Relationship between models of care and key rehabilitation milestones following unilateral transtibial amputation: a national cross-sectional study

Objectives: Identify different models of care (MOC) post Trans-Tibial Amputation (TTA) and relate these to achievement of rehabilitation milestones.
Design: Retrospective analysis of rehabilitation milestone data and a survey of MOC in ten vascular centres.
Setting: NHS Scotland Vascular Centres.
Participants: All unilateral TTA between January 2011 and December 2014 (n = 643).
Main outcome measures: The time to achieve the rehabilitation milestones: compression therapy, early walking aid, casting for a prosthetic limb, prosthetic delivery, in-patient discharge and final discharge from rehabilitation. MOC were scored according to seven key aspects of service provision.
Results: Mean age of the cohort was 66.7 (±=12.5) years, 75.9% males and 62.8% had peripheral arterial disease with diabetes. Mean days to achieve rehabilitation milestones varied across centres: compression therapy (11.9 (±24.9); early walking aid (27.6 (±36.4); prosthetic casting 60.2 (±57.5); prosthetic delivery 73.8 (±59.8), in-patient discharge 67.6 (±54.8) and final discharge from rehabilitation 166.1 (±100.6). Only two centres included all seven key aspects of service provision within their MOC. Vascular centres who achieved the optimal MOC also achieved their rehabilitation milestones the quickest.
Conclusions: This study demonstrated a positive association between optimal MOC and early achievement of rehabilitation milestones post TTA. Key aspects of service provision associated with a quicker time to achieve rehabilitation milestones included: use of a post-operative rigid dressing; specialist physiotherapy input in the early post-operative period; daily in-patient gym sessions and in-patient prosthetic provision. This study is the first to document the MOC following TTA relating these to the achievement of rehabilitation milestones.