sector/VHA usage on outcomes and costs. Outcomes will include length of survival, re-hospitalization (any cause), repeat amputation/revision, transition to long term care, morbidity related to immobility, and total health care costs. Methods will involve a quasi-experimental design using multi-variable risk factor analyses and propensity score matching. The study is establishing evidence-based instruments for prognostication, and case-mix-adjusted quality indicators appropriate to a continuum of rehabilitation services. Findings will continue to provide evidence for the relative benefits of various patterns of rehabilitation, including dual Medicare-VHA use. The result could be new knowledge about how clinical demand factors drive clinician decision making within contexts of the availability and organization of health services, providing the groundwork for enhancing the integration, quality, and outcomes of rehabilitation services for this population.