This is a proposal to continue and extend an ongoing prospective study of outcomes following high energy lower extremity trauma. The principal objectives of the Lower Extremity Assessment Project or 'LEAP' study were to (1) compare clinical and functional outcomes for those undergoing amputation versus successful reconstruction, (2) identify early clinical predictors of successful limb salvage and good functional outcomes, and (3) identify characteristics of the patient and his environment that mediate the quality of functional outcomes and quality of well being. The investigators propose to extend the followup to 5 years post-injury. Preliminary results of the 2 year follow-up indicate substantial improvement in physical function over time. However, 2 year outcomes are far from optimal. Only 50 percent of all patients are back to their major role activity; SIP scores are indicative of significant disability. Furthermore, little difference in outcomes was observed among those undergoing amputation versus reconstruction. Without longer term follow-up of these individuals, the investigators state they have an incomplete picture of recovery and expected levels of permanent impairment and disability over all patients, and by treatment. Although patients appear to have achieved a plateau in terms of clinical recovery, there is reason to believe that functional recovery may continue to improve for some patients; for others, function may deteriorate. The 5-year followup will address the following specific aims: (1) to determine the long term (5 year) outcomes and quality of life following high energy lower extremity trauma and to compare outcomes of those undergoing amputation during the initial hospitalization, amputation following discharge from the hospital, and successful reconstruction; (2) to estimate 5 year and lifetime costs associated with amputation versus reconstruction following high energy lower extremity trauma; and (3) to determine the correlates of good outcome at 5 years post injury for both amputation and reconstruction patients. In addition, they propose to extend analysis of the 2-year data to address several important clinical and methodological issues.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR042659-08
Application #
6511839
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Panagis, James S
Project Start
1993-07-25
Project End
2005-03-31
Budget Start
2003-04-01
Budget End
2005-03-31
Support Year
8
Fiscal Year
2002
Total Cost
$484,841
Indirect Cost
Name
Johns Hopkins University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Ellington, J Kent; Bosse, Michael J; Castillo, Renan C et al. (2013) The mangled foot and ankle: results from a 2-year prospective study. J Orthop Trauma 27:43-8
Castillo, Renan C; Wegener, Stephen T; Heins, Sara E et al. (2013) Longitudinal relationships between anxiety, depression, and pain: results from a two-year cohort study of lower extremity trauma patients. Pain 154:2860-6
Wegener, Stephen T; Castillo, Renan C; Haythornthwaite, Jennifer et al. (2011) Psychological distress mediates the effect of pain on function. Pain 152:1349-57
Castillo, Renan C; Mackenzie, Ellen J; Bosse, Michael J et al. (2011) Orthopaedic trauma clinical research: is 2-year follow-up necessary? Results from a longitudinal study of severe lower extremity trauma. J Trauma 71:1726-31
Archer, Kristin R; Castillo, Renan C; MacKenzie, Ellen J et al. (2010) Perceived need and unmet need for vocational, mental health, and other support services after severe lower-extremity trauma. Arch Phys Med Rehabil 91:774-80
Starman, James S; Castillo, Renan C; Bosse, Michael J et al. (2010) Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years. Clin Orthop Relat Res 468:1669-75
Pollak, Andrew N; Jones, Alan L; Castillo, Renan C et al. (2010) The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am 92:7-15
Archer, Kristin R; Mackenzie, Ellen J; Castillo, Renan C et al. (2009) Orthopedic surgeons and physical therapists differ in assessment of need for physical therapy after traumatic lower-extremity injury. Phys Ther 89:1337-49
O'Toole, Robert V; Castillo, Renan C; Pollak, Andrew N et al. (2008) Determinants of patient satisfaction after severe lower-extremity injuries. J Bone Joint Surg Am 90:1206-11
Castillo, Renan C; MacKenzie, Ellen J; Archer, Kristin R et al. (2008) Evidence of beneficial effect of physical therapy after lower-extremity trauma. Arch Phys Med Rehabil 89:1873-9

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