Changes in health-related quality of and functional independence in patients after lower limb amputation and in-patient rehabilitation program

Background: Despite improved health education and advances in medical and surgical technologies the incidence of lower extremity amputation remained relatively stable over the years. These has an immediate bearing on raising direct and indirect costs of the health care system. Thus, the lower extremity amputation population continues to be a major challenge for rehabilitation professionals. The goal of this study was to evaluate the short-term changes in health-related quality of life as well as functional independence in lower extremity amputees undergoing multidisciplinary inpatient rehabilitation. Methods: Sixty four of seventy consecutive lower extremity amputees participated in the study. SF-36 for evaluating of the health-related quality of life and FIM as measure of the functional independence were administered on admission and at discharge from a multidisciplinary inpatient rehabilitation program. Eight subscales and both summary scores were calculated using a norm-based scaling. Summary FIM scores were linear transformed into a 0 - 100 scale. Results: There was improvement in all subscales of SF-36. The changes in bodily pain, both role scales and both summary scores were statistically significant. The functional independence as measured by FIM improved significantly from 69.3 to 78.4 points or 8.5 percentage points on the transformed scale. Discussion: The changes in the physical scales of the SF-36 were comparable but these in the mental scales and in terms of functional independence were lower then reported elsewhere. Both orthogonal and oblique (correlated) factor scores should be used for evaluating of SF-36. Short-term responsiveness of both measurements used in the current study have not been reported conclusively yet. Co-morbidity seems to have a major impact on the results of rehabilitation programs of amputees. Conclusions: This study has demonstrated a positive effect of a multidisciplinary in-patient rehabilitation program on the health-related quality of life and the functional independence of lower extremity amputees. Long-term follow-up data are necessary to evaluate the effectiveness of the rehabilitation. Predictors of rehabilitation success should be identified for optimising of rehabilitative intervention strategies.