ALGORITHM FOR REHABILITATION OF COMBAT-RELATED PATIENTS WITH LIMB AMPUTATIONS BASED ON MULTIPROFESSIONAL AND INDIVIDUAL APPROACH

  • А. А. Bespalenko Military Medical Clinical Treatment & Rehabilitation Center https://orcid.org/0000-0003-2498-4334
  • O. I. Shchehlіuk Military Medical Clinical Treatment & Rehabilitation Center
  • A. Yu. Kikh Military Medical Clinical Treatment & Rehabilitation Center
  • О. А. Buryanov O.O.Bogomolets National Medical University https://orcid.org/0000-0003-2674-5054
  • O. M. Volyansky Military Medical Clinical Treatment & Rehabilitation Center
  • V. V. Korchenok Military Medical Clinical Treatment & Rehabilitation Center
  • M.M. Myhailovska Military Medical Clinical Treatment & Rehabilitation Center
Keywords: amputation, multiprofessional approach, prosthetics, rehabilitation

Abstract

Introduction. According to the literature, limb injuries predominate (65%). among the participants of the Anti-terrorist Оperation (AO), Joint Forces Оperation (JFO) The amputation rate is relatively high, often combined with other musculoskeletal injuries, and requires an individual and multi-professional (MP) approach.

Purpose of the study: to analyze the structure of amputations in participants of AO and JFO; to create an algorithm for the rehabilitation of military personal with amputations, taking into account the individual and MP approach. 

Materials and methods. The analysis of the results of treatment of 51 patients with amputation from the participants of AO, JFO, who were hospitalized in the department of rehabilitation of patients with amputated extremities of the Military Medical Clinical Center of Occupational Pathology of the Armed Forces in the period from 26.12.2016 to 01.08.2019. The average age at the time of injury was 33 years (from 18 to 54). Distribution by gender: men - 98.1% (n = 50), women - 1.9% (n = 1).

Results. The absence of one limb due to amputation was observed in 84.3% (n = 43), double amputation - 13.7% (n = 7), triple - in 2.0% (n = 1). The main cause of the amputation was a mine-explosion injury - 78.4% (n = 40). Most often, limb amputation was combined with acubarotrauma - 47% (n = 24) and closed traumatic brain injury - 41.2% (n = 21). Adaptation disorders and depressive disorders were common concomitant disorders (56.8% (n = 29)). In 31% (n = 16) amputation was combined with fractures of tubular bones of other extremities.

These circumstances significantly influenced the course of rehabilitation. Given the above circumstances, we have proposed an algorithm for the rehabilitation of patients with traumatic amputation in the postoperative period, the period of preparation for prosthetics, prosthetics and the remote period in accordance with the individual rehabilitation program (IRP).

Conclusion. Given the specific of modern trauma (first of all the frequent association of amputation with other musculoskeletal injuries, injuries of the internal organs, psychological disorders) the algorithm for managing patients with amputation should include: complex treatment with differentiated individual approach, using modern technologies MP approach and according to IRP.

References

Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: The significance and presentation of recommendations. J Clin Epidemiol. Jul 2013;66(7):719-725.

Brunelli S, Morone G, Iosa M, et al. Efficacy of progressive muscle relaxation, mental imagery, and phantom exercise training on phantom limb: A randomized controlled trial. Arch Phys Med Rehabil. Feb 2015;96(2):181-187.

Coffey L, O'Keeffe F, Gallagher P, Desmond D, Lombard-Vance R. Cognitive functioning in persons with lower limb amputations: A review. Disabil Rehabil. 2012;34(23):1950-1964.

Critchton N. Visual analogue scale (vas). J Clin Nurs. 2001;10.5:706

Ertl JP, Pritchett JW, Ertl W, Brackett WJ. Lower-extremity amputations. Medscape. Apr 04 2016.

Gailey RS, Roach KE, Applegate EB, et al. The Amputee Mobility Predictor: An instrument to assess determinants of the lower-limb amputee's ability to ambulate. Arch Phys Med Rehabil. May 2002;83(5):613-627.

Hasanadka R, McLafferty RB, Moore CJ, Hood DB, Ramsey DE, Hodgson KJ. Predictors of wound complications following major amputation for critical limb ischemia. J Vasc Surg. Nov 2011;54(5):1374-1382.

Ministry of Defence of USA. Amputation statistics 1 April2013-31 March 2018. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/728224/20180612_Amputation_Statistic_O_v2.pdf. Accessed: July 26, 2018.

Ministry of Defence of Ukraine. Available from: http://www.mil.gov.ua/news/2016/07/07/na-sogodni-vzhe-protezovano-92-vidsotki-zahisnikiv-batkivshhini-z-nih-90-vidsotkiv-na-proteznih- pidpriemstvah-ukraini--/. Accessed: July 7, 2016.

Resnik L, Borgia M. Reliability of outcome measures for people with lower-limb amputations: Distinguishing true change from statistical error. Phys Ther. Apr 2011;91(4):555-565.

Sinha R, van den Heuvel WJ, Arokiasamy P. Adjustments to amputation and an artificial limb in lower limb amputees. Prosthet Orthot Int. Apr 2014;38(2):115-121.

Tsema IE, Bespalenko A. Analysis of limb amputations during armed conflict at the East of Ukraine. Norwegian Journal of Development of the International Science. 2016;(1):79–80.

Tuncay T, Musabak I. Problem-focused coping strategies predict posttraumatic growth in Veterans with lower-limb amputations. Journal of Social Service Research. 2015/08/08 2015;41(4):466-483.

U.S. Department of Veteran Affairs, Department of Defense. Rehabilitation of Lower Limb Amputation. Available from: https://www.healthquality.va.gov/guidelines/Rehab/amp/ Accessed: September, 2017

VA Amputee Data Repository. VHA Support Service Center. January 2017.

Varma P, Stineman MG, Dillingham TR. Epidemiology of limb loss. Phys Med Rehabil Clin N Am. Feb 2014;25(1):1-8.

Webster JB, Poorman CE, Cifu DX. Guest editorial: Department of Veterans Affairs Amputations System of Care: 5 years of accomplishments and outcomes. J Rehabil Res Dev. 2014;51(4):vii-xvi.

Wegener ST, Mackenzie EJ, Ephraim P, Ehde D, Williams R. Self-management improves outcomes in persons with limb loss. Arch Phys Med Rehabil. Mar 2009;90(3):373-380.

Published
2020-06-24
How to Cite
BespalenkoА. А., ShchehlіukO. I., Kikh, A. Y., BuryanovО. А., Volyansky, O. M., Korchenok, V. V., & Myhailovska, M. (2020). ALGORITHM FOR REHABILITATION OF COMBAT-RELATED PATIENTS WITH LIMB AMPUTATIONS BASED ON MULTIPROFESSIONAL AND INDIVIDUAL APPROACH. Ukrainian Journal of Military Medicine, 1(1), 64-72. https://doi.org/10.46847/ujmm.2020.1(1)-064
Section
Current aspects of diagnosis and treatment