Rehabilitation after lower limb amputation: between functional recovery and quality of life

Abstract

Below knee amputation is a big operation with far-reaching effects on the physical, psychological and social life of the patient. The most common reasons for an amputation are vascular disease, diabetes complications and traumatic injuries. In worldwide epidemiological research amputation rates scored highly with wide differences according to the country and access of medical service. For instance, one rate of 22.5 cases/100 000 per year was reported in Canada, with predomination in males over the age group of 65 years. The rate of amputation among American Indians is also three times the U.S. average. The use of procedures is extremely variable in European and Asian countries, with the highest rates being found for UK and the lowest for Japan. In the United States, hospitalization rates for non-traumatic amputation of a lower extremity decreased by over 50% from 1988 to 2008. In Germany and Italy also, prevalence of amputations among the elderly patients with complicated diabetes or PAD is very high. Objective: To review the scientific research regarding physical therapy of individuals with lower limb amputation. Materials and methods. A literature search was performed in the Scopus, PubMed and Google Scholar databases with search terms related to rehabilitation after LLA. Different dimensions of postamputation rehabilitation – physical, psychosocial, and emotional recovery – are useful for patients to start prior to surgery. Early physiotherapy, choice of prosthesis and psychological therapy are important in the rehabilitation process. End, virtual rehabilitation electrostimulation, mirror therapy and hydrotherapy have been demonstrated effective particularly in various stages of treatment. In the elderly, multidisciplinary treatment in conjunction with the individualization of loads and recovery phases with a slow progression can enhance success. It has been demonstrated that even patients older than 80 years can achieve functional recovery by appropriate treatment. Already 3 months post-rehabilitation there are signs of positive quality of life development, particularly with sustenance support. Early rehabilitation cuts annual mortality by 30% and increases the likelihood of successful prosthetic adaptation. Current guidelines are towards the use of biomechanical analysis, psychological counselling and incorporating nurses in patient daily care. Therefore, the rehabilitation of a patient with lower extremity amputation requires holistic management program with an early onset program, multidisciplinary involvement and customized programs. In this way not only functional capacities are recovered, but also quality of life and social integration can be enhanced in these patients.