Journal of Rehabilitation Research & Development (JRRD)

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Volume 52 Number 7, 2015
   Pages 851 — 858

Abstract — Ambulation and independence among Veterans with nontraumatic bilateral lower–limb loss

Sherene E. Sharath, MPH;1 Helene Henson, MD;2–3 Stacy Flynn, PT, CWS;2 George Pisimisis, MD;4 Panos Kougias, MD, MS;4 Neal R. Barshes, MD, MPH4*

1Health Services Research & Development, Michael E. DeBakey Department of Veterans Affairs (VA) Medical Center, Houston, TX; 2Amputee System of Care, Michael E. DeBakey VA Medical Center, Houston, TX; 3Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX; 4Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine/Michael E. DeBakey VA Medical Center, Houston, TX

Abstract — In describing functional outcomes and independent living in a cohort of bilateral major amputees, we sought to provide current estimates of function and independence after a second major amputation in an elderly Veteran population with peripheral arterial disease and/or diabetes. After retrospectively reviewing and excluding the electronic health records of those failing to meet the inclusion criteria, we identified 40 patients with a history of unilateral major amputation who underwent a second major amputation during the defined study period. Of these, 43% (17) were bilateral transfemoral amputations (TFAs); bilateral transtibial amputations (TTAs) and TFA–TTA accounted for the rest (33% and 25%, respectively). Of the 19 (48%) patients who were ambulatory prior to bilateral amputation, only 2 (11%) remained ambulatory after the second amputation, while 17 (89%) patients lost ambulatory capabilities. Compared with those who were </=65 yr, those between 66 and 79 yr were 18% less likely to ambulate precontralateral amputation (p = 0.03). All patients with bilateral TFA were nonambulatory. Independence postcontralateral amputation decreased from 88% (35) to 53% (21). When data were available (58%), pre and post Functional Independence Measure scores showed a decrease in 74% of patients, while 22% showed an increase. In conclusion, bilateral lower–limb amputation among dysvascular Veterans is highly associated with a loss of ambulation.

Key words: activities of daily living, ambulation, amputations, diabetes, Functional Independence Measure, functional outcomes, independence, limb loss, transfemoral amputations, transtibial amputations.


View HTML ¦ View PDF ¦ Contents Vol. 52, No.7

This article and any supplementary material should be cited as follows:
Sharath S, Henson H, Flynn S, Pisimisis G, Kougias P, Barshes NR. Ambulation and independence among Veterans with nontraumatic bilateral lower–limb loss. J Rehabil Res Dev. 2015;52(7):851–58.
http://dx.doi.org/10.1682/JRRD.2014.07.0176
ORCID: Sherene E. Sharath, MPH: 0000-0001-5334-5799; Panos Kougias, MD, MS: 0000-0001-8561-2185; Neal R. Barshes, MD, MPH: 0000-0003-1019-8930
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Last Reviewed or Updated  Thursday, December 3, 2015 11:56 AM

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