Prosthesis Use and Satisfaction Among Persons With Dysvascular Lower Limb Amputations Across Postacute Care Discharge Settings

Objective: To test the hypotheses that patients undergoing major lower limb amputations who received postacute care at an inpatient rehabilitation facility (IRF) would experience higher prosthesis use and satisfaction and lower prosthesis-related adverse effects than those treated at a skilled nursing facility (SNF) or at home. Design: Population-based, observational, prospective, multicenter study. Setting: Hospitals and communities in 2 racially and geographically diverse states. Participants: Patients 21 years and older who were identified during the surgical acute care stay as undergoing major lower limb amputations. Main Outcome Measures: Prosthesis use; satisfaction with prosthesis' comfort, appearance, and gait; and the presence of skin irritation, pain, and wounds as a result of prosthesis use. Methods: Two-stage instrumental variable models applied to data collected from medical records and patient interviews. Results: Only 149 (50.2%) of the 297 study participants had a prosthesis at the 6-month follow-up. Regression-adjusted outcomes indicate that patients treated at IRFs used their prosthesis more hours per week (52.8 versus 36.2 h/wk or 46% higher use), were less likely to experience prosthesis-related pain (16% versus 33.7%) and were significantly more likely to be satisfied with their gait (76.1% versus 59.3%) than were patients treated at SNFs. No significant differences in outcomes were found between patients who received care at an IRF and patients who were discharged home. Conclusions: These results add to the growing body of literature suggesting a general pattern of better outcomes for persons with vascular-related amputations who receive postacute care at IRFs relative to SNFs.