{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T16:21:17Z","timestamp":1789230077617,"version":"build-2803163510"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,9,21]],"date-time":"2016-09-21T00:00:00Z","timestamp":1474416000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective cohort analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Inpatient rehabilitation after lower extremity amputations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Length of stay, discharge destination, and change in total and motor function scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below\u2010knee (74%) and above\u2010knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, <jats:italic>P<\/jats:italic> \u2264 .01), older age (beta = 0.2, <jats:italic>P<\/jats:italic> \u2264 .01), and a history of ischemic heart disease (beta = 3.8, <jats:italic>P<\/jats:italic> = .03) or congestive heart failure (beta = 5, <jats:italic>P<\/jats:italic> = .04). Patients who spent &lt;7 days in hospital were significantly more likely to have a shorter rehabilitation stay (beta = \u22124, <jats:italic>P<\/jats:italic> = .03). Advanced patient age was the only predictor for hospital readmission (odds ratio = 1.03, <jats:italic>P<\/jats:italic> \u2264 .01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rehabilitation length of stay in Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age, undergoing surgery in the province of Manitoba, and having a history of ischemic heart disease or congestive heart failure predict a longer rehabilitation stay. A shorter perioperative hospitalization period (&lt;7 days) predicts a shorter rehabilitation duration. Future studies are needed to explore these issues and to optimize the delivery of rehabilitation services to Canadians after lower extremity amputation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>II<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2016.09.009","type":"journal-article","created":{"date-parts":[[2016,9,21]],"date-time":"2016-09-21T20:25:42Z","timestamp":1474489542000},"page":"494-501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Rehabilitation Trends After Lower Extremity Amputations in Canada"],"prefix":"10.1002","volume":"9","author":[{"given":"Ahmed","family":"Kayssi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Dilkas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derry L.","family":"Dance","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"de Mestral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas L.","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham","family":"Roche\u2010Nagle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9,21]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2011.03279.x"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.005"},{"key":"e_1_2_6_4_2","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1503\/cjs.013115","article-title":"A Canadian population\u2010based description of the indications for lower\u2010extremity amputations and outcomes","volume":"59","author":"Kayssi A.","year":"2016","journal-title":"Can J Surg"},{"key":"e_1_2_6_5_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.2340\/165019771994263115119","article-title":"Interrater reliability of the 7\u2010level functional independence measure (FIM)","volume":"26","author":"Hamilton B.B.","year":"1994","journal-title":"Scand J Rehabil Med"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.1991.07.0035"},{"key":"e_1_2_6_7_2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3109\/03093649209164324","article-title":"Rehabilitation after amputation for vascular disease: A follow\u2010up study","volume":"16","author":"De Luccia N.","year":"1992","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(03)00092-2"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90074-1"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2010.12.019"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1983.tb03721.x"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800811110"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.34605"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.33221"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(96)90184-7"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(96)90303-2"},{"key":"e_1_2_6_17_2","first-page":"479","article-title":"Agreement of functional independence measure item scores in patients transferred from one rehabilitation setting to another","volume":"45","author":"Kohler F.","year":"2009","journal-title":"Eur J Phys Rehabil Med"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1981.01380130069016"},{"key":"e_1_2_6_19_2","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jvs.2015.09.017","article-title":"Predictors of hospital readmissions after lower extremity amputations in Canada","volume":"63","author":"Kayssi A.","year":"2016","journal-title":"J Vasc Surg"},{"key":"e_1_2_6_20_2","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1080\/09638280410001708850","article-title":"Amputation rehabilitation and prosthetic restoration. 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