Recovering from spontaneous coronary artery dissection: Patient-reported challenges and rehabilitative intervention needs.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome that disproportionally affects younger women. The underlying etiology is incompletely understood, postmorbid psychological distress is high, and treatment plans are predominantly based on clinician experience. There remains uncertainty on how to adequately address the needs of patients with SCAD as part of secondary prevention. METHOD: As a Define and Refine phase of the ORBIT model (Phase 1), this study investigated SCAD patients' challenges and rehabilitative intervention needs using a qualitative research design. Patients with SCAD were purposively recruited to participate in structured interviews that were analyzed using inductive thematic coding techniques. RESULTS: Patients with SCAD (n = 15; 86.7% female; mean age = 47.5 years; data saturation reached with patient sample) expressed challenges in (a) navigating uncertainty associated with the disease; (b) living with anxiety; (c) reconciling pre and post-SCAD identities; (d) accurately identifying symptoms and experiencing a sense of isolation in recovery due to gender and young age; and (e) managing changing family dynamics and family members' stress. Intervention needs included (a) addressing unique demographic and cardiovascular profiles when designing programs for cardiac rehabilitation; (b) providing more psychological and peer support resources to address anxiety and sense of isolation; (c) disseminating information on rapidly evolving SCAD research; and (d) acknowledging and providing support to the family system. CONCLUSIONS: The results signal curricula to be included in tailored SCAD programming and underscore the need for further study and dissemination of optimal secondary preventative care for this patient population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Transition to Home-Based Treatment Plans for Center-Based Cardiac, Pulmonary, and Vascular Rehabilitation during COVID-19.

BACKGROUND: Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD: Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS: Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS: Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.

[Current issues of rehabilitation of the disabled older persons with limb loss due to obliterative arterial disease.]

Utilization of prosthetic and orthotic care services among patients with limb stump due to obliterative diseases of peripheral arteries was analyzed based on population register of limb amputations. It was established that not more than 34% of patients apply for primary prosthesis after lower limb amputation. This rate decreases among patients older than 60 years, and significantly decreases among patients older than 70 years - down to 16,2%. In order to improve the mobility level and quality of life among this population of patients it is considered to design and implement interdepartmental rehabilitation programs in the regions.

Exploring the role of physical activity and exercise for managing vascular comorbidities in people with multiple sclerosis: A scoping review.

INTRODUCTION: Vascular comorbidities are prevalent among people with multiple sclerosis (MS) and have adverse disease-related consequences. In the general population, physical activity (PA) and exercise training have proven beneficial at all levels of vascular disease risk management. People with MS exhibit particularly low rates of PA; therefore, PA represents a modifiable health behavior for potentially managing vascular comorbidity risk in MS, and in turn, reducing disease burden. However, points of evidence justifying such an approach have yet to be summarized. OBJECTIVE: To conduct a scoping review of existing evidence linking PA and exercise training to potential modification of vascular comorbidities and related risk factors in people with MS. METHODS: We searched five electronic databases (PubMed, Ovid MEDLINE, Embase, PsycINFO, and CINAHL Plus) from inception to November 2017, for articles involving relevant vascular comorbidities (obesity, hyperlipidemia, heart disease, hypertension, and diabetes) in people with MS in conjunction with measures of PA, physical fitness, sedentary behavior, or exercise training. Studies were limited to English-language and primary research articles. Data were extracted and summarized by comorbidity type and study design (observational vs. interventional). RESULTS: Our initial search identified 1028 articles; subsequent screening resulted in 34 articles meeting the final inclusion criteria, including both observational (n = 17) and interventional (n = 17) studies. Most of the articles reported on obesity (n = 29), although evidence surrounding hyperlipidemia (n = 5), arterial function and hypertension (n = 5), and diabetes (n = 5) was also identified. Data supporting a beneficial role for PA or exercise training could be drawn from each comorbidity category. Overall, 14 of the 17 observational studies identified (82.4%) reported an association between higher levels of PA or cardiorespiratory fitness, or decreased sedentary behavior, and better function of at least one risk factor related to vascular comorbid conditions in people with MS. The efficacy of exercise training in limiting vascular comorbidity risk and burden was dependent upon intervention type and duration, with 9 of 17 interventional studies (52.9%) reporting improvement in at least one relevant measure of vascular comorbidity in participants with MS. CONCLUSIONS: Evidence points to a potential relationship between PA and exercise and risk factors related to vascular comorbidities in people with MS. PA and exercise training interventions may represent an effective therapeutic strategy for managing vascular comorbidities in people with MS, justifying further investigation.

Spontaneous Coronary Artery Dissection (SCAD): FEMALE SURVIVORS' EXPERIENCES OF STRESS AND SUPPORT.

PURPOSE: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic type of acute myocardial infarction that primarily affects young, healthy women without typical risk factors for heart disease. Few investigations have examined psychosocial variables in this population and none have looked at patient perceptions of the experience and stresses associated with having a SCAD event or the resources currently available to SCAD survivors. This investigation describes survivors' subjective experiences of SCAD. Participants also provided information about types and helpfulness of resources available to them post-SCAD, including cardiac rehabilitation. METHODS: Participants were recruited online and completed a one-time questionnaire. RESULTS: Participants (n = 409) completed a questionnaire concerning their experiences with their SCAD event in the 1 y and 2 wk prior to the SCAD event. Their responses reflected moderate to high perceptions of stress. Participants experienced the SCAD event as highly stressful and frightening and their heart health presents as a moderate-severe source of current, post-diagnosis stress. Spontaneous coronary artery dissection-based informational support was frequently rated as inadequate, whereas other supportive resources varied in their helpfulness and accessibility. Participants reported positive experiences in cardiac rehabilitation and strong interest in SCAD-specific, professionally led, online patient education and support groups. CONCLUSIONS: This study is the largest to date investigation of SCAD survivors and their experiences in this understudied and perhaps underrecognized condition. Opportunities for researchers and providers to develop, tailor, and disseminate SCAD-specific interventions are discussed.

Rehabilitation of patients with venous diseases of the lower limbs: State of the art.

BACKGROUND: To date, no document comprehensively focused on the complex issue of the rehabilitation of chronic venous diseases of the lower limbs. METHOD: This article overviews and summarizes current strategies concerning venous rehabilitation of lower limbs. RESULTS: Venous rehabilitation is based on four main strategies: (1) lifestyle adaptations and occupational therapies; (2) physical therapies; (3) adapted physical activities; (4) psychological and social support. Rehabilitative protocols must be tailored to the specific needs of each patient, depending on the severity of chronic venous disease and on the location and pattern of venous lesion(s), but also on age, motor deficits, co-morbidities and psychosocial conditions. CONCLUSIONS: Venous rehabilitation consists of non-pharmacologic and non-surgical interventions aiming at prevention of venous disease progression and complications, reduction of symptoms and improvement of quality of life. Well-designed clinical trials are required to evaluate the efficacy of the described rehabilitative protocols in influencing the evolution of venous disorders.

Usefulness of Cardiac Rehabilitation After Spontaneous Coronary Artery Dissection.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction; however, the role of cardiac rehabilitation (CR) for patients with SCAD has not been well defined. To further understand CR in patients with SCAD, we studied a large cohort of patients with confirmed SCAD enrolled in the Mayo Clinic SCAD Registry from January 2010 to December 2014 (n = 354). Demographics, clinical characteristics, mental health status, and details about CR participation and experience were collected through medical record review and questionnaires. Participants at time of SCAD were 46 ± 10 years old; 96% were women. Most (76%) attended ≥1 CR sessions, averaging 18 ± 12 sessions. Most reported CR-related physical and emotional benefits (82% and 75%, respectively). Of the CR nonparticipants, 57 of 85 reported not participating because CR was not recommended by their health care provider. Other reasons included inadequate transportation (10 of 85), no insurance coverage (7 of 85), cost (2 of 85), no energy (2 of 85), being too ill (2 of 85), and miscellaneous comments (5 of 85). In conclusion, 3 of 4 of patients with SCAD participated in CR, most of whom reported benefit. Lack of recommendation for CR by a health care provider was the primary reason patients did not participate.

The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results.

BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear. METHODS: We designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered. RESULTS: We report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001). CONCLUSIONS: This is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.

Cardiac rehabilitation after spontaneous coronary artery dissection.

PURPOSE: Although cardiac rehabilitation (CR) improves outcomes in patients after atherosclerotic myocardial infarctions, little is known of the CR benefit among patients with spontaneous coronary artery dissection (SCAD), who are primarily young, otherwise healthy women. The purpose of this study was to describe SCAD patient outcomes in phase 2 outpatient CR. METHODS: Patients with SCAD who enrolled in CR were retrospectively identified. Patients participated in standard CR, which included supervised and independent flexibility, stretching, aerobic, and strength training exercises. Patients received counseling regarding nutrition, weight and stress management. Assessments at baseline and program completion included cardiopulmonary exercise testing or 6-Minute Walk Test, body composition using plethysmography, depression (Patient Health Questionnaire-9), and stress (a scale of 1-10) scores. RESULTS: Nine patients, all women, enrolled in CR an average of 12.3 days (range, 7-21 days) after their SCAD event, with one enrolling again after a recurrence. Cardiac rehabilitation was well received, with participants completing an average of 28 CR sessions (range, 5-39 sessions). Patients did not report cardiac symptoms and there were no adverse events during exercise testing or training. Peak oxygen uptake increased by an average of 18% (n = 4) and 6-minute walk distance increased 22% (n = 4). Average body mass decreased 1.1 kg, fat mass decreased 1.6 kg, and lean mass increased 0.4 kg. Depression and stress scores improved by an average of 2.3 and 1.3 points, respectively. CONCLUSIONS: Standard CR beginning 1 to 2 weeks after SCAD seems to be feasible and safe and results in improved aerobic capacity, body composition, and measures of depression and stress. Because of these benefits, we recommend that patients with SCAD participate in CR.

Integrated cardiovascular rehabilitation: how do noncardiac and polyvascular disease patients fare?

INTRODUCTION: The burden of noncommunicable disease is increasing. Preliminary evidence suggests that benefits of cardiovascular rehabilitation (CR) participation are also observed in patients with stroke and diabetes (vascular diseases [VDs]). This study compared (1) CR utilization by clinical indication; (2) sociodemographic and clinical characteristics of VD patients who participate in CR versus those who do not; and (3) change in risk factors, functional capacity, psychosocial well-being, and health behaviors from pre- to postprogram in cardiac versus VD patients who participated in CR. METHODS: This multisite study invited new CR patients to complete a survey preprogram and again 6 months later. Clinical data including risk factors and exercise test results were extracted from patients' charts at both time points. The surveys included the Duke Activity Status Index, the Godin Leisure-Time Exercise Questionnaire, the Morisky Medication Adherence Survey, and the Patient Health Questionnaire. RESULTS: Overall, 237 (84.0%) completed the pre-CR survey, and 201 (71.3%) completed the final survey. Cardiac patients (n = 104, 68.9%) were significantly more likely to complete CR than VD patients (n = 37, 54.4%; P = .039). Vascular disease patients who enrolled in CR engaged in more physical activity pre-program (P < .05). Cardiac patients who attended CR achieved significant improvements in activity status, exercise behavior, and nutrition at the posttest (P < .01 for each). Among VD patients, there were trends toward lower depressive symptoms and greater exercise in those who participated in CR by posttest. CONCLUSIONS: This study of integrated chronic disease management provides preliminary support for the benefits of CR for patients with vascular disease.

A case of Vernet syndrome associated with internal jugular phlebectasia.

A 36-year-old woman presented with right shoulder weakness after a left parotid tumor resection. The overall clinical presentation included severe paralysis and atrophy of the right sternocleidomastoid and upper trapezius, an absent right gag reflex, and diminished right posterior tongue pinprick sensation. A diagnosis of right-sided Vernet syndrome (cranial nerve IX, X, XI lesions) was made, presumably from compression of cranial nerves by internal jugular vein phlebectasia. To our knowledge, this is the first case report of spontaneous Vernet syndrome associated with internal jugular vein phlebectasia in the absence of other lesions of the jugular foramen.

[Development of the rehabilitation system for wounded during the late hospital stage].

The current article deals with the main methods of development of the rehabilitation system for wounded during the late hospital stage. The problems of specialized rehabilitation for injured, patients of cardiology and neurology and the application of the newest rehabilitation techniques used to optimize medical aid in order to promote professional qualities recovery experience are also considered.

Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study.

BACKGROUND: The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context. METHODS: An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used. RESULTS: The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility. CONCLUSION: The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.

Disminución de la presión arterial en pacientes con arteriopatía periférica mediante el masaje reflejo del tejido conjuntivo / Decrease in blood pressure in patients with peripheral arterial disease by connective tissue reflex massage

Objetivos: Evaluar la eficacia del masaje reflejo del tejido conjuntivo en la presión arterial sistólica y diastólica en pacientes con enfermedad arterial periférica. Metodología: Participaron en el estudio 26 pacientes con enfermedad arterial periférica del Distrito Sanitario de Granada durante un período de intervención de 15 semanas. La muestra de estudio se dividió de forma aleatoria en grupo experimental y grupo control. Los criterios de exclusión fueron los siguientes: insuficiencia arterial periférica en estadios más avanzados, insuficiencia venosa periférica, insuficiencia cardíaca, renal o hepática. La variable independiente considerada ha sido la aplicación del masaje reflejo del tejido conjuntivo según el método de Elizabeth Dicke. Asimismo, la variable dependiente estudiada ha sido la evaluación de la presión arterial sistólica y diastólica en ambas extremidades superiores. Resultados: Se observan diferencias significativas entre la valoración basal y las valoraciones posbasales, entre los dos grupos de estudio, en la presión arterial diastólica derecha (basal, p<0,043; primera valoración, p<0,041; segunda valoración, p<0,047) y la presión arterial sistólica izquierda (basal, p<0,042; primera valoración, p<0,04; segunda valoración, p<0,049). Conclusiones: El masaje reflejo del tejido conjuntivo genera un descenso de la presión arterial en pacientes con enfermedad arterial periférica en estadio I(AU)

Aims: Evaluate the effectiveness of connective tissue reflex massage on systolic and diastolic blood pressure in patients with peripheral arterial disease. Methodology: Twenty-six patients with peripheral arterial disease from the Health District of Granada participated in the study during a 15-week intervention period. The study sample was randomly divided into an experimental group and a control group. Exclusion criteria were peripheral arterial insufficiency at more advanced stages, peripheral venous insufficiency, cardiac, renal or hepatic insufficiency. Application of the connective tissue reflex massage according to the method of Elizabeth Dicke was regarded as the independent variable. The dependent variable was evaluation of systolic and diastolic blood pressure in both upper limbs. Outcomes: Significant differences could be observed between the baseline and post-baseline evaluations between the two study groups in the right diastolic blood pressure (baseline, p<0.043; 1st evaluation, p<0.041; 2nd evaluation, p<0.047), and left systolic blood pressure (basal, p<0.042; 1st evaluation, p<0.04; 2nd evaluation, p<0.049). Conclusions: Connective tissue reflex massage causes a blood pressure decrease in patients with stage I peripheral arterial disease(AU)

[Organizational aspects in one phlebology center: the Tuscany model]. / Aspetti organizzativi di un centro di flebologia: il modello toscano.

The author reports about the organization of the phlebology center at the University of Siena, directed since 1985 by Professor Mancini. The center is equipped with 5 phlebology outpatient settings, with own instruments for non-invasive vascular diagnostics, with one operating theatre and with own equipment for phlebological rehabilitation. At present, in this center a group of specialist doctors and experts in phlebological formation works and practices everyday more than 30 performances instrumental vascular diagnostic both in election, both also in urgency for the patients coming from the Ready Aid. The therapeutic performance, which the phlebology surgical activity, the sclerotherapy, the ulcer dressing, are carried out on specific days of the week. The organization of the Center of Phlebology has to answer indeed to the demands of the use, simplifying the procedures of access, decreasing the times of attended of the diagnostic performance and the therapeutics and the reducing to the least one the interferences with the common habits of life, kind of the elderly patients.

Efficacy of computer-aided dosing of warfarin among patients in a rehabilitation hospital.

OBJECTIVE: To determine whether computer-aided dosing of warfarin is superior to physician dosing to maintain a patient in a rehabilitation hospital within a target international normalized ratio goal. DESIGN: Randomized, double-blinded, clinical trial in an inpatient rehabilitation hospital. A total of 30 consecutive patients admitted receiving warfarin were randomized to either clinician dosing or computer-aided warfarin dosing for the duration of their hospitalization. The main outcome measures included the percentage of days in a therapeutic anticoagulation range and the number of blood draws. Exclusion criteria included short length of stay (n=110, 39%) and a physician declared international normalized ratio target range of <2.0 (n=67, 23%). A total of 73 patients were excluded because of heme-positive stools at admission, recent gastrointestinal bleed, early discharge or consent refusal. Dawn AC software was used to determine warfarin dosage and frequency of blood draws to maintain a target international normalized ratio of 2.0-3.0 for the computer-dosed group (n=14). Several physicians recommended warfarin dosages for the second group (n=16). Two were dropped from the computer model secondary to lost data files for these two patients. RESULTS: Computer-aided dosing of warfarin resulted in 61.7% of days within the therapeutic range (international normalized ratio, 2-3), whereas clinician dosing resulted in only 44.1%. There were no significant differences in the number of blood draws or demographic variables between the two groups. CONCLUSION: Computers were significantly better at maintaining patients within a therapeutic international normalized ratio range than physicians. There were no significant differences in the number of recommended blood draws.

Satisfaction with care in vascular surgery inpatient units.

OBJECTIVE: to identify and solve problems concerning satisfaction of inpatients in three different vascular surgery units. MATERIALS AND METHODS: a self-administered non anonymous questionnaire was submitted. Four dimensions of patients' satisfaction and a measure of overall satisfaction were evaluated. For each of them a logistic regression model was elaborated. RESULTS: one hundred and fifty-six eligible patients agreed to participate. For the "overall satisfaction" 56% rated the care received as excellent; patients completely satisfied for "treatment and related information" were 76%; for the "availability of staff" 96%, for "helpfulness and communication by staff" 56% and for "management of patient's complaint by medical staff" 86%. Logistic regression analysis showed, after adjustment for relevant background factors, a statistically significant difference among units of care for the overall satisfaction. CONCLUSIONS: the study highlighted the importance of considering in vascular units the patients' satisfaction as an essential component of quality of care independently of the severity of cases. The hospital management recognised the low level of communication by the staff as one of the hospital bottle-necks and tried to solve a logistic problem identified as responsible for a low score in the overall satisfaction in one unit.

Unna and elastic postoperative dressings: comparison of their effects on function of adults with amputation and vascular disease.

OBJECTIVES: To compare the functional outcome associated with the use of Unna semirigid dressings (SRD) and elastic bandage soft dressings (ED) for adults with lower limb amputation. DESIGN: Experimental design. SETTING: Inpatient rehabilitation unit of an urban academic medical center. PARTICIPANTS: A successive series of adults with vascular disease who had lower limb amputation surgery. Subjects were randomly assigned to the SRD (12 patients with 12 recent amputations) or the ED (9 patients with 10 recent amputations) group. Subjects in each group were not significantly different except for age; those in the SRD group were somewhat older. INTERVENTION: Subjects in the SRD group had Unna dressings applied to the amputation limb by physical therapists trained in the technique. Those in the ED group had elastic bandaging by therapists, nurses, family, and themselves, all of whom were trained in the technique. RESULTS: Sixty-seven percent of the SRD group and 20% of those in the ED group were discharged from the rehabilitation unit ambulating with prostheses. Of those who received prostheses, time from admission to the rehabilitation unit to readiness for fitting averaged 20.8 days for the SRD group and 28.7 days for the ED group. Comparison of survival curves shows that the time from surgery to fitting in the SRD group was almost half that of the ED group; 30% of the SRD group was fitted within 34 days, whereas it took 64 days for the same percentage of the ED group to be fitted. CONCLUSIONS: Unna semirigid dressings are more effective in fostering amputation limb wound healing and preparing the amputation limb for prosthetic fitting. Subjects treated with SRDs were more likely to be fitted with prostheses and to return home walking with a prosthesis.