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Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation.

Publication ,  Journal Article
Kurichi, JE; Small, DS; Bates, BE; Prvu-Bettger, JA; Kwong, PL; Vogel, WB; Bidelspach, DE; Stineman, MG
Published in: Med Care
April 2009

BACKGROUND: Little is known about the effect of different types of inpatient rehabilitation on outcomes of patients undergoing lower extremity amputation for nontraumatic reasons. OBJECTIVE: To compare outcomes between patients who received inpatient rehabilitation on specific rehabilitation bed units (specialized) to patients who received rehabilitation on general medical/surgical units (generalized) during the acute postoperative period. METHODS: This was an observational study including 1339 veterans who underwent lower extremity amputation between October 1, 2002 and September 30, 2004. Data were compiled from 9 administrative databases from the Veterans Health Administration. Propensity score risk adjustment methodology was used to reduce selection bias in looking at the effect of type of rehabilitation on outcomes (1-year survival, home discharge from the hospital, prescription of a prosthetic limb within 1 year post surgery, and improvement in physical functioning at rehabilitation discharge). RESULTS: After applying propensity score risk adjustment, there was strong evidence that patients who received specialized versus generalized rehabilitation were more likely to be discharged home (risk difference = 0.10), receive a prescription for a prosthetic limb (risk difference = 0.13), and improve physical functioning (gains on average 6.2 points higher). Specialized patients had higher 1-year survival (risk difference = 0.05), but the difference was not statistically significant. The sensitivity analysis demonstrated our findings to be unaffected by a moderately strong amount of unmeasured confounding. CONCLUSIONS: Receipt of specialized compared with generalized rehabilitation during the acute postoperative inpatient period was associated with better outcomes. Future studies will need to look at different intensity, timing, and location of rehabilitation services.

Duke Scholars

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

April 2009

Volume

47

Issue

4

Start / End Page

457 / 465

Location

United States

Related Subject Headings

  • Veterans
  • United States
  • Treatment Outcome
  • Specialization
  • Selection Bias
  • Risk Adjustment
  • Rehabilitation Nursing
  • Models, Statistical
  • Middle Aged
  • Male
 

Citation

APA
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ICMJE
MLA
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Kurichi, J. E., Small, D. S., Bates, B. E., Prvu-Bettger, J. A., Kwong, P. L., Vogel, W. B., … Stineman, M. G. (2009). Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation. Med Care, 47(4), 457–465. https://doi.org/10.1097/MLR.0b013e31818b08c6
Kurichi, Jibby E., Dylan S. Small, Barbara E. Bates, Janet A. Prvu-Bettger, Pui L. Kwong, W Bruce Vogel, Douglas E. Bidelspach, and Margaret G. Stineman. “Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation.Med Care 47, no. 4 (April 2009): 457–65. https://doi.org/10.1097/MLR.0b013e31818b08c6.
Kurichi JE, Small DS, Bates BE, Prvu-Bettger JA, Kwong PL, Vogel WB, et al. Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation. Med Care. 2009 Apr;47(4):457–65.
Kurichi, Jibby E., et al. “Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation.Med Care, vol. 47, no. 4, Apr. 2009, pp. 457–65. Pubmed, doi:10.1097/MLR.0b013e31818b08c6.
Kurichi JE, Small DS, Bates BE, Prvu-Bettger JA, Kwong PL, Vogel WB, Bidelspach DE, Stineman MG. Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation. Med Care. 2009 Apr;47(4):457–465.

Published In

Med Care

DOI

EISSN

1537-1948

Publication Date

April 2009

Volume

47

Issue

4

Start / End Page

457 / 465

Location

United States

Related Subject Headings

  • Veterans
  • United States
  • Treatment Outcome
  • Specialization
  • Selection Bias
  • Risk Adjustment
  • Rehabilitation Nursing
  • Models, Statistical
  • Middle Aged
  • Male