S185 S290
Poster 164:
The Need to Develop an Amputee Continuum of Care
System: Prosthetic Access and Acceptability Analysis
Andrew Pedtke, MD (LIM Innovations, SF, CA, United States),
Ranjit Steiner, BA - Journalism, George Burnard, Cory Laws, PhD
Disclosures:
Andrew Pedtke: Ownership or partnership - LIM
Innovations
Objective:
To evaluate the current continuum of care and healthcare
models for amputees.
Current models present several barriers to care resulting in many
amputees who remain in need of prosthetic care due to a highly
fragmented post-amputation continuum of care.
Design:
This paper is based on the clinical experience of the authors,
a review of the literature, and information gathered from a case study
conducted by our organization. Google Scholar online keyword
searches were executed and search terms included: Amputee, Care,
Prosthetics, Above Knee, K-Level, Medical Provider, and Healthcare.
Setting:
Various clinical settings and time points representing the
stages of post-amputation care including eligibility for prosthesis,
having a provider, conducting an evaluation with a prosthetist,
receiving a prosthesis, use of rehabilitation, and ambulation after 12
months.
Participants:
Retrospective analysis on the population of lower-limb
amputees.
Interventions:
Interventions represent the various stages of post-
amputation care.
Main Outcome Measures:
Outcomes measures are defined as suc-
cessfully navigating or receiving care described in “Setting”.
Results:
We found that only 23.5% of lower limb amputees successfully
navigate through the care system and have mobility 12 months after
amputation. In our research, we synthesize what the amputee contin-
uumof carewould look like, but until themodel is applied and tracked in
a healthcare system, we will not have a true representation.
Conclusions:
Undoubtedly there is a significant fragmentation of care
in the prosthetic industry. Developing a continuum of care and
tracking patients as they move through the system would provide
valuable detail to assist patients, providers and payers in making
relevant decisions when it comes to amputee care.
Level of Evidence:
Level V
Poster 165:
What is the Effect of Family Functioning on Transition
to Independent Living in Adult Spina Bifida?
David Berbrayer, MD, BSC(MED), MCFPC, FRCPC, DABPM&R, FAAPM&R
(Univ of Toronto Sunnybrook HSC, Toronto, Ontario, Canada)
Disclosures:
David Berbrayer: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
To determine effect of family functioning on transition to
independent living In adult Spina Bifida.
Design:
Cross sectional study design: data collected with single self-
administered survey that was distributed to adult spina bifida.Survey
composed six sections: 1. basic demographic 2. Self-Report Family
Inventory: Version II” 3. qualitative questions 4. “Satisfaction With
Living Environment” questionnaire. 5. modified version of the “Expe-
rience of Home” questionnaire, by Moloney. 6. “Barthel Questionnaire
(compare the functional abilities of those adults with spina bifida who
were living independently against those who were not). Primary
outcome to be analyzed was whether or not family functioning was
related to the status of living independently or not. To quantitatively
assess family functioning, results of the “Self-Report Family Inventory:
Version 2” were used. Questionnaire was scored in five domains
separately and the overall sum of these 8 scores was calculated. These
six values were compared against the status of “living independently”
or “not living independently”. Each questionnaires a mean score and
standard deviation was calculated for those participants in the “living
independently” and the “not living independently” categories.
Setting:
University hospital.
Participants:
Spina Bifida.
Interventions:
Not applicable.
Main Outcome Measures:
Above.
Results:
30 participants -18 independent;12 dependent. 6M 24F. Bar-
thel score:8-20. Self report family inventory in 5 categories: Health/
Competence, Conflict, Cohesion, Leadership and Expressiveness. Best
score independence was leadership skills in family unit. Participants
living independently were asked on scale to determine if they were
happier living independently. Response was that they were unhappy.
Most participants chose to live in the family or independently out of
their own choice. Those living independently were 38 years compared
to living in family 24. Earlier transition at 14 years were likely to be
independent.
Conclusions:
1. Family role in independence in adult spina bifida
2. Adolescents should know medical history.
3. Spina bifida adults are living longer
4. Living independently depends on age and family
5. Caregivers interfering with the process
6. Transition to independent living may be more of an issue of “when”
not “if”
Level of Evidence:
Level I
Poster 166:
Review of Deep Vein Thrombosis (DVT) Prophylaxis in
Acute Rehabilitation Patients Who Developed a DVT
Komal G. Patel, DO (North Shore-LIJ Health System), Naomi Kaplan,
MBBS, Eduardo Chen, MD, Adrian Cristian, MD MHCM
Disclosures:
Komal Patel: I Have No Relevant Financial Relationships
To Disclose
Objective:
Patients come to in-patient rehabilitation facilities (IRF)
on DVT prophylaxis, however are not always fully protected. The
objective is to identify incidence of DVTs in high risk patients who are
already on DVT prophylaxis and to identify a pattern in prophylactic
agent that have a higher incidence.
Design:
Retrospective chart review to find patient’s location of DVT as
determined by venous Doppler, prophylactic measures prior to
development of DVT, patient’s acute rehabilitation diagnosis, and
measure taken once DVT was discovered.
Setting:
Acute in-patient rehabilitation facility.
Participants:
22 patients admitted to IRF from January 2016 to pre-
sent day who developed a DVT while on prophylaxis.
Interventions:
Not applicable.
Main Outcome Measures:
Incidence of DVTs while on prophylaxis as
documented by venous Dopplers. Type of DVT prophylaxis patient was
on at time of DVT development.
Results:
Distribution of patient population: 10 orthopedic patients (4
total knee replacements, 2 laminectomy and fusions, 5 hip/femur
fractures status post fixation or arthroplasty), 9 post-stroke patients, 1
debility patient, 2 Guillain Barre Syndrome patients. Distribution of
DVT prophylaxis prior to development of clot: 4 patients on Heparin
5000 units every 8 hours, 5 patients on Aspirin 325mg twice a day, 5
patients on Enoxaparin 40mg daily, 2 patients on intermittent pneu-
matic compressions, 2 patients Fondaparinux 2.5mg daily, 1 patient
Apixaban 2.5mg twice a day. Distribution of location of DVT: 13 pa-
tients with left lower extremity DVT, 8 patients with right lower ex-
tremity DVT, 2 patients with unknown location of DVT.
Conclusions:
Even though patients are placed on DVT prophylaxis
prior to being transferred from acute hospital to IRF, they are still at
risk of developing DVT regardless of commonly used prophylactic
medications. High risk patients include the post-stroke and post-
orthopedic procedure patients. Screening in this high risk population
may still be valuable to management despite being on prophylaxis.
Level of Evidence:
Level III
S185
Abstracts / PM R 9 (2017) S131-S290