Diabetes and lower extremity amputation - rehabilitation pathways and outcomes at a regional hospital.

BACKGROUND: Lower extremity amputations (LEAs) are most frequently due to diabetes mellitus (DM), a disease on the rise. The objective of this study was to determine the prevalence and aetiology of LEAs at Addington Hospital from 2013 to 2017 and to explore the physiotherapy referral practices and outcomes. METHODS: Retrospective study carried out at Addington Hospital, Durban. Patients who underwent LEAs were filtered from theatre registers and the hospital Meditech database. Data collected included patients' demographic profile, diabetic status, level of amputation, limb orientation, physiotherapy referral status, and rehabilitation outcomes. Physiotherapy files were scanned for the attendance of referred patients. Study endpoints were prevalence, diabetes status, referral status, compliance and rehabilitation outcomes. RESULTS: From 2013 to 2017, 1 028 LEAs in 843 patients were identified with single amputations (697) and multiple amputations (146). The median age was 61 (IQR 52-68) years, and the M:F ratio was 1.3:1. A total of 574 (68.1%) patients had DM. Seven hundred and thirty-eight (71.8%) amputations were as a result of DM. The level of amputations was below-knee (479; 46.6%), toectomy (236; 23%), above-knee (196; 19%) and trans-metatarsal (117; 11.4%). Only 148 patients (17.6%) were referred for physiotherapy, of which 91 (61.5%) attended. Mobility in those who attended rehabilitation was with a walking frame (51; 56%), crutches (29; 31.9%), prosthesis and crutches (7; 7.7%), and wheelchair-bound (4; 4.4%). CONCLUSION: Over half the amputations were associated with DM, which was also a risk factor for multiple amputations. Although referral and attendance for physiotherapy were very poor, mobility in those who attended was excellent, indicating a dire need to improve hospital referral pathways.

A five-year audit of lower limb amputations below the knee and rehabilitation outcomes: the Durban experience

Introduction: Lower limb amputation (LLA) due to diabetes mellitus (DM) is a growing epidemic worldwide. Objectives: To determine the prevalence of LLAs at Addington Hospital from 2010 to 2014 and to explore the rehabilitation outcomes of amputees. Design and setting: A retrospective chart review of LLAs below the knee was undertaken at Addington Hospital. Subjects: Patients who underwent LLAs were filtered from theatre registers. Methodology:A data collection sheet included demographic profile, diabetic status, level of amputation, limb orientation and rehabilitation outcomes. Outcome measures: Study endpoints were prevalence, compliance and rehabilitation outcomes. Results: From 2010 to 2014, 767 LLAs in 667 patients were identified. Mean age was 59 (13.2) years. M:F ratio was 1:1. Of these, 354 patients (53.1%) had DM. Level of amputation was below-knee 57%, trans-metatarsal 12.4% and toectomy 30.6%. Only 116 patients (17.4%) were referred for physiotherapy, of whom 95 (81.9%) attended. Median frequency of physiotherapy visits was five and four for diabetic and non-diabetic amputees respectively. Mobility after rehabilitation was with a walking frame (49%), crutches (32%), prosthesis and crutches (8%), wheelchair-bound (9%) and independent gait (1%). Conclusion: Over half of amputations were associated with DM. The gender incidence was similar. Referral to physiotherapy and adherence thereto was poor