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The lower limb-loss rehabilitation continuum (LLRC) - a framework for program design and implementation.

Prateek Grover1, Corinne M Karuppan2

  • 1Mercy Clinics and Mercy Rehabilitation Hospital, Springfield, MO, USA.

Disability and Rehabilitation
|May 6, 2023
PubMed
Summary

This study introduces the Lower Limb-Loss Rehabilitation Continuum (LLRC) framework to structure amputation recovery. The LLRC framework proved effective in improving patient outcomes and streamlining the rehabilitation process for prosthetic device use.

Keywords:
Amputationartificial limbscare continuumoutcomesprogram developmentrehabilitation

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Area of Science:

  • Rehabilitation Medicine
  • Prosthetics and Orthotics
  • Health Services Research

Background:

  • Optimal prosthetic device-enabled functioning after amputation necessitates a structured rehabilitation approach, yet program designs and outcomes are not well-defined.
  • Existing literature lacks a standardized framework for the complex, multi-step process of lower limb loss rehabilitation.
  • Stakeholder input and established continuum of care models are crucial for developing effective rehabilitation programs.

Purpose of the Study:

  • To describe a novel implementation framework, the Lower Limb-Loss Rehabilitation Continuum (LLRC), for lower limb loss rehabilitation.
  • To evaluate the utility and effectiveness of the LLRC framework through program implementation and outcome assessment.
  • To provide a structured, standardized approach for prosthetic device-enabled functioning following amputation.

Main Methods:

  • Developed the Lower Limb-Loss Rehabilitation Continuum (LLRC) framework based on literature review and stakeholder consultation.
  • Structured the LLRC into five sequential steps: Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), and Prosthetic Rehabilitation (PR).
  • Evaluated the LLRC framework's utility via retrospective observational study of patients with unilateral lower-limb amputations in a semiurban US setting, assessing program functioning and process outcomes.

Main Results:

  • The LLRC framework was successfully implemented in a healthcare setting, demonstrating its practical utility.
  • Functional outcome scores (FIM gain and efficiency) were higher during Preprosthetic Rehabilitation (PPR) compared to Prosthetic Rehabilitation (PR).
  • The longest rehabilitation phases were Limb Healing and Maturation (LHM) and Prosthetic Fitting (PF), with an overall program completion time of approximately 5 months.

Conclusions:

  • The Lower Limb-Loss Rehabilitation Continuum (LLRC) framework is a valuable tool for designing and implementing structured limb loss rehabilitation programs.
  • The LLRC framework provides standardized terminology and metrics, facilitating consistent care delivery and outcome measurement.
  • While effective, the LLRC highlights opportunities for optimizing the duration of Limb Healing and Maturation (LHM) and Prosthetic Fitting (PF) steps.