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VOLUME 3, ISSUE 2 

 2020 

 

RESEARCH ARTICLE 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 

amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020;Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

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https://doi.org/10.33137/cpoj.v3i2.34471


 

1 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

 

 

 
RESEARCH ARTICLE 

 

HEMODIALYSIS IS NOT ASSOCIATED WITH PRE-PROSTHETIC INPATIENT REHABILITATION 
OUTCOMES AFTER DYSVASCULAR LOWER EXTREMITY AMPUTATION: A RETROSPECTIVE 
COHORT STUDY  

 
Journeay W.S.1,2 *, Marquez M.G.3, Kowgier M.4 
 

1 Providence Healthcare – Unity Health Toronto, Toronto, ON, Canada. 
2 Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada. 
3 Department of Anatomy and Cell Biology, McGill University, Montreal, Canada. 
4 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

Diabetes and peripheral arterial disease along with 

associated dysvascular complications are major risk factors 

for lower extremity amputation (LEA).1-4 Peripheral arterial 

disease and diabetes are associated with greater than 80% 

of LEA in Canada4,5 and recent data published by Hussain 

et al.,6 concluded that diabetes-related amputations are on 

the rise. Patients with comorbid diabetes and end-stage 

renal disease (ESRD) receiving hemodialysis (HD) are at 

particularly high risk of LEA.7-9  

Individuals with dysvascular limb loss that also receive HD 

often have additional comorbidity, mortality and poorer 

ambulatory outcomes.8,10-14 Other common comorbidities in 

patients living with dysvascular amputation include 

 
OPEN  ACCESS Volume 3, Issue 2, Article No.2. 2020 

 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

 

ABSTRACT 

BACKGROUND: Lower extremity amputation due to complications from peripheral vascular disease 

and/or diabetes are common and these patients often have multiple comorbidities. Patients with end-

stage renal disease receiving hemodialysis (ESRD/HD) are a particularly vulnerable group at risk for 

amputation. After lower extremity amputation (LEA) surgery, many patients undergo post-operative 

inpatient rehabilitation to improve their pre-prosthetic functional independence. Given the increased 

complexity of dysvascular patients living with ESRD/HD compared to those without ESRD/HD, the 

association of HD with pre-prosthetic inpatient functional outcomes warrants further study. 

OBJECTIVE: The objective of this study was to compare the pre-prosthetic functional outcomes and 

Length of Stay (LOS) among patients with recent dysvascular LEA with and without ESRD/HD. 

METHODOLOGY: A retrospective cohort design was used to analyze a group of 167 patients with 

unilateral, dysvascular limb loss who were admitted to inpatient rehabilitation with 24 of these patients in 

the ESRD/HD group.  Age, gender, amputation level, amputation side, length of stay (LOS), time since 

surgery, Functional Independence Measure (FIM) scores (admission and discharge), and Charlson 

Comorbidity Index (CCI) were collected.  

FINDINGS:  There was no difference between patients with dysvascular amputation with and without 

ESRD/HD in the association of functional outcomes or LOS in this cohort and rehabilitation model. The 

CCI score was higher in the ESRD/HD group. Multivariate analysis indicated an inverse relationship with 

age and FIM scores, where increased age was associated with lower Total and Motor FIM at admission 

and discharge. There were no associations with FIM change. Age was positively associated with LOS. 

Being female was inversely associated to motor FIM scores at admission and discharge 

CONCLUSION: Among patients with recent dysvascular LEA, ESRD/HD is not associated with different 

functional outcomes or LOS in the pre-prosthetic inpatient rehabilitation setting. This suggests that 

despite added comorbidity that patients with ESRD/HD may still benefit from inpatient rehabilitation to 

optimize pre-prosthetic function. 

ARTICLE INFO 

Received: July 13, 2020 

Accepted: August 30, 2020 

Published: September 4, 2020 

CITATION 

Journeay W.S., Marquez M.G., 

Kowgier M. Hemodialysis is not 

associated with pre-prosthetic 

inpatient rehabilitation outcomes 

after dysvascular lower extremity 

amputation: a retrospective 

cohort study. Canadian 

Prosthetics & Orthotics Journal. 

2020; Volume 3, Issue 2, No.2. 

https://doi.org/10.33137/cpoj.v3i

2.34471 

KEYWORDS 

Dysvascular amputation, End-

stage renal disease, 

Hemodialysis, Inpatient 

rehabilitation, Charlson 

comorbidity index  

 

* CORRESPONDING AUTHOR: 
Dr. W. Shane Journeay, PhD, MD, MPH, FRCPC, BC-Occ Med  
Providence Healthcare – Unity Health Toronto,  
3276 St Clair Avenue East, Toronto ON M1L 1W1 
E-mail: shane.journeay@utoronto.ca 
ORCID: https://orcid.org/0000-0001-6075-3176 
 

https://doi.org/10.33137/cpoj.v3i2.34471
https://jps.library.utoronto.ca/index.php/cpoj/index
https://doi.org/10.33137/cpoj.v3i2.34471
https://doi.org/10.33137/cpoj.v3i2.34471
https://orcid.org/0000-0001-6075-3176


 

2 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

ISSN: 2561-987X HEMODIALYSIS AND PRE-PROSTHETIC INPATIENT REHABILITATION 
Journeay et al. 2020 

 
CPOJ 

 
hypertension, diabetes, heart disease and peripheral 

arterial disease. Data on the specific relationships between 

comorbidity and inpatient rehabilitation functional outcomes 

after LEA are still emerging15,16 with relatively less published 

on the rehabilitation of patients needing HD.11,17 Patients 

receiving HD tend to be medically complex and need to 

attend HD while also undergoing rehabilitation, which can 

potentially impact the course of an inpatient rehabilitation 

admission after LEA. Moreover, patients with ESRD tend to 

have more advanced comorbid disease and frailty18 and 

therefore LEA is often a significant medical event requiring 

post-operative rehabilitation.19 Given the poor long-term 

outcomes of patients with dysvascular amputation receiving 

HD7,10,12,20 it remains important to determine the post-

operative, inpatient functional outcomes and rehabilitations 

needs as many patients will need to achieve a functional 

status sufficient to return home.21 

Inpatient rehabilitation after LEA is particularly beneficial as 

it is associated with fewer additional amputations, reduced 

mortality, a greater probability of receiving a prosthesis, and 

improved medical stability.22-24 Regardless of one’s 

prosthetic candidacy, patients undergoing amputation have 

a number of post-operative rehabilitation needs including 

wound care, transfer training, wheelchair skills and 

contracture prevention which are needed to facilitate a safe 

discharge from a rehabilitation hospital. One commonly 

used measure of functional change in the inpatient 

rehabilitation setting is the Functional Independence 

Measure (FIM).25,26 

Previous work by Arneja et al.11 demonstrated that patients 

with recent limb loss who were receiving HD had a longer 

length of stay (LOS) in rehabilitation and lower FIM scores 

than patients who did not require HD. This retrospective 

study included prosthetic rehabilitation outcomes with FIM 

scores reported at discharge from inpatient rehabilitation 

and at mean follow up of 13.8 months (3-31 months). They 

did not include a standardized index of comorbidity or 

admission FIM scores.  Czyrny & Merrill27 also compared 19 

patients with LEA with ESRD receiving HD and 19 patients 

with peripheral vascular disease-related amputation not 

receiving HD. They studied ambulatory outcomes in 

addition to FIM at admission, discharge and FIM change. 

They noted an increased burden of comorbidity in the ESRD 

group but found no differences between the two groups in 

functional outcomes at discharge which included 

ambulation with a prosthesis. 

We aimed to compare the pre-prosthetic functional 

outcomes and LOS among patients with dysvascular LEA 

with and without ESRD/ HD. This work adds to the literature 

by using the Charlson Comorbidity Index (CCI) in this 

population and capturing both the admission and discharge 

FIM for pre-prosthetic, post-operative inpatient rehabilitation 

in patients with recent LEA. 

METHODOLOGY 

This was a retrospective cohort study and was approved by 

the  Research  Ethics  Board of  Providence  Healthcare  

and closed by the Unity Health Toronto Research Ethics 

Board. All patients with a LEA that were discharged from our 

rehabilitation hospital between January 1, 2014 and March 

30, 2018 were identified and their medical records were 

reviewed. Inclusion criteria for the study consisted of those 

with a recent unilateral, transfemoral (TF) or transtibial (TT) 

amputation. Only patients with amputations due to a 

dysvascular etiology were included, and those due to 

trauma, cancer, or other reasons were excluded. Those 

patients receiving HD who also met the inclusion criteria 

were included. Inclusion and exclusion criteria were 

developed to establish a uniform data set of the most 

common reason for admission to post-amputation inpatient 

rehabilitation (dysvascular amputation). Patients who met 

inclusion criteria but had an incomplete data set were 

excluded. All data retrieved from medical records came from 

both physical charts and electronic files utilized by Health 

Information Management at the hospital.  

The rehabilitation model at this institution involved post-

operative interdisciplinary rehabilitation including physio-

therapy, occupational therapy, nursing, wound care, and 

physiatry consultation. Patients did not receive HD on-site 

but were able to travel to their HD treatments at outside 

facilities three days per week. The focus of rehabilitation for 

these patients was solely pre-prosthetic rehabilitation which 

includes, but is not limited to: wound care, standing 

tolerance, contracture prevention, ADLs, transfers, and 

wheelchair skills. Patients were discharged home after pre-

prosthetic rehabilitation and then were revisited regarding 

prosthetic candidacy and gait training at a later date.  

Data that was extracted from the medical records included 

age, sex, amputation level, amputation side, surgery date, 

LOS in inpatient rehabilitation, FIM scores at admission and 

discharge,25,26 and CCI total score.28,29 The authors are 

aware that the CCI was initially used as an epidemiological 

tool to predict mortality in patients admitted to hospital. 

However, we have selected the CCI as a standardized 

method in which to catalogue comorbidities and have used 

it in previous published work.15 Each patient was reviewed 

using the CCI and assigned points for the individual 

conditions, then given a total score. These scores were 

based on information present upon their admission and any 

past medical history that was documented in the chart. The 

time since surgery was also recorded by calculating the 

number of days between the surgery date and the 

admission date to inpatient rehabilitation. LOS in 

rehabilitation was calculated from admission date to 

discharge date. Total FIM, and total motor FIM, information 

was retrieved from admission and discharge data. We 

included motor FIM because in the pre-prosthetic phase of 

rehabilitation the motor FIM scores would reflect acquisition 

https://doi.org/10.33137/cpoj.v3i2.34471


 

3 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

ISSN: 2561-987X HEMODIALYSIS AND PRE-PROSTHETIC INPATIENT REHABILITATION 
Journeay et al. 2020 

 
CPOJ 

 
of independence with transfers and wheelchair mobility as 

this study did not examine prosthetic gait outcomes.   

Statistical Methods 

Continuous variables were summarized by observed means 

with standard deviation (SD) and categorical variables were 

summarized by frequency counts (percentages). Univariate 

and multivariate linear regression analyses were used to 

investigate the effect of HD on each of the outcomes of Total 

and Motor FIM, at both admission and discharge separately 

(i.e., cross-sectional effects), as well as LOS.  To investigate 

the longitudinal effects, changes between discharge and 

admission were computed for both Total (FIM Total change) 

and Motor FIM (Motor FIM Change). Univariate and 

multivariate linear regression analyses were used to 

investigate the effect of HD on each of the outcomes of FIM 

Total Change and Motor FIM Change. Multiple regression 

analysis adjusted for clinically relevant variables including 

age, sex, amputation level, amputation side, and the 

Charlson Comorbidity Index. Data was analyzed using the 

R statistical software (version 3.5.1). 

RESULTS 

All patients admitted with a diagnosis of LEA from January 

1, 2014 to March 30, 2018 were identified by our medical 

records team for a total of 382 records.  Three patients were 

excluded due to death prior to discharge. Four patients were 

excluded due to incomplete admission to discharge data 

sets. Two hundred and eight patients were excluded by not 

meeting inclusion criteria such as: etiology of amputation 

(i.e. not dysvascular), had bilateral amputations, or were not 

TT or TF level amputations (i.e. only forefoot or toe 

amputation), or were not admitted post-operatively but 

rather for other reasons such as gait training or other 

medical conditions. There was a total of 167 patients with 

dysvascular amputation meeting the inclusion criteria with 

24 of these patients receiving HD (Table 1).  

A descriptive comparison of the dysvascular and 

dysvascular with ESRD/HD groups showed a significant 

difference between the CCI scores [4.7 (SD=1.7) vs 8.0 

(SD=1.7)], P<0.001. Table 1 presents further descriptive 

data, and a demographic comparison of the dysvascular 

only and HD groups. 

After univariate analysis, age was negatively associated 

with both Total FIM at admission (Beta -0.58, CI [ (-0.78) - 

(-0.39)], P<0.001) and at discharge (Beta -0.48, CI [ (-0.66) 

- (-0.29)] P<0.001). Age was also associated with motor FIM 

at admission (Beta -0.44, CI [ (-0.60) - (-0.28)] P<0.001) and 

at discharge (Beta -0.34, CI [ (-0.49) - (-0.19)] P<0.001).  

Sex was also associated with motor FIM at admission (Beta 

-4.13, CI [ (-7.99) - (-0.27)], P=0.038) and discharge (Beta -

4.28, CI [ (-7.83) - (-0.73)], P=0.019). Age showed a 

relationship with LOS that was nearly statistically significant 

in the univariate analysis (Beta 0.25, CI [ (-0.01) - (0.50)], 

P=0.066) and was therefore carried forward in the 

multivariate analysis. There were no associations between 

the HD vs no HD. The remaining univariate analyses are 

presented in Table 2. 

The factors that showed an association after the univariate 

analysis or were clinically relevant were then adjusted using 

multivariate analysis. Greater age was shown to be 

associated with lower Total FIM scores at admission 

(Estimate -0.59, SE 0.10, P<0.001) and discharge (Estimate 

-0.49, SE 0.10, P<0.001). Age was associated with motor 

FIM at admission (Estimate -0.46, SE 0.08, P<0.001) and 

discharge (Estimate -0.33, SE 0.08, P<0.001). Being female 

was inversely associated to motor FIM scores at admission 

(Estimate -4.50, SE 1.84, P=0.016) and discharge (Estimate 

-4.21, SE 1.75, P=0.017). Age was positively associated 

with LOS (Estimate 0.28, SE 0.14, P=0.044). Table 3 

includes remaining data from multivariate analysis. 

Table 1: Cohort description. *P<0.05.  

 

DISCUSSION  

The objective of this study was to examine the association 

of HD with  pre-prosthetic inpatient rehabilitation outcomes 

and LOS in a cohort of patients with dysvascular LEA. 

Notable findings from this study included: 1. Both groups of 

patients were similar in the amputation characteristics 

however patients with HD had a higher CCI indicating a 

greater burden of comorbidity 2. Despite a higher CCI in the 

HD group there was no difference in FIM scores or LOS. 3. 

Age and sex were associated with Total and motor FIM at 

admission and discharge and age was associated with 

LOS. 

  

  
Dysvascular Cohort 

 No Hemodialysis 
n=143 

Hemodialysis 
n=24 

Age (years) 67.7 (SD=11.1) 64 (SD=7.4) 

Sex 
M 95(66%) 18(75%) 

F 48(33%) 6(25%) 

Amputation 

Level 

Transfemoral 59 (41%) 9 (38%) 

Transtibial 84 (59%) 15 (62%) 

Amputation 

Side 

Left 69 (48) 12 (50%) 

Right 74 (52) 12 (50%) 

Time since surgery to 

admission  (days) 
15.2 (SD=13.8) 17.3 (SD=10.6) 

Length of stay in 

rehabilitation (days) 
33.9 (SD=18.6) 32.4 (SD=17.2) 

Charlson Comorbidity Index 4.7 (SD=1.7) 8.0 (SD=1.7)* 

FIM scores 

Total 

Admission 
72.6 (SD=14.4) 73.2 (SD=13.5) 

Total 

Discharge 
97.5 (SD=14.3) 97.2 (SD=11.1) 

Motor Total 

Admission 
42.7 (SD=12.0) 42.3 (SD=12.6) 

Motor Total 

Discharge 
66.9 (SD=11.4) 65.8 (SD=9.5) 

Efficiency 0.9 (SD=0.5) 0.9 (SD=0.6) 

https://doi.org/10.33137/cpoj.v3i2.34471


 

4 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

ISSN: 2561-987X HEMODIALYSIS AND PRE-PROSTHETIC INPATIENT REHABILITATION 
Journeay et al. 2020 

 
CPOJ 

 
  

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https://doi.org/10.33137/cpoj.v3i2.34471


 

5 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

ISSN: 2561-987X HEMODIALYSIS AND PRE-PROSTHETIC INPATIENT REHABILITATION 
Journeay et al. 2020 

 
CPOJ 

 
This study is unique in that it examines the CCI in patients 

with dysvascular limb loss with and without ESRD/HD and 

the association with inpatient pre-prosthetic functional 

outcomes and LOS. Prior work would suggest that patients 

living with ESRD/HD have greater medical complexity and 

an increased number of comorbidities.11,14,20 However, our 

data add to the literature by reporting the CCI in an inpatient 

rehabilitation cohort. Our previous work examined the CCI 

and its components in a dysvascular group of patients with 

limb loss but excluded patients receiving HD.15 Given the 

literature suggesting a number of poorer outcomes after 

LEA we sought to compare this group to patients without 

ESRD/HD in the inpatient rehabilitation setting. While the 

CCI was higher in the HD group, we found no associations 

with FIM or LOS.  Although speculative, it is possible that 

increased comorbidity may be associated with poorer 

ambulatory outcomes, but is not associated with short-

duration pre-prosthetic functional gains. 

The literature would suggest that patients with dysvascular 

LEA who also have ESRD/HD have much higher mortality 

rates than those without HD and very low rates of 

ambulation with a prosthesis. One study reported that <10% 

of patients receiving HD retained their ability to ambulate at 

1-year after amputation.12 It has also been shown that in 

patients with dysvascular LEA that those who are 

ambulatory have higher survival than those who do not 

ambulate.12,14 While inpatient rehabilitation has been shown 

to increase the likelihood of receiving a prosthesis in those 

with limb loss,22 it remains unknown whether this is true in 

the ESRD/HD population. Therefore, after amputation 

surgery these patients may still benefit from inpatient 

rehabilitation to maintain their pre-prosthetic independence. 

Specifically, in patients living with ESRD/HD where survival 

and ambulatory outcomes are poor, post-operative inpatient 

rehabilitation can allow for medical monitoring, transfer and 

wheelchair training and assessment of ADL prior to 

discharge from the inpatient rehabilitation hospital setting.19 

Our data would suggest that despite greater comorbidity in 

patients with dysvascular amputation with ESRD/HD, there 

is no difference in Total and motor FIM or LOS compared to  

patients without ESRD/HD for pre-prosthetic inpatient 

rehabilitation.  

 A study by Arneja et al.11 examined functional outcomes of 

patients with LEA receiving HD and those without HD. In 

their study only discharge FIM scores were included, while 

our study contained both admission and discharge FIM. 

Additionally, their study examined various comorbidities but 

did not use an established index such as the CCI. Overall, 

in our study the total CCI score did not show association 

with pre-prosthetic functional outcomes in this cohort after 

multivariate analysis. FIM changes and scores in our cohort 

indicate the acquisition of independence with ADL, transfers 

and wheelchair mobility as this study did not examine 

prosthetic gait outcomes. 

These patients are medically complex and admitted for pre-

prosthetic rehabilitation, so their functional change as 

reflected by the FIM would be different than studies that 

have included ambulation as an outcome. Given the 

increased comorbidities and frailty in the ESRD/HD group, 

this data suggests that patients undergoing dysvascular 

amputation can still derive benefit from pre-prosthetic 

rehabilitation even if they are receiving HD. Additionally, 

there was no association of comorbidity with LOS 

suggesting that despite an increased burden of  comorbidity 

and attendance at HD during rehabilitation, these patients 

can achieve a pre-prosthetic functional level that supports a 

safe discharge in a similar amount of time to non-ESRD/HD 

patients with recent LEA while admitted to inpatient 

rehabilitation. 

Age was a factor that was found to have an association with 

total and motor FIM at both admission and discharge, with 

advanced age associated with lower FIM scores. There was 

not an association with FIM change, however, suggesting 

that despite lower FIM at admission and discharge the rate 

of change during the inpatient stay was not associated with 

age. There are prior studies that support the notion that 

advanced age is associated with poorer functional 

outcomes in patients with limb loss.30,31 However, another 

report by Chopra et al.14 did not indicate an association 

between greater age and poorer ambulatory rates, which 

they attributed to their cohort size. It is also well established 

that age is a powerful prognostic factor in gait retraining 

after amputation.32 In other work, age was also associated 

with decreased survival post amputation in patients 

receiving HD.12 Thus, while age was associated with FIM at 

the time of admission and discharge, this group of patients 

did derive benefit from pre-prosthetic inpatient rehabilitation 

regardless of their future prosthetic candidacy. Additionally, 

age was associated with LOS, suggesting that the older, 

dysvascular patient with recent LEA may require additional 

time in hospital to reach pre-prosthetic functional 

independence. 

Limitations 

While prior reports indicated that ESRD/HD is associated 

with increased mortality and lower ambulatory function after 

dysvascular amputation,12,14,33 this cohort admitted for pre-

prosthetic rehabilitation was not impacted. This suggests 

that patients with dysvascular LEA admitted post-

operatively and who may never be prosthetic candidates 

may still benefit from inpatient rehabilitation to recover from 

surgery and restore independence prior to discharge even 

with ESRD/HD. The CCI reflects specific medical 

comorbidities however other factors may also play a role in 

rehabilitation after limb loss including the condition of the 

contralateral limb, visual impairments, delayed wound 

healing and mental health status, which could be explored 

in future studies. Furthermore, this cohort represents one 

post-amputation care model in Canada and therefore the 

https://doi.org/10.33137/cpoj.v3i2.34471


 

6 

Journeay W.S., Marquez M.G., Kowgier M. Hemodialysis is not associated with pre-prosthetic inpatient rehabilitation outcomes after dysvascular lower extremity 
amputation: a retrospective cohort study. Canadian Prosthetics & Orthotics Journal. 2020; Volume 3, Issue 2, No.2. https://doi.org/10.33137/cpoj.v3i2.34471 

ISSN: 2561-987X HEMODIALYSIS AND PRE-PROSTHETIC INPATIENT REHABILITATION 
Journeay et al. 2020 

 
CPOJ 

 
results may not be directly generalized to other forms of 

rehabilitation services in different centers. 

CONCLUSION 

We conducted this study to examine the role of ESRD/HD 

in pre-prosthetic inpatient rehabilitation functional outcomes 

and LOS in a cohort of dysvascular patients with recent 

lower extremity amputation. ESRD/HD was not associated 

with poorer FIM scores or LOS. In keeping with previously 

published work, we did find association with age and the 

admission and discharge total FIM, motor FIM and LOS. 

These data suggest that despite the medical complexity, 

higher mortality and poorer prognosis for ambulation after 

LEA in patients living with ESRD/HD, they have a similar 

pre-prosthetic, inpatient rehabilitation functional benefit as 

dysvascular patients who not have ESRD/HD. 

ACKNOWLEDGEMENTS 

The authors would like to acknowledge the staff in the Health 

Information Management office at Providence Healthcare for their 

support and assistance with this project. 

DECLARATION OF CONFLICTING 

INTERESTS 

The authors have no conflicts of interest to declare.  

AUTHOR CONTRIBUTION 

W. Shane Journeay: Conceived the study and design, data 

interpretation and led the manuscript writing. 

Michelle G. Marquez: Data collection, data interpretation, literature 

review and assisted in manuscript writing. 

Matthew Kowgier: Assisted in study design, led statistical analysis 

and contributed to manuscript development 

 

SOURCES OF SUPPORT 

Michelle G. Marquez received a Providence Healthcare student 

research stipend. 

ETHICAL APPROVAL 

This was a retrospective cohort study and was approved by the 

Research Ethics Board of Providence Healthcare and closed by the 

Unity Health Toronto Research Ethics Board. 

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