Intermediate rehabilitation outcome in below-knee amputations: descriptive study comparing war-related with other...

To asses the intermediate rehabilitation outcome of patients with war-related below-knee amputations and compare it with the patients with other causes of amputation.

The study comprised 74 patients with below-knee stumps admitted for rehabilitation at the Department of Physical Therapy and Rehabilitation, Split University Hospital, Croatia, in 1994. They were fitted with a preliminary prosthesis, a donation from the Finish Red Cross. The rehabilitation was performed by a professional team and included regular bandaging of the stump, exercises to prevent knee and hip joint contracture, general fitness exercises, standing-up, falling and walking exercises, and electrostimulation of the thigh muscles. The time to reach each rehabilitation phase (walking with 2 crutches, walking with 1 crutch, walking with no crutches) was measured. The satisfaction of the patients with the prosthesis was also assessed at the end of rehabilitation.

Among 74 patients with below knee amputation, war trauma was the cause for amputation in 31 patients, and in 6 of them the amputations were bilateral. Patients with war-related below-knee amputations were younger than the patients with amputations related to vascular disease, including diabetes. The rehabilitation time was significantly shorter in patients with war-related amputations (61.1+/-11.4 days to walking with no crutches) compared with patients with vascular disease-related amputations (80.9+/-8.1 days; p<0.001). The satisfaction with the prosthesis was more variable in patients with war-related amputations than in other patients.

Early physical rehabilitation and replacement of the lost extremity with a preliminary prosthesis is an optimal intervention in below-knee amputations due to war-injury. Special attention should be paid to the psychological support to these patients during rehabilitation therapy.