TRIA-MF protocol as an innovative tool in the comprehensive treatment and outcome evaluation of lower limb amputees before and after prosthesis use
Main Article Content
Abstract
Background: A structured multidisciplinary team is very important during every phase of the amputation process and a good communicative team guarantees a greater tranquility for the patient, thanks to more homogenous information, that is already discussed between the clinicians.
Aim: The aim of this study was to define the efficacy and outcome value of an innovative procedure tool (TRIA-MF protocol) in the treatment of lower limb amputees before and after prosthesis use with the purpose to quantify the quality of the procedure and its economic impact on the clinical patients’ recovery.
Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders.
Methods: 12 patients (4 women and 8 males) subjected to lower limb amputation and admitted according to the principles of inclusion criteria of the TRIA-MF protocol at the Rehabilitation Department of the Clinical Institute Città di Brescia were recruited in this study. All patients were included in an integrated and task-specific management protocol of the amputee, which allowed to follow the rehabilitation process from amputation to the final restoration, for a period of 6 months for each patient. Patients were evaluated 5 times during the study, collecting their degree of pain (VAS), their independence profile (Barthel Index) and the cirtometry of their amputation stump. Data on the duration of their admission to the rehabilitation unit, the inter-time between the amputation and acquisition of the temporary prosthesis, and between temporary prosthesis acquisition and the final prosthesis acquisition were also reported.
Results: Patients of our sample, at the end of their hospitalization, highlight a significant modification of the temporal data at 1 month and 6 months from their hospital discharge. A statistical significant increase of the Barthel Index value was observed in all patients recruited in this study proceeding from time T0 to time T4; in the same way, a statistical significant decrease of the VAS scale was observed in all patients recruited proceeding from time T0 to time T4; the cirtometry of the amputation stump (expressed in cm) showed a statistical significant decrease in all patients recruited proceeding from time T0 to time T4. We haven’t observed a statistical significant correlation between the duration of the rehabilitative hospitalization and our clinical data; no statistical significant correlation was observed between the amputation stump cirtometry time-related modification and our intertime data.
Conclusions: The protocol was found to be a clear and relevant tool with the definition of the operational profile for each single professional figure involved; it could also be considered as an optimal tool for coding the management and evaluation of the effectiveness of amputee treatment, with a related high reproducibility, sensitivity and specificity profile. In line with the literature, the TRIA-MF protocol has allowed us not to exceed a period of hospitalization in rehabilitation units of more than 23 days, thus showing that it is an excellent tool for optimizing the management costs of the amputee over time.
Article Details
Copyright (c) 2019 Falso M, et al.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Ippolito E, Flaviani L, Belcaro G. Amputazione degli arti inferiori nelle arteriopatie periferiche. Edizioni Minerva Medica, 2005; Ref.: https://goo.gl/j1zT7d
De Ciechi R. Ausili per persone adulte ed anziane amputate di arto inferiore. Corso di perfezionamento. Fondazione Don Carlo Gnocchi, 2009/2010. Ref.: https://goo.gl/nRLXoy
Zaniolo O. Costi del diabete in Italia. Farmaeconomia e percorsi terapeutici, 2009. Ref.: https://goo.gl/ketA1M
Geertzen J1, van der Linde H2, Rosenbrand K3, Conradi M4, Deckers J, et al. Dutch evidence-based guidelines for amputation and prosthetic of lower extremity: parts 2. Prosthet Orthot Int. 2015; 39: 361-371. Ref.: https://goo.gl/HSBRpk
Conte MS. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) and the (hoped for) dawn of evidence-based treatment for advanced limb ischemia. J Vasc Surg. 2010; 51(5 Suppl): 69S-75S. Ref.: https://goo.gl/R4UUR8
Klenow TD, Mengelkoch LJ, Stevens PM, Ràbago CA, Hill OT, et al. The role of exercise testing in predicting successful ambulation with a lower extremity prosthesis: a systematic literature review and clinical practice guideline. J Neuroeng Rehabil. 2018; 15(Suppl 1): 64. Ref.: https://goo.gl/Y3p5LC
Sanders JE, Fatone S. Residual limb volume change: Systematic review of measurement and management. J Rehabil Res Dev. 2011; 48: 949–986. Ref.: https://goo.gl/SGGe3G
Yahata T, Takeuchi A, Yoshida S, Tsuchiya H. Distinctive features of stump volume change in a fresh lower limb amputee with Parkes-Weber syndrome. BMJ Case Rep. 2014; 2014. pii: bcr2014206315. Ref.: https://goo.gl/fZ33fC
Highsmith MJ, Kahle JT, Klenow TD, Andrews CR, Lewis KL, et al. interventions to Manage Residual Limb Ulceration due to Prosthetic use in Individuals with Lower Extremity Amputation: A Systematic Review of the Literature. Technol Innov. 2016; 18: 115-123. Ref.: https://goo.gl/dWXT4H
Mendoza-Cruz F, Rodríguez-Reyes G, Galván Duque-Gastélum C, Alvarez-Camacho M. Comparative study of the volume difference vs. healthy limb, morphological and population description in transfemoral amputees. Rev Invest Clin. 2014; 66 Suppl 1: S85-93. Ref.: https://goo.gl/YW2Fti
Liu J, Lu N, Lou VWQ. Care tasks in the stress process for family caregivers in urban China. Clinical Gerontology. 2017; 40: 428-434. Ref.: https://goo.gl/Wf5uZq
Madsen UR, Hommel A, Bååth C, Berthelsen CB. 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. Ref.:
Rotariu M, Filep R, Turnea M, Ilea M, Arotăriţei D, Popescu M. Analyse of socket-prosthesis-blunt complex for lower limb amputee using objective measure of patient's gait cycle. Rev Med Chir Soc Med Nat Iasi. 2015; 119: 281-286. https://goo.gl/SxRqrA
Murray CD1, Simpson J, Eccles F, Forshaw MJ. Involvement in rehabilitative care and wellbeing for partners of people with an amputation. Psychol Health Med. 2015; 20: 71-76. Ref.: https://goo.gl/xJ3KKW
Mckechnie PS,John A. Anxiety and depression following traumatic limb amputation: a systematic review. Injury. 2014; 45: 1859-1866. Ref.: https://goo.gl/BfCyJ2
Horgan O,MacLachlan M. Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil. 2004; 26: 837-850. Ref.: https://goo.gl/kwvjTB
Augustin M, Baade K, Heyer K, Price PE, Herberger K, et al. Quality-of-life evaluation in chronic wounds: comparative analysis of three disease-specific questionnaires. Int Wound J. 2017; 14: 1299-1304. Ref.: https://goo.gl/kK7HRN