Self-reported functional outcomes after major lower extremity trauma may decline over time
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Results showed self-reported functional outcomes may decline over time among patients with major lower extremity trauma, especially among those who underwent early amputation.
In the Military Extremity Trauma Amputation/Limb Salvage (METALS) II study, Jessica C. Rivera, MD, PhD, and colleagues interviewed 277 patients with combat sustained major lower extremity trauma who underwent either reconstruction or amputation and were included in the METALS I study. Researchers compared the overall dysfunction score as well as the activities of daily living and mobility subscores of the Short Musculoskeletal Function Assessment (SMFA) between the initial interview in the METALS I study and the follow-up interview in the METALS II study.
In her presentation at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting, Rivera noted a significant difference in the SMFA self-reported dysfunction domain between the reconstruction and amputation groups about 3 years following injury.
“[I]f you wait for time to pass you can see that that gap actually narrows quite a bit,” Rivera said. “I will also point out that well over half of [the reconstruction patients] were reporting staying the same or maybe even getting a little bit better, while close to half of the patients with amputation limb status reported a decline in their dysfunction domain outcomes.”
The mobility domain had a similar outcome, according to Rivera, with a significant difference between the two groups at the initial interview followed by an increase in mobility for patients who underwent reconstruction and a decline in mobility for patients who underwent amputation.
“The emotional status domain of the SMFA is showing us those same results. There is a gap, the gap is smaller, the reconstruction [patients] are hanging in there and the amputation [patients] are getting worse,” Rivera said. “I would also point out that none of this approximates population norms for this particular patient reported outcome tool.”
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Rivera JC, et al. Long-term self-reported functional outcomes following unilateral major lower extremity combat injury – preliminary results from the METALS II Study Group. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 16-17, 2021; New York City.
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