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Survival Analysis in Amputees Based on Physical Independence Grade Achievement—Invited Critique
Michael T. Watkins, MD
Arch Surg. 2009;144(6):552.
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Stineman and colleagues studied the effect of functional recovery on survival after lower extremity amputation in a population of military veterans. This retrospective study used a published validated Physical Independence Grading System to express meaningful physical function profiles of progressive independence over time. They hypothesized that functional grades achieved by amputees would serve as predictors of mortality risk even after accounting for other risk factors. A large number of patients did not recover past the first grade of physical independence, indicating severe physical dysfunction in this cohort. Primarily, younger unmarried patients with fewer interventions achieved higher functional grades of physical activity, an intuitively reasonable conclusion. Concomitant with this observation was the finding that amputation level was not associated with mortality after adjusting for demographic data and other clinical characteristics; however, the overall age was still related to 6-month mortality. The finding that amputation level did not . . . [Full Text of this Article] AUTHOR INFORMATION
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