Purpose: The majority of lower limb amputations (LLAs) are undertaken in people with Peripheral Arterial Occlusive Disease (PAOD), approximately 50% have diabetes. Quality of life is an important outcome in LLAs, little is known about what influences it, therefore how to improve it. The aim of this systematic review was to identify the factors that influence quality of life after LLA for PAOD.Methods: MEDLINE, Embase, CINAHL, Psych Info, Web of science and Cochrane databases were searched to identify articles that quantitatively measured quality of life in those with a LLA for PAOD. Articles were quality assessed by two assessors, evidence tables summarised each article, and a narrative synthesis performed.Results: Twelve articles were included. Study designs and outcome measures used varied.Quality assessment scores ranged from 36% to 92%. The ability to walk successfully with a prosthesis had the greatest positive impact on quality of life. A trans-femoral amputation was negatively associated with quality of life due to increased difficulty in walking with a prosthesis. Other factors such as older age, being male, longer time since amputation, level of social support, and presence of diabetes also negatively affected quality of life.Conclusions: Being able to walk with a prosthesis is of primary importance to improve quality of life for people with lower limb amputation due to PAOD. In order to further understand and improve the quality of life of this population, there is a need for more prospective longitudinal studies, with a standardised outcome measure.3

Background:Diabetes mellitus is a leading cause of major lower extremity amputation.Objective:To examine the influence of gender, level of amputation and diabetes mellitus status on being fit with a prosthetic limb following lower extremity amputation for peripheral arterial disease.Study design:Retrospective analysis of the Scottish Physiotherapy Amputee Research Group dataset.Results:Within the cohort with peripheral arterial disease (n = 1735), 64% were men (n = 1112) and 48% (n = 834) had diabetes mellitus. Those with diabetes mellitus were younger than those without: mean 67.5 and 71.1 years, respectively (p < 0.001). Trans-tibial amputation:trans-femoral amputation ratio was 2.33 in those with diabetes mellitus, and 0.93 in those without. A total of 41% of those with diabetes mellitus were successfully fit with a prosthetic limb compared to 38% of those without diabetes mellitus. Male gender positively predicted fitting with a prosthetic limb at both trans-tibial amputation (p = 0.001) and trans-femoral amputation (p = 0.001) levels. Bilateral amputations and increasing age were negative predictors of fitting with a prosthetic limb (p < 0.001). Diabetes mellitus negatively predicted fitting with a prosthetic limb at trans-femoral amputation level (p < 0.001). Mortality was 17% for the cohort, 22% when the amputation was at trans-femoral amputation level.Conclusion:Of those with lower extremity amputation as a result of peripheral arterial disease, those with diabetes mellitus were younger, and more had trans-tibial amputation. Although both age and amputation level are good predictors of fitting with a prosthetic limb, successful limb fit rates were no better than those without diabetes mellitus.Clinical relevanceThis is of clinical relevance to those who are involved in the decision-making process of prosthetic fitting following major amputation for dysvascular and diabetes aetiologies.

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physiotherapy input in the early post-operative period; daily in-patient gym sessions and in-patient prosthetic provision.

This study demonstrates that there is a high proportion of people from socially deprived areas who undergo a lower extremity amputation due to vascular disease. It highlights the detrimental association between social deprivation and quality of life, specifically with reference to limb fitting, mobility, and participation at one year after amputation. Objective: Lower extremity amputation (LEA) is more common in people from lower socioeconomic groups. This study examined this further by investigating the influence of socioeconomic status on mobility, participation, and quality of life (QoL) after LEA. Methods: Prospective data were gathered for all LEAs performed in one year in one Scottish Health Board, commencing March 2014. A postcode derived Scottish Index of Multiple Deprivation (SIMD) was applied by quintile (SIMD 1 ¼ most deprived). Routine data were collected on the cohort of 171 patients; 101 participants consented and received postal questionnaires on QoL (EQ-5D-5L), participation (Reintegration to Normal Living Index [RNLI]), and mobility (Prosthetic Limb User Survey of Mobility), six (n ¼ 67) and 12 months (n ¼ 50) after LEA. Results: The mean AE SD age of the cohort was 66.2 AE 11.4 years; 75% were male and 53% had diabetes. In total, 67% lived in SIMD 1 and 2 and 11.1% in SIMD 5. Sixty per cent had a transtibial amputation. Mortality was 6% at 30 days 17% at six, and 29% at 12 months. Those in SIMD 1 were significantly younger (62.9 years) than those in SIMD 5 (76.3 years). Significantly more participants with a transfemoral amputation (TFA) lived in SIMD 1 (44%) compared with SIMD 5 (11%) (p ¼ .004). Participation was low (RNLI scores: 6 months ¼ 55.7; 12 months ¼ 56.6) and PLUS M scores suggested mobility was poor overall at six (39.1) and 12 months (38.9). Mean QoL was 0.37 at 6 months and 0.33 at 12 months. Conclusion: Although this study observed more LEAs in those from low socioeconomic areas, it is impossible to conclude whether QoL after LEA is truly influenced by socioeconomic status. There was an association between the disproportionately high rate of LEAs in SIMD groups 1 and 2 and the high prevalence of smoking, 61% vs. only 21% of those in the least deprived areas (SIMD 3, 4, and 5) being current smokers.