Effect of postacute rehabilitation setting on mental and emotional health among persons with dysvascular amputations

Abstract

Objective: To examine the effect of postacute rehabilitation settings on depression and emotional and social functioning among patients undergoing major lower extremity dysvascular amputations.

Design: A population-based, prospective cohort study.

Setting: Two racially diverse metropolitan areas (Baltimore, Maryland, and Milwaukee, Wisconsin).

Patients: Persons undergoing major amputation.

Methods: Data were collected from medical records and patient interviews during acute hospitalization, and 6-month postamputation data were analyzed with use of multivariate regression techniques.

Main outcome measures: Multivariate regressions were used to examine the independent effect of postacute rehabilitation setting on the probability of experiencing depression, low mental health, low social functioning, and low emotional role functioning 6 months postindex amputation, while controlling for preamputation functioning and an array of potential confounders, including pre-existing medical conditions, sociodemographic characteristics, baseline health, and functional status described previously.

Results: Of the 297 patients participating in the study, 43.4% received most of their inpatient postacute care at an inpatient rehabilitation facility (IRF), 32% at a skilled nursing facility (SNF), and 24.6% were discharged home with no inpatient rehabilitation. Even after we adjusted for preamputation characteristics and potential selection bias into the postacute care setting, patients receiving postacute care at an IRF were significantly less likely than those receiving postacute care at an SNF or home to experience depressive symptoms. Patients receiving care at IRFs were also less likely to report low emotional functioning than their counterparts receiving postamputation care at home or in an SNF. Patients in IRFs also reported better social functioning than did those who received postacute care in SNFs.

Conclusions: This study showed an association between reduction in depressive symptoms and emotional suffering and management after lower limb amputation on an inpatient rehabilitation unit. These results add to the growing body of literature suggesting better outcomes for persons with vascular-related amputations who receive care at an IRF relative to other postacute care settings.