Introduction

1. The Current Standard of Pre- and Postoperative Practices for Transtibial Amputees, 45 to 75 years old, with Peripheral Vascular Disease Kathryn Antle MS, Prosthetic Resident; Alicia Davis CPO, MPA, FAAOP University of Michigan Orthotics and Prosthetics Center • Introduction • No global standards of practice regarding rehabilitation for patients presenting with amputation currently exist and few have studied the effectiveness of various programs used. The objective of this study was to determine the current standard of practice in rehabilitation of patients presenting with amputation by testing the following hypotheses: • A global standard preoperative physical therapy rehabilitation program does not exist for patients requiring amputation • A global standard postoperative physical therapy rehabilitation program does not exist for patients presenting with amputation • A standard outcome measure regarding rehabilitation of patients presenting with amputation needs to be established • Materials/Methods • A 30 question online survey, regarding pre- and post-operative rehabilitative care of 45-75 year old transtibial patients presenting with amputation secondary to diabetes or peripheral vascular disease (PVD), was made available to over 460 prosthetic practitioners (CPs) and physical therapists (PTs) nationwide. Survey results were compiled and analyzed. • Results • Data collected from 98 CPs and PTs, of whom 48 correctly completed the survey. • 10 of the respondents work in a hospital facility, 35 in a private clinic, and 3 at other facilities. • Of the 30 respondents who stated the patient did not receive a prescription for PT, 14 would give exercises, all of which varied in description, to the patient. • 92% of CP/PTs report communicating with other healthcare workers • 81% work with other healthcare providers within their clinic. • 54% state their clinic uses a variety of outcome measures. Chart 2: Pre-op Areas of Importance for Amputees Table 2: Survey questions – percentages Chart 3: Post-op Areas of Importance for Amputees Percentage (%) *Patient (Pt), Physical Therapy (PT), Prescription (Rx), Physician (Dr) Chart 1: Factors for Prosthetic Success Conclusions Based on the initial results, no global standard exists for patients presenting with amputation regarding pre- and post-operative rehabilitative physical therapy. Realizing that each patient will proceed through therapy at a different rate, a global standard protocol and standard outcome measure would allow PTs, CPs, and physicians the ability to describe the status of the patient using the same terminology. Outcome measures have been developed for amputee rehabilitation focusing on various areas of importance but no standard measure exists when determining a global view of the patient’s rehabilitation status. Acknowledgments: The authors would like to thank all that took time to complete the survey and gave advice when designing the survey study. References: 1. Assessing Outcomes and the Future. J Pros Orth 2004;16(3S):13. 2. Privratsky, A. Do Prosthetists See a Benefit in Having "In-House" Physical Therapy Services for Patients With Amputation? JPO 2008;20(2):61-67. 3. Gailey R, Clark C. Physical therapy management of adult lower limb amputees. In: Bowker, H.K., Michael, J.W. (Eds), Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles. Rosemont, IL: American Academy of Orthopedic Surgeons; 1992. 4. Lusardi, MM, Nielsen, CC. Orthotics and Prosthetics in Rehabilitation 2nd Edition. St. Louis, Missouri: Elsevier; 2007 Table 3: Outcome measures used in clinics Table 1: Demographic Information of Respondents Number of respondents Number of respondents