Ambulation and independence among Veterans with nontraumatic bilateral lower-limb loss

J Rehabil Res Dev. 2015;52(7):851-8. doi: 10.1682/JRRD.2014.07.0176.

Abstract

In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA-TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower-limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.

Keywords: Functional Independence Measure; activities of daily living; ambulation; amputations; diabetes; functional outcomes; independence; limb loss; transfemoral amputations; transtibial amputations.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / rehabilitation*
  • Amputees / rehabilitation*
  • Artificial Limbs
  • Female
  • Follow-Up Studies
  • Humans
  • Lower Extremity / surgery*
  • Male
  • Middle Aged
  • Mobility Limitation*
  • Recovery of Function*
  • Retrospective Studies
  • United States
  • Veterans*
  • Walking / physiology*