47 Prešern-Štrukelj, Čelan, Zupanc / Rehabilitacija - letn. VII, supl. 3 (2008) FROM AMPUTATION TO REINTEGRATION M. Prešern-Štrukelj M. Prešern-Štrukelj 1 , D. Čelan 2 , U. Zupanc 1 1 Institute for Rehabilitation, Ljubljana, Slovenia Institute for Rehabilitation, Ljubljana, Slovenia 2 Medical Clinical Centre Maribor, Slovenia Medical Clinical Centre Maribor, Slovenia patients were fitted with prostheses and were able to walk acceptable distance. The functional state of the patients at discharge was based on gait tests and the improved assess- ment of motor abilities on the Functional Independence Measure (FIM). The follow up of amputee patients is important part of complete rehabilitation program. Their reintegration has to be followed and carefully stimulated by rehabilitation team. Abstract The article discusses the program of rehabilitation and reintegration of patients with lower-limb amputation, who had undergone amputation at the Medical Clinical Center Maribor and were then, in regard to their func- tional state, referred to rehabilitation at the Institute for Rehabilitation, Republic of Slovenia. We retrospectively followed 58 patients. In our research 88% of included INTRODUCTION Most lower-limb amputations result from impaired periph- eral arterial blood flow and consequential chronic critical ischemia. In general, the patients are elderly, they suffer from numerous comorbidities and frequently live in inadequate social conditions. The goal of amputee’s rehabilitation is to help patient return to the highest level of function, while improving the overall quality of life - physically, emotionally, and socially (1-3). In our retrospective study patients who had lower limb amputation and concluded early rehabilitation program in Medical Clinical Centre Maribor, were then referred to com- plex rehabilitation program at the Institute for Rehabilitation, Republic of Slovenia. The aim of our study was to find out how amputee patients finishing rehabilitation program were able to walk with prosthesis and return to active life. METHODS AND SUBJECTS Methods After early rehabilitation in Maribor a group of amputee patients was included in complex rehabilitation program at the Institute for Rehabilitation in Ljubljana. The rehabilita- tion team, the physicians - PRM specialist, specialist in inter- nal medicine, medical nurses, physiotherapist, occupational therapist, prosthetic engineer, social worker, psychologist and vocational counsellor according to patients needs help the patient to adapt to a new life-style. The activity or disability level was regularly followed by the rehabilitation team using motor Functional Independence Measure (motor FIM) and walking tests. Subjects Subjects 115 lower-limb amputations were performed on 105 patients (aged from 17 to 95 years) in Medical Clinical Centre Mari- bor between May 1st 2006 and April 29th 2007. 67 of them were referred to Rehabilitation Institute in Ljubljana for rehabilitation, 9 did not respond. So 58 amputee patients (aged from 17 to 87 years) were admit- ted to rehabilitation. The causes of lower-limb amputation were: in 29 patients (50%) complications of diabetes, in 22 patients (38%) peripheral arterial disease, in 4 patients (7%) injury, in 2 (3%) osteomyelitis and in 1 patient (2%) carcinoma. The level of amputation: 64% trans-tibial (TT), 26% trans-femoral (TF), 3% bilateral TT, 3% bilateral TF and 3% bilateral, TT and TF amputation. RESULTS 51 amputee patients (88%) were fitted with prosthesis. In 7 patients (12%), prosthetic fitting was not performed due to their weak physical condition. The average motor FIM at admission was 68 (from 21 to 84), at discharge 74 (from 30 to 84), it increased in average for 6 (from 0 to 21). Walking tests were performed in 44 patients with appropriate physical condition. Walking speed was assessed as the time 48 needed to walk 10 meters with prosthesis.On average, the subjects needed 34 seconds to walk 10 meters (from 7 to 85 seconds). Walking endurance was assessed as the distance covered with prosthesis in 6 minutes. In that time, the sub- jects walked 132 meters on average (from 20 to 340m). 52 patients (90%) returned home, to their previous social environment, 6 patients (10%) were discharged into nursing home. The average period from the amputation to admission on rehabilitation was 112 days (from 40 to 348 ). The aver- age period from admission to discharge from the Institute was 28 days. DISCUSSION The functional level of amputee patients depends on the interaction between physical, mental, psychological and social factors (4-6). We agree FIM score is not useful in predicting success- ful prosthetic rehabilitation in lower extremity amputee patients (7). The motor subscore acompagnes the use of prosthesis. We compared some demographic characteristics of our group with the analysis of the amputees in Croatia (8). The most common diseases that resulted in amputation were: diabetes mellitus and obstructive vascular diseases, trauma, osteomyelitis and tumors. Average period from the amputation to admission for reha- bilitation program was 112 days (from 40 to 348) in Slovenia and over 190 days in Croatia. The average period from admission to discharge from the Institute was 28 days in Slovenia and about 40 days in Croatia. CONCLUSION In amputee patients with normal stump healing the admis- sion to the complex rehabilitation program should be done as soon as possible. Its goal is to help patient return to the highest level of function, while improving the overall quality of life - physically, emotionally, and socially. The functional state of the patients at discharge from the rehabilitation program in our Institute was based on gait tests and the improved assessment of motor abilities on the Functional Independence Measure (FIM). After finishing the rehabilitation program most of the amputee patients observed in our study returned to their homes and their further reintegration will be followed-up at their regular outpatient controls. R References eferences: 1. Prešern-Štrukelj M. Rehabilitacija starejših po amputaciji spodnjih udov zaradi žilne bolezni. In: Burger H, (ur.). Amputacije in protetika: zbornik predavanj. 1. izd. Ljubljana: Inštitut Republike Slovenije za rehabilitacijo 2002:27-33. 2. Schoppen T. Functional outcome after a lower limb amputation. http://irs.ub.rug.nl/ppn/239868706 3. Davis BL, Kuznicki J, Praveen SS, Sferra JJ. Lower- extremity amputations in patients with diabetes: pre- and post-surgical decisions related to successful rehabilita- tion. Diabetes Metab Res Rev 2004;Suppl 1:S45-50. 4. Erjavec T, Prešern-Štrukelj M, Burger H. The diagnostic importance of exercise testing in developing appropri- ate rehabilitation programmes for patients following transfemoral amputation. Eur J Phys Rehabil Med 2008;44:133-9. 5. Larner S, van Ross E, Hale C. Do psychological measures predict the ability of lower limb amputees to learn to use a prosthesis? Clin Rehabil 2003;17(5):493-8. 6. Schoppen T, Boonstra A, Groothoff JW, de Vries J, Göeken LN, Eisma WH. Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees. Arch Phys Med Rehabil 2003;84:803-11. 7. Leung EC, Rush PJ, Devlin M. Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure. Arch Phys Med Rehabil 1996;77(6):605-8. 8. Kauzlaric N, Sekelj-Kauzlaric K, Jelic M.Experience in prosthetic supply of patients with lower limb amputations in Croatia. Prosthet Orthot Int 2002;26(2):93-100. Prešern-Štrukelj, Čelan, Zupanc / Rehabilitacija - letn. VII, supl. 3 (2008)