Abstract
A prospective study of morbidity among 55 lower limb amputees was carried out by multiprofessional teams in two rehabilitation units in Lothian. The aim of treatment was the restoration of independence rather than concentration solely on walking training, although this was important in that 90% of patients were fitted with a temporary artificial limb. The problems and progress of these patients varied, but 90% returned successfully to the community where they made moderate demands on community services. Important differences in professional assessment were noted. The physiotherapists judged that 73% of the patients studied were mobile without help prior to discharge, whereas nurses placed only 46% of the same group at this level of independence. The occupational therapist assessed more of the patients (68%) as fully independent in selfcare than the nurses (44%). This difference between what the patient can do when assessed in therapy and what he actually does when observed in the ward was resolved in case conferences.
Forty of the 46 patients who survived for one year replied to a postal questionnaire. Of these, 29 reported independence in mobility indoors and 20 reported total independence in activities of daily living, indicating that as a group they had achieved the level of function predicted. Only two patients required institutional care; two patients (17% of those previously employed) had returned to work.
Successful rehabilitation of patients with multiple problems requires a holistic approach. This study demonstrates the need for multiprofessional case discussions so that appropriate decisions on discharge and future management can be made.
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