Mid- to long-term factors influencing functional status of people affected by lower-limb amputation associated with hemiparesis due to stroke

Abstract

Purpose: In people with lower-limb amputation and hemiparesis, prognostic factors of rehabilitation outcomes were investigated at hospital discharge. This study aims to identify which factors influence functional outcomes at mid- to long-term follow-up.Methods: Follow-up observational study on forty-four people (68 ± 9 years old) with unilateral amputation for vascular disease, temporally preceding or following hemiparesis due to stroke (26 patients prior amputation; 18 patients prior stroke), was performed. Barthel Index (BI) and Locomotor Capabilities Index (LCI) scores were recorded at discharge from the rehabilitation hospital and 3.4 years later. Use of the prosthesis was also recorded.Results: At the follow-up, BI and LCI scores had significantly decreased (10 and 13%, respectively). Contralaterality of the impairment was the main prognostic factor for reduced functional status (p = 0.025) and prosthesis abandonment (p = 0.028, OR = 4.4), especially for women (OR = 8). Severity of hemiparesis affected the BI score (p < 0.01) and level of amputation the LCI score (p < 0.01).Conclusions: At the light of the observed decrement of functional status after discharge, particular attention should be paid to the patients more exposed to the risk of worsening and/or prosthesis abandon, such as women with contralateral impairment. The results of this study may assist rehabilitation teams in performing a more specific and effective long-term rehabilitative interventions.Implications for RehabilitationAfter discharge, the functional status of people with lower-limb amputation and hemiparesis decreases. This result suggests to carry out frequent clinical follow-up and, as necessary, further rehabilitative/prosthetic interventions.66% of the people with dual disability are prosthetic user after about 3.4 years. This data encourage the rehabilitative team to maximize the efforts during the postacute rehabilitative program.During rehabilitation, particularly attention should be deserved to women with contralateral impairment that are more exposed to the risk of prosthesis abandonment.People who had a Locomotor Capability Index score >20 at discharge continued to use prosthesis at follow-up: this threshold should be taken into account during rehabilitation.