S147 S290
Poster 19:
Evaluating Amputee Mobility with AMPPRO and PEQ-
MS: A 4.5-Year Retrospective Chart Review
Brian Kaluf (Ability Prosthetics and Orthotics, Inc., Exton, PA, USA)
Disclosures:
Brian Kaluf: Research Grants - Freedom Innovations, LLC
Objective:
A 4.5-year retrospective chart review of outcome measure
data from patients with amputation investigated the relationship of
patient perceived mobility and functional ability, as well as the effect
of age, amputation level and cause of amputation. The effects of
proposed Medicare policy changes relating to lower limb amputees
were then evaluated through projections against retrospective data.
The subjective nature of the Medicare Functional Classification Level
(MFCL) for amputees, poses frequently cited limitations. Recently,
Medicare proposed changes to the MFCL guidelines without investi-
gating potential implications. Outcome measure data allows projec-
tion of how proposed Medicare policy changes would affect access to
care for patients in different MFCL.
Design:
Retrospective chart review.
Setting:
Outpatient prosthetic clinic.
Participants:
109 lower limb amputees across 11 clinics.
Interventions:
Lower limb prostheses.
Main Outcome Measures:
The Prosthetic Evaluation Questionnaire
Mobility Subscale (PEQ-MS) rates difficulty performing 12 ambulatory
tasks. The Amputee Mobility Predictor (AMPPRO) assesses mobility and
function of amputees. These tools produce quantitative data on
mobility and functional outcome.
Results:
There was a positive correlation between PEQ-MS and AMP-
PRO scores. Average AMPPRO decreased with age. PEQ-MS scores did
not follow the same trend. Little difference was seen across ampu-
tation level, but traumatic/tumor amputation cause had higher AMP-
PRO and PEQ-MS scores than dysvascular/infection. If proposed
Medicare policy was enacted, 44% of patients would lose access to
their current prosthetic technology due to falling into a lower MFCL
category. By looking at AMPPRO scores, even patients with high
functional mobility would be affected by proposed policy change.
Conclusions:
Patients with higher functional mobility (AMPPRO) had
higher perceived mobility (PEQ-MS). Age and amputation cause influ-
enced mobility. Using retrospective outcome measure data to project
effects of a proposed Medicare policy change, showed how patients at
all levels of functional mobility could lose access to their current
prosthetic technology with the proposed policy change.
Level of Evidence:
Level III
Poster 20:
Preliminary Study of Vitamin D Level in Adult
Patients with Severe Burn
Yuemeng Dai, MD (Univ of TX Southwestern Med Ctr),
Karen J. Kowalske, MD, Cindy A. Dolezal, PT, DPT
Disclosures:
Yuemeng Dai: I Have No Relevant Financial Relationships
To Disclose
Objective:
To measure and trend vitamin D (25-(OH)D) level in hos-
pitalized adult patients with severe burn (
>
20% total body surface
area (TBSA)).
Design:
Prospective cohort study.
Setting:
Burn unit and inpatient rehabilitation unit of level one
trauma hospital.
Participants:
Adult patients with severe burn.
Interventions:
Not applicable.
Main Outcome Measures:
Serum vitamin D (25-(OH)D) level weekly.
Results:
Four patients (three males, one female, age 19-56) with se-
vere burn injury (45%-75% total body surface area) have been enrolled,
none of whom received vitamin D supplementation during the study.
All patients had very low level of vitamin D (25-(OH)D) on admission
(i.e. Patient 1: 22.2 ng/mL; patient 2:
<
13 ng/mL; patient 3: 14.9 ng/
mL, patient 4
<
13 ng/mL). To trend the vitamin D level during the
hospital stay, the vitamin D (25-(OH)D) level was measured every week
for up to 8 weeks or until patient was discharged home. Patient 1 was
followed for 4 weeks and the vitamin D (25-(OH)D) level was 26.9 ng/
mL upon discharge, which was the highest level during the hospital
stay. Patient 2 was followed for 8 weeks and the vitamin D (25-(OH)D)
level was slightly increased to 20.8 ng/mL on week 8. Patient 3 was
followed for 2 weeks and the vitamin D (25-(OH)D) level was 19 ng/mL
in the second week. Patient 4 was followed for 4 weeks and the
vitamin D (25-(OH)D) level continued to be
<
13 ng/mL (undetectable
level) every week.
Conclusions:
This preliminary study shows that all four adult patients
with severe burns had vitamin D deficiency (
<
30 ng/mL), which was
not significantly improved during hospital stay without vitamin D
supplement treatment. This suggests that the vitamin D level in the
patients with severe burn should be measured on admission and the
early vitamin D supplementation might be necessary for those with
vitamin D deficiency. This study is currently ongoing and the results
will be confirmed as enrollment continues.
Level of Evidence:
Level IV
Poster 21:
Telemetric Wound Monitoring and its Clinical
Applications: A Review of the Literature
Vinicius Tieppo Francio, MD/PhD(c) (USAT College of Medicine,
Oklahoma City, OK, United States), Robert Dima, none,
Mark A. Young, MD, MBA, FACP
Disclosures:
Vinicius Tieppo Francio: I Have No Relevant Financial
Relationships To Disclose
Objective:
Chronic wounds present a significant financial burden to
the U.S. healthcare system, and current methods in wound monitoring
are often ineffective. The cost for wound treatment is nearly $25
billion annually. To improve economical and clinical efficiency, it is
imperative to explore novel technological wound monitoring methods
that avoid wound aggravation. The purpose of this review is to
investigate the current state of the research in telemetric wound
monitoring and its potential benefits and impact to care delivery.
Design:
Review of the literature.
Setting:
N/A.
Participants:
N/A.
Interventions:
N/A.
Main Outcome Measures:
N/A.
Results:
Current methods in wound monitoring tend to disturb the
healing process. Moisture, pressure, temperature and pH under
dressings are difficult to monitor, yet significantly impact healing rates
and the likelihood of infection. In response to the need for more
effective wound monitoring, recent studies exploring the efficacy of
remote wound monitoring using telemetric devices coupled with
specialized sensors have been published. Based on our review,
different telemetry systems that can accurately measure changes in
moisture, temperature, pH and pressure under dressings have been
developed. They feature flexible pad materials adaptable to human
skin contour. These systems are low energy for patient safety yet
capable of effective transmission (typically 4-5 meter range). Few
human studies assessing their performance have been published, but
those reviewed suggest that this technology may be of potential
benefit in clinical practice to monitor physiological variables, which
are difficult to observe with manual methods yet relevant to the
healing process.
Conclusions:
The utilization of telemetry sensing technology could be
considered a useful strategy to improve wound monitoring, thus
potentially improving clinical outcomes, decreasing infection rates
and hospitalization length of stay. Current barriers to the use of these
systems are the lack of human studies and the limitations of the
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Abstracts / PM R 9 (2017) S131-S290