Clinical factors associated with prescription of a prosthetic limb in elderly veterans
Clinical factors associated with prescription of a prosthetic limb in elderly veterans
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DOI：
10.1111/j.1532-5415.2007.01187.x
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发表时间：
2007-06-01
影响因子：
6.3
通讯作者：
Stineman, Margaret G.
中科院分区：
文献类型：
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作者：
Kurichi, Jibby E.;Kwong, Pui L.;Stineman, Margaret G.
目的：为了确定高龄如何影响假体处方。设计：回顾性队列分析与理论驱动的逻辑回归模型。一个截肢后的生活质量（PAQ）框架的结果提出和实证检验。设置：退伍军人事务部医疗中心。参与者：2375名退伍军人与下肢截肢出院2002年10月1日和2003年9月30日。测量：假肢处方在1年内截肢。结果：年龄小于76岁的患者接受处方的可能性是86岁及以上患者的4.5倍（比值比=4.51，95%置信区间=1.36-14.99），在控制了性别、婚姻状况、住院前生活环境、解剖水平、病因、合并症、医疗紧急程度、和初始功能状态。接受扩展护理的患者和患有外周血管疾病、全身性脓毒症、肾衰竭、充血性心力衰竭、精神病、转移性癌症、瘫痪或其他神经系统疾病的患者接受处方的可能性较小，因为急性中枢神经系统疾病、重度肾脏疾病或严重营养不良而接受手术的患者也是如此。退伍军人最初评估为更认知和身体能力有较高的可能性假肢处方，那些与transtimbal截肢有较高的可能性假肢处方比那些transfemoral amplitations.Conclusion：截肢者年龄在75岁及以上是不太可能接受假肢处方比年轻人，即使在控制合并症和功能状态。研究结果支持PAQ框架，其中背景，病因，解剖水平，合并症，医学敏锐度和初始功能是结果的决定因素。对能量水平、独立移动能力或行使判断能力产生不利影响的医疗和功能状况会降低假肢处方的可能性。
Objectives: To determine how advanced age influences prosthetic prescription.Design: Retrospective cohort analysis with theory-driven logistic regression models. A Post Amputation Quality-of-Life (PAQ) framework of outcomes was proposed and empirically tested.Setting: Veterans Affairs Medical Centers.Participants: Two thousand three hundred seventy-five veterans with lower extremity amputations discharged between October 1, 2002, and September 30, 2003.Measurements: Prosthetic prescription within 1 year of amputation.Results: Patients younger than 76 were 4.5 times as likely to receive a prescription compared to those aged 86 and older (odds ratio=4.51, 95% confidence interval=1.36-14.99) after controlling for sex, marital status, living circumstance before hospitalization, anatomical level, etiologies, comorbidities, medical acuity, and initial functional status. Patients admitted from extended care and patients with peripheral vascular disease, systemic sepsis, renal failure, congestive heart failure, psychoses, metastatic cancer, paralysis, or other neurological disorders were less likely to receive a prescription, as were patients who underwent procedures for acute central nervous system disorders, severe renal disease, or serious nutritional compromise. Veterans evaluated initially as more cognitively and physically able had higher likelihood of prosthetic prescription, and those with transtibial amputations had higher likelihood of prosthetic prescription than those with transfemoral amputations.Conclusion: Amputees aged 75 and older are less likely to receive a prosthetic limb prescription than younger individuals, even after controlling for comorbidities and functional status. Findings support the PAQ framework, in which contexts, etiologies, anatomic level, comorbidities, medical acuity, and initial function are determinants of outcome. Medical and functional conditions that adversely affect level of energy, ability to move independently, or ability to exercise judgment reduce the likelihood of prosthetic prescription.