Veränderungen des allgemeinen Gesundheitszustandes und der funktionellen Unabhängigkeit bei Patienten nach Amputationen der unteren Extremität und stationärer Rehabilitation

Zusammenfassung

Hintergrund: Trotz der deutlich verbesserten Prävention und der Erfolge in der Behandlung von Risikofaktoren ist die Zahl der Amputationen der unteren Extremität in den letzten Jahren konstant geblieben. Patienten mit Amputationen verursachen erhebliche Kosten im Gesundheitswesen. Daher bleibt die Behandlung solcher Patienten eine Herausforderung für ein multidisziplinäres Rehabilitationsteam. Ziel dieser Studie war es, die kurzfristigen Veränderungen des allgemeinen Gesundheitszustandes und der funktionellen Unabhängigkeit der amputierten Patienten nach stationärer Rehabilitation zu erfassen. Methodik: Von 70 konsekutiven Patienten nach Amputationen der unteren Extremitäten wurden 64 für die Studie qualifiziert. SF-36 als Fragebogen zur Erfassung des allgemeinen Gesundheitszustandes und FIM als Fremdbeurteilung der funktionellen Selbständigkeit wurden am Anfang und am Ende einer multidisziplinären stationären Rehabilitation administriert. Acht Subdimensionen und beide Summenscores von SF-36 wurden normbasiert ausgewertet. FIM wurde sowohl als Summenscore berechnet als auch auf eine 0 - 100-Skala transformiert. Ergebnisse: Es zeigten sich positive Veränderungen in allen Subskalen und den beiden Summenscores von SF-36. In den Skalen RP, BP und RE sowie beiden Summenscores waren diese signifikant. Die funktionelle Unabhängigkeit hat sich signifikant von 69,3 FIM-Punkten auf 78,4 FIM-Punkte verbessert. Dies entspricht einer Verbesserung um 8,5 Prozentpunkte auf der transformierten Skala. Diskussion: Die Veränderungen in den physischen Subskalen von SF-36 entsprechen den Angaben in der Literatur, die mentalen Subskalen und der FIM zeigen geringere Veränderungen. Bei der Auswertung der Summenscores von SF-36 sollen die Korrelationen zwischen physischen und mentalen Konstrukten berücksichtigt werden. Die Datenlage zur kurzfristigen Änderungssensitivität der verwendeten Messinstrumente ist bisher nicht ausreichend. Die Komorbidität spielt eine erhebliche Rolle bei der Evaluation des Rehabilitationserfolges bei amputierten Patienten. Schlussfolgerungen: Die Studie zeigt positive Effekte des multidisziplinären stationären Rehabilitationsprogramms bei Patienten mit Amputationen der unteren Extremität. Langzeitstudien sind notwendig, um die Dauerwirkung der Rehabilitation zu evaluieren. Weitere Forschung soll Prädiktoren des Rehabilitationsergebnisses identifizieren, um eine optimale Behandlungsstrategie zu etablieren.

Abstract

Background: Despite improved health education and advances in medical and surgical technologies the incidence of lower extremity amputation remained relatively stable over the years. These has an immediate bearing on raising direct and indirect costs of the health care system. Thus, the lower extremity amputation population continues to be a major challenge for rehabilitation professionals. The goal of this study was to evaluate the short-term changes in health-related quality of life as well as functional independence in lower extremity amputees undergoing multidisciplinary inpatient rehabilitation. Methods: Sixty four of seventy consecutive lower extremity amputees participated in the study. SF-36 for evaluating of the health-related quality of life and FIM as measure of the functional independence were administered on admission and at discharge from a multidisciplinary inpatient rehabilitation program. Eight subscales and both summary scores were calculated using a norm-based scaling. Summary FIM scores were linear transformed into a 0 - 100 scale. Results: There was improvement in all subscales of SF-36. The changes in bodily pain, both role scales and both summary scores were statistically significant. The functional independence as measured by FIM improved significantly from 69.3 to 78.4 points or 8.5 percentage points on the transformed scale. Discussion: The changes in the physical scales of the SF-36 were comparable but these in the mental scales and in terms of functional independence were lower then reported elsewhere. Both orthogonal and oblique (correlated) factor scores should be used for evaluating of SF-36. Short-term responsiveness of both measurements used in the current study have not been reported conclusively yet. Co-morbidity seems to have a major impact on the results of rehabilitation programs of amputees. Conclusions: This study has demonstrated a positive effect of a multidisciplinary in-patient rehabilitation program on the health-related quality of life and the functional independence of lower extremity amputees. Long-term follow-up data are necessary to evaluate the effectiveness of the rehabilitation. Predictors of rehabilitation success should be identified for optimising of rehabilitative intervention strategies.

Schlüsselwörter

Gesundheitsstatus - Amputation - funktionelle Unabhängigkeit - SF-36 - FIM

Key words

Health-related quality of life - amputation - functional independence - SF-36 - FIM

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