Factors Influencing the Use of Inpatient Rehabilitation Services Among Amputees in Acute Hospitals: An Observational Study

截肢患者術後接受住院急性復健利用率的觀察性研究

黃雅鈴(Ya-Ling Huang) ； 楊明忠(Ming-Chung Yang) ； 武俊傑(Chun-Chieh Wu) ； 李棟洲(Tung-Chou Li)

《台灣復健醫學雜誌》 47卷1期 (2019/06) Pp. 67-77

https://doi.org/10.6315/TJPMR.201906_47(1).0007

摘要

Objective: To examine rates of inpatient rehabilitation (IR) use in a nationwide amputee and determine factors associated with receiving rehabilitation services during acute admission. Methods: This research is a retrospective observational study. We sampled data from a nationally representative sample of 1,000,000 enrollees of the single-payer government-based National Health Insurance (NHI) program in Taiwan from 1996 to 2013. Claims data for rehabilitation during index admission after amputation were analyzed, and factors associated with IR use were identified. Multivariable logistic regression was performed with adjustment for clustering to identify which factors were independently associated with acute IR referral. Results: Among the 5,162 amputees enrolled in this study, the primary reasons for amputation were diabetes (47.3%), trauma (32.4%), and peripheral vascular disease (10.7%). A total of 748 (14.5%) amputees received rehabilitation services during admission. The proportion of patients receiving rehabilitation services was low if the patient was older (OR: 0.52), received amputation due to DM (OR: 0.4), received minor lower limb amputation (OR: 0.44), was discharged from the internal medicine ward (OR: 0.68), or was hospitalized in a veteran hospital (OR: 0.23). Gender and dialysis did not influence the utilization of rehabilitation services. Conclusions: This study showed that both clinical characteristics and facility factors appear to influence the receipt of IR after amputation, thus suggesting that care patterns are not standardized across the nation. Prosthesis training is not equal to amputation rehabilitation, and identification of factors influencing the receipt of acute IR may help overcome barriers for the service and enhance the quality of healthcare.

關鍵字

Utilization ； Inpatient ； Rehabilitation ； Acute ； Amputation

並列摘要

目的：統計台灣截肢病人在該次手術後住院期間接受復健治療的比率，並探討影響截肢術後接受復健服務的相關因素。方法：利用1996年至2013年台灣健保資料庫的全國代表性百萬人抽樣檔，以回溯觀察性研究方式對病人在截肢手術該次住院過程中使用復健資源的數據進行分析。我們除了確定住院復健使用相關因素外，並進行了多變量邏輯回歸，並根據群聚類別進行調整，以確定哪些因素與急性住院使用復健服務的獨立相關因子。結果：在5162位截肢病人中，大多數截肢是由於糖尿病（47.3%），創傷（32.4%）或周邊血管疾病（10.7%）。住院期間共748人（14.5%）接受復健服務。若病人年齡較大（OR：0.52）、因糖尿病截肢（OR：0.4）、下肢踝關節以下截肢（OR：0.44）、從內科病房出院（OR：0.68）、或在榮民醫院住院（OR：0.23）的病人接受復健服務的比例較低。性別和透析不會影響復健服務的使用。結論：本研究顯示臨床特徵和設施因素似乎都會影響截肢病人接受住院復健的機會，這表示全國的復健照護模式並未標準化。義肢訓練不等於截肢復健，確認影響急性住院接受復健的因素有助於我們思考如何協助病患克服失能及併發症，並提高復健服務品質。

並列關鍵字

利用率（Utilization） ； 住院（Inpatient） ； 復健（Rehabilitation） ； 急性（Acute） ； 截肢（Amputation）

參考文獻

Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Arch Phys Med Rehabil 2009;90:634–45.

Madsen UR, Hommel A, Bååth C, et al. Pendulating—A grounded theory explaining patients' behavior shortly after having a leg amputated due to vascular disease. Int J Qual Stud Health Well-being 2016;11:32739.

Madsen UR, Bååth C, Berthelsen CB, et al. A prospective study of short-term functional outcome after dysvascular major lower limb amputation. Int J Orthop Trauma Nurs 2018;28:22–9.

Taylor SM, Kalbaugh CA, Blackhurst DW, et al. Preoperative clinical factors predict postoperative functional outcomes after major lower limb amputation: an analysis of 553 consecutive patients. J Vasc Surg 2005;42:227–35.

Hakimi KN. Pre-Operative Rehabilitation Evaluation of the Dysvascular Patient Prior to Amputation. Physical Medicine and Rehabilitation Clinics of North America 2009;20:677–88.