The strongest predictors of length of stay and prosthetic fitting for people with lower limb amputations

Abstract

Title: The Strongest Predictors of Length of Stay and Prosthetic Fitting for People with Lower Limb Amputations. Objective: To identify the strongest predictors of rehabilitation length of stay and prosthetic fitting success for lower limb amputees. Design: Retrospective analysis of clinically collected cohort. Setting: Canadian inpatient rehabilitation facility. Participants: Consecutive lower limb amputees admitted for prosthetic fitting from 2010-2017 (N = 103; mean age 65.3 ± 10.6 years). Interventions: Not applicable. Main Outcome Measures: Predictor variables included the Lower Limb Amputee Measurement Scale (LLAMS), which is a 31-question tool to predict length of stay with indicators in medical, cognitive, social, physical, activities of daily living, and other subsections; admission Functional Independence Measure (FIM®); level of amputation (below-knee or above-knee); age; sex; and time from surgery to admission. Length of stay was measured as days from admission to discharge. Successful prosthetic fitting was defined as ability to use a prosthesis on discharge. Results: The mean length of stay was 63.6 (± 33.3) days and 21.4% of patients failed prosthetic fitting. Higher LLAMS, lower FIM®, and above-knee amputation significantly predicted longer length of stay (p < 0.001, R² = 0.36). Age, sex, and time from surgery did not significantly predict length of stay or prosthetic fitting. Higher LLAMS significantly (p = 0.032) predicted unsuccessful prosthetic fitting. A revised LLAMS, including the strongest predictors of length of stay increased the R² of the model from 0.36 to 0.51. A revised LLAMS, including the strongest predictors of prosthetic fitting increased the R² of the model from 0.15 to 0.32. Conclusions: The LLAMS, admission FIM®, and level of amputation can be used to predict length of stay in people with lower limb amputations admitted for prosthetic fitting. Within the LLAMS, history of cognitive impairment/psychiatric illness, clinical judgement, and living alone were the strongest predictors of increased length of stay. Functional tasks and skin condition indicators were the strongest predictors of successful fitting. Shortening the tool to five items increased the predictive ability of the LLAMS.