From the Guidelines
The best practices for an amputee during inpatient rehabilitation include actively participating in all therapy sessions, following pain management protocols, performing regular stump care, and engaging in cardiovascular exercise, as these practices are crucial for optimizing recovery, preventing complications, and preparing for successful prosthetic use. The following practices are recommended:
- Actively participate in all therapy sessions, typically 3 hours per day combining physical and occupational therapy, as recommended by the American Academy of Orthopaedic Surgeons 1.
- Follow pain management protocols, which may include medications like gabapentin for nerve pain and opioids for acute pain, as prescribed by your doctor.
- Perform regular stump care, including cleaning, moisturizing, and desensitization exercises as instructed by your care team.
- Engage in cardiovascular exercise, such as arm cycling or swimming, to maintain overall fitness.
- Practice proper positioning and wrapping of the residual limb to manage swelling and prepare for prosthetic fitting.
- Participate in prosthetic training sessions, starting with basic standing and progressing to walking and more complex tasks.
- Attend psychological counseling sessions to address emotional adjustment and body image concerns.
- Learn and practice activities of daily living (ADLs) with adaptive equipment as needed.
- Maintain proper nutrition and hydration to support healing and energy levels.
- Get adequate rest and sleep to aid recovery and manage fatigue. These practices are supported by the American Academy of Orthopaedic Surgeons clinical practice guideline summary for limb salvage or early amputation 1, which emphasizes the importance of shared decision making and consideration of patient physiology and mortality risk in the decision to pursue limb salvage versus amputation. While other studies, such as the Canadian stroke best practice recommendations 1, provide additional guidance on specific therapies and interventions, the American Academy of Orthopaedic Surgeons guideline provides the most relevant and up-to-date recommendations for amputee rehabilitation. Therefore, the most effective approach to amputee rehabilitation is a multidisciplinary one that addresses physical, emotional, and functional aspects of rehabilitation, and is guided by the latest evidence-based recommendations.
From the Research
Best Practices for Amputee Rehabilitation
During an inpatient rehabilitation stay, several best practices can be implemented to improve the care and outcomes of amputees. These include:
- Early implementation of an interdisciplinary amputee team approach to rehabilitation, with active participation of the patient, to facilitate short hospital stays and earlier return to productivity 2
- Comprehensive rehabilitation that goes beyond the provision of a prosthetic device, addressing the patient's overall needs, including comorbidity, social supports, and limited resources 3
- Addressing specific challenges such as skin integrity, postamputation pain, and falls, to improve care delivery, reduce suffering, and improve patient safety 4
- Providing preoperative assessment and education, postoperative intervention, and indications for inpatient rehabilitation, to facilitate effective functioning at home and participation in recreational activities 2
- Using nursing diagnoses and interventions to develop a standardized nursing care plan and creative new modalities for patient and family education 5
Rehabilitation Goals and Outcomes
The goals of inpatient rehabilitation for amputees include improving functional scores, achieving independence in daily activities, and facilitating community reintegration. Studies have shown that inpatient rehabilitation can improve functional outcomes, even in complex cases such as quadruple amputees with end-stage renal disease 6. Rehabilitation programs should aim to:
- Improve functional independence, as measured by tools such as the Functional Independence Measurement (FIM) score 6
- Enhance patient safety and reduce the risk of complications such as falls and skin integrity issues 4
- Facilitate successful discharge to home or transfer to an acute care facility, with adequate support and resources for ongoing care 5
Interdisciplinary Approach
An interdisciplinary approach to amputee rehabilitation is crucial, involving a team of healthcare professionals, including nurses, physicians, physical therapists, and occupational therapists. This team should work together to:
- Develop a comprehensive care plan that addresses the patient's physical, emotional, and social needs 3
- Provide education and support to patients and their families, to facilitate successful rehabilitation and community reintegration 2, 5
- Continuously monitor and evaluate the patient's progress, making adjustments to the care plan as needed to optimize outcomes 4, 6