To the Editor:

We read with great interest the paper concerning What’s New in Orthopaedic Rehabilitation by Hebela et al. (2004;86:2577-2581), and in particular the section concerning “Amputation Surgery and Prosthetics”. The authors conclude that “understanding the issues facing amputees may play a more important role than the level of amputation in determining function”. However, they do not describe how the physicians could use this knowledge to enhance recovery of their patients.

As the authors state, there is no direct correlation between the level of lower extremity amputation and the patients’ perceived level of function. Other authors (1) have reported several variables related to the prosthesis and patient social interaction, as well as psychological factors that are correlated to a patient’s perceived level of function. A better understanding of what a patient needs after amputation may represent the first step of a patient-centered educational program (2). The orthopaedic surgeon, as part of an interdisciplinary team, may use such data to determine therapeutic objectives that are compatible with the patients’ reality, and to understand what each patient must learn to satisfactorily progress through a rehabilitation program. This means that simply giving information to the patient about surgery, rehabilitation or the prosthesis may well be insufficient, and that this approach should be modified in order to allow for true patient learning, thus helping him to reach as much autonomy as possible.

References

1. Green GV, Short K, Easley M. Transtibial amputation. Foot Ankle Clin. 2001;6:315-327.

2. Assal JP. Revisiting the approach to treatment of long term illness: from the acute to the chronic state. A need for educational and managerial skills for long term follow-up. Patient Educ Couns. 1999;37:99- 111.