RESUMO
BACKGROUND: Prosthesis rehabilitation after dysvascular transtibial amputation (TTA) is focused on optimizing functional capacity with limited emphasis on promoting health self-efficacy. Self-efficacy interventions decrease disability for people living with chronic disease, but the influence of self-efficacy on disability is unknown for people with dysvascular TTA. OBJECTIVES: To identify if self-efficacy mediates the relationship between self-reported functional capacity and disability after dysvascular TTA. DESIGN: Cross-sectional, secondary data analysis. SETTING: Outpatient rehabilitation facilities. PARTICIPANTS: Thirty-eight men (63.6 ± 9.1 years old) with dysvascular TTA. METHODS: Participants had been living with an amputation for less than 6 months and using walking as their primary form of locomotion using a prosthesis. The independent variable, functional capacity, was measured using the Prosthesis Evaluation Questionnaire-Mobility Scale (PEQ-MS). The proposed mediator, self-efficacy, was measured with the Self-Efficacy of Managing Chronic Disease questionnaire (SEMCD). MAIN OUTCOME MEASURE: Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. RESULTS: The relationship between self-reported functional capacity and disability is partially mediated by self-efficacy. Relationships between WHODAS 2.0 and PEQ-MS (r = -0.61), WHODAS 2.0 and SEMCD (r = -0.51), and PEQ-MS and SEMCD (r = 0.44) were significant (P < .01). Controlling for SEMCD (P = .04), the relationship between PEQ-MS and WHODAS 2.0 remained significant (P < .01). Statistically significant mediation was determined by a bootstrap method for the product of coefficients (95% confidence interval: -2.23, -7.39). CONCLUSIONS: This study provides initial evidence that the relationship between self-reported functional capacity and disability is partially mediated by self-efficacy after dysvascular TTA. The longitudinal effect of self-efficacy should be further examined to identify causal pathways of disability after dysvascular amputation. Furthermore, additional factors contributing to the relationship between self-reported functional capacity and disability need to be identified. LEVEL OF EVIDENCE: III.
Assuntos
Amputação Cirúrgica/reabilitação , Amputados/reabilitação , Avaliação da Deficiência , Autoeficácia , Tíbia/cirurgia , Idoso , Assistência Ambulatorial/métodos , Amputação Cirúrgica/métodos , Membros Artificiais/estatística & dados numéricos , Intervalos de Confiança , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Percepção , Autoavaliação (Psicologia)RESUMO
OBJECTIVES: To report the incidence of symptomatic heterotopic ossification (HO) in a defined civilian amputee population, describe its characteristics, and compare these findings to published data in military amputees. DESIGN: Retrospective chart analysis from July 1998 to July 2009. SETTING: Ambulatory amputee clinic within a large university medical center. PARTICIPANTS: Adults with lower limb amputation (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patients with symptomatic HO confirmed by radiographs. RESULTS: A total of 261 patients were evaluated; 158 met inclusion criteria, with 59% having traumatic etiology, 18% vascular etiology, 22% infection, and 1% tumor. Symptomatic HO was diagnosed in 36 (22.8%) patients, and 94% patients had mild HO on radiographic scoring. Rate of HO in amputations related to trauma was not increased compared with those of other etiologies. Surgical resection of the ectopic bone was required in 4 (11%) patients. CONCLUSIONS: HO is seen commonly after civilian lower limb amputation regardless of etiology. The prevalence was less than that observed in previous reports from military populations. This is the first report estimating the prevalence of HO in adult civilian amputees.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Amputação Traumática/epidemiologia , Militares/estatística & dados numéricos , Ossificação Heterotópica/epidemiologia , Amputação Cirúrgica/efeitos adversos , Amputação Traumática/complicações , Membros Artificiais/efeitos adversos , Membros Artificiais/estatística & dados numéricos , Causalidade , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/cirurgia , Pennsylvania , Prevalência , Radiografia , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. METHODS: A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. RESULTS: Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. CONCLUSION: The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.
Assuntos
Amputados/reabilitação , Membros Artificiais/estatística & dados numéricos , Extremidade Inferior , Doença Arterial Periférica/reabilitação , Fatores Etários , Idoso , Amputados/estatística & dados numéricos , Comorbidade , Estudos Transversais , Complicações do Diabetes/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/mortalidade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores Sexuais , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to transfer three simplified alignment techniques to prosthetic technicians in a developing country through training materials and a hands-on training workshop, and to subsequently evaluate the efficacy of the alignment systems in producing acceptably aligned monolimb prostheses. METHOD: Prosthetists utilized the anatomically-based-alignment (ABA)-standing, ABA-supine and vertical alignment axis (VAA) alignment systems to produce three monolimbs for each of 30 healthy and active transtibial amputees. Prosthetists assessed all three monolimbs for each subject in both static and gait conditions to determine which monolimb had the best alignment and produced the best functional gait. Subjects also selected the monolimb which they believed had the best alignment; subjects utilized each monolimb for a 1-month home assessment. RESULTS: Twenty-eight subjects completed the study. Eighty-four monolimbs were evaluated by the prosthetists and the subjects. A few monolimbs had minor socket fitting and alignment issues, but none prevented evaluation in the laboratory or during the 1-month home assessment. Only three monolimbs had poor alignment and could not be worn by the subjects. CONCLUSIONS: All three systems captured acceptable alignments, although the two systems that incorporate weight bearing, the ABA-standing and VAA alignment systems, produced slightly better outcomes. The alignment ratings between these two systems were statistically insignificant.