885 - Does Phantom Limb Pain Affect Inpatient Rehabilitation Clinical and Functional Outcomes?

Objectives: The prevalence of amputation survivors is rapidly growing and expected to double to 3.6 million by 2050. Phantom limb pain (PLP) is a common complication which occurs in 42-79% of amputees. Sometimes, patients require various post-acute care rehabilitation, including inpatient rehabilitation facility (IRF) hospitalization for comprehensive therapy in preparation for returning home. During IRF patients require are expected to engage in rigorous physical therapy and PLP may interfere with their participation. The objective of this study was to compare clinical and functional outcomes during an IRF stay in patients with and without PLP.

Design: National data from a large multicenter rehabilitation hospital system were queried for patients with lower extremity amputation (n=951). Patients were stratified by diagnosis of PLP (n=160 yes, n=791 no). IRF Patient Assessment Instrument functional scores (Section GG, 6-point independence ratings for self-care activities, body transfers, mobility). Clinical outcomes were discharge-to-home, length of stay (LOS), therapy time, discharge location, medical complications and acute care transfers (ACT).

Results: PLP patients were younger compared to those without (61.1±13.6 years vs 63.8±13.0 years), p=0.018); however, there were no differences in sex distribution (70.6% male PLP vs 75.1% male non-PLP, p=0.28), or BMI adjusted for limb loss (p=0.36). PLP patients had higher prevalence of polyneuropathy compared to non-PLP patients (p=0.002). Overall functional scores for PLP patients at admission were higher (9.4±6.2 points PLP vs 6.9±5.6 points non-PLP, p=0.021); however, they experienced similar improvement in functional score during IRF stay (26.9±11.8 PLP vs 24.0±12.5 non-PLP, p=0.23). There were no differences in physical therapy (p=0.64) or occupational therapy time (p=0.32), LOS (p=0.66), ACT rate (p >0.99) and proportion of patients discharged home (p=0.74).

Conclusions: PLP impacts neither participation in therapy, nor functional or clinical outcomes during an inpatient rehabilitation stay. Care teams can expect comparable rehabilitation outcomes if a patient with amputation presents with concurrent PLP.