Poster 69: Outcomes of Patients Transitioning From Unilateral Transtibial Amputation to Bilateral Transtibial Amputations and Their Long-Term Outcomes

Abstract

Objective: To compare the rehabilitation outcomes of people with bilateral transtibial amputation (BTTA) in relation to their outcomes after unilateral transtibial amputation rehabilitation (UTTA) and their long-term outcomes, using valid and reliable measures. Design: All consecutively admitted patients with BTTA due to diabetic or peripheral vascular disease between the years 1998 to 2003 were sampled. Data from database analysis, retrospective chart review, and a telephone interview were collected. Data were analyzed using SPSS. Setting: Regional amputee rehabilitation hospital, outpatient clinics, and telephone interviews (home setting). Participants: All consecutively admitted patients with BTTA due to diabetic or peripheral vascular disease between the years 1998 and 2003 were sampled (N=82). Interventions: Data from database analysis, retrospective chart review, and a telephone interview were collected. Main Outcome Measures: The main outcome measures used compared discharge scores after patients' first and second transtibial amputation rehabilitation stays for the Houghton (prosthetic wear), two-minute walk test (2MWT), 12-Item Short-Form Health Survey (SF-12), and prosthetic candidacy. Long-term outcomes collected included mortality, modified Houghton score, SF-12, Frenchay Activity Index. Results: The average age at the time of second amputation was 65.5 years and the average time between amputations was 2.96 years. The majority (73.2%) of patients were men. There was no significant difference between patients' matched outcomes (after unilateral vs bilateral amputation rehabilitation) for length of stay, Houghton, 2MWT, or prosthetic candidacy despite having more comorbidities (P<.01). However, BTTA patients required a more supportive gait aid than they did as a unilateral amputee (P<.01) and required more assistance to ambulate on discharge from rehabilitation (P=.02). Of 82 patients admitted for BTTA rehabilitation, 35 patients were interviewed an average of 3.31 years postamputation. Another 32 patients had died an average of 4.2 years postrehabilitation discharge (Kaplan-Meier survival analysis). The mean modified Houghton score at telephone follow-up was 6.3 (maximum score, 9) with a significant improvement from rehabilitation discharge to follow-up (P=.001). 86% were still wearing prostheses regularly and 83% were walking. Most remained independent in activities of daily living (ADLs). Conclusions: Patients undergoing BTTA who are referred to rehabilitation had prosthetic outcomes similar to what these patients had after rehabilitation for UTTA, despite having more advanced age and illness. They also tend to do very well at long-term follow-up and continue to make gains even after being discharged from rehabilitation. At long-term follow-up, the majority were independent in ADLs and 85% were wearing prostheses and ambulating independently indoors. The average life span after discharge was 4.2 years, which is a longer lifespan than that reported in the literature for patients with UTTA. These patients may represent a subset of patients who live longer after amputation. Therefore, strong consideration should be given for prosthetic rehabilitation of patients with BTTA.