Strength, Pain, Function in OIF/OEF Amputees: A Nurse-Managed Program.

摘要

The study compared two approaches to prosthetic rehabilitation treatment in military personnel with a unilateral trans-tibial amputation (TTA). A randomized control design assessed the effects of adding a home-based neuromuscular electrical stimulation (NMES) protocol to the standard prosthetic rehabilitation protocol. Methods: Participants in the NMES group received 12 weeks of electrical muscle stimulation 15-20 min/day, 5 days a week. Both groups received a 12-week standard Amputee rehabilitation protocol. The aims were to compare the two groups on: knee muscle strength; functional performance (mobility), QOL; and symptoms associated with residual and phantom limb pain. Sample: 45 subjects aged 18-55 yrs with traumatic TTA were randomly assigned to nurse-managed NMES Rehabilitation Program (n=23) or standard Amputee Protocol (n=22). Analysis: Linear mixed models compared the outcomes of both groups after 3, 6, 9 and 12 weeks. Multiple linear regression analysis was used for functional performance with 2 time points (after 6 and 12 weeks). Findings: Acceptance of the nurse-managed program was good as withdrawal rates were similar for both groups. No differences were found between the groups for any outcome measurement. Both groups showed improvement in strength in the amputated extremity, in functional performance, and in self- perception of functional capability. Implications for Military Nursing: Pain and reduced mobility are major problems for injured TTA warriors. The study examined a potentially useful intervention for our war fighters with a battle- related amputation by combining a nurse-managed NMES home-based program with in- clinic physical therapy. The goal of the nurse-managed program was to promote adherence, increase quality of life, enhance continuity of care, and promote better outcomes. The addition of the home-based program was well accepted, did not adversely impact rehabilitation and may represent a useful addition for some individuals. However, the study did not demonstrate quicker recovery as compared to in-clinic physical therapy.