Intermediate rehabilitation outcome in below-knee amputations: descriptive study comparing war-related with other causes of amputation.

AIM: To asses the intermediate rehabilitation outcome of patients with war-related below-knee amputations and compare it with the patients with other causes of amputation.
METHOD: The study comprised 74 patients with below-knee stumps admitted for rehabilitation at the Department of Physical Therapy and Rehabilitation, Split University Hospital, Croatia, in 1994. They were fitted with a preliminary prosthesis, a donation from the Finish Red Cross. The rehabilitation was performed by a professional team and included regular bandaging of the stump, exercises to prevent knee and hip joint contracture, general fitness exercises, standing-up, falling and walking exercises, and electrostimulation of the thigh muscles. The time to reach each rehabilitation phase (walking with 2 crutches, walking with 1 crutch, walking with no crutches) was measured. The satisfaction of the patients with the prosthesis was also assessed at the end of rehabilitation.
RESULTS: Among 74 patients with below knee amputation, war trauma was the cause for amputation in 31 patients, and in 6 of them the amputations were bilateral. Patients with war-related below-knee amputations were younger than the patients with amputations related to vascular disease, including diabetes. The rehabilitation time was significantly shorter in patients with war-related amputations (61.1+/-11.4 days to walking with no crutches) compared with patients with vascular disease-related amputations (80.9+/-8.1 days; p<0.001). The satisfaction with the prosthesis was more variable in patients with war-related amputations than in other patients.
CONCLUSION: Early physical rehabilitation and replacement of the lost extremity with a preliminary prosthesis is an optimal intervention in below-knee amputations due to war-injury. Special attention should be paid to the psychological support to these patients during rehabilitation therapy.