Objective: To analyse the prevalence of phantom (limb) pain over time and to analyse factors associated with phantom (limb) pain in a prospective cohort of amputees. Design: A multicentre longitudinal study. Patients: One hundred and thirty-four patients scheduled for amputation were included. Methods: Patients filled in questionnaires before amputation, and postal questionnaires six months, 1½ years and 2½ years to a maximum of 3½ years after amputation. Preoperative assessment included patients' characteristics, date, side and level of, and reason for amputation. The follow-up questionnaires assessed the frequencies of the experienced phantom pain, prosthetic use and walking distance. The occurrence of phantom pain was defined as phantom pain a few times a day or more frequently. Results: Pre-and postoperative questionnaires were available filled in by 85 amputees (33 females and 52 males). The percentage of lower limb amputees with phantom pain was the highest at six months after amputation, and of upper limb amputees at 1½ years. In general, more women than men experienced phantom pain. One and a half years and 2½ years after amputation the highest percentages of the lower limb amputees used their prosthesis more than 4 hours a day (66%), after that time this percentage decreased to 60%. The results of the two-level logistic regression analysis to predict phantom pain show that phantom pain was less frequently present in men (odds ratio (OR) ¼ 0.12), in lower limb amputees (OR ¼ 0.14) and that it decreased in due course (OR ¼ 0.53 for 1 year). Conclusion: Protective factors for phantom pain are: being male, having a lower limb amputation and the time elapsed since amputation.

Objective: To describe changes in health-related quality of life in people with lower limb amputation, from time of amputation to 18 months, taking into consideration the influence of age and walking distance. In addition, quality of life for people with amputation is compared with the Dutch population norm values. Design: Multicentre, longitudinal study. Subjects: All people undergoing first amputation: 106 were referred, of whom 82 were included, mean age 67.8 years (standard deviation; SD 13.0), 67% men. A total of 35 remained in the study at 18 months. Methods: Dutch language RAND-36 questionnaire (Research and Development Corporation measure of Quality of Life) was completed at time of amputation, 6 and 18 months after amputation. Results: Over time, a significant improvement was seen in physical function, social function, pain, vitality, and perceived change in health (all p < 0.001). Subjects over 65 years of age had a poorer outcome compared with people < 65 years for physical function only (p < 0.001). Walking distance was associated with improved scores in social function (p = 0.047). Conclusion: Quality of life improved significantly in 5 of 7 domains investigated; most change occurred in the first 6 months. Physical function remained well below population norm values. Different domains may be affected in different ways for older and younger age groups, but this requires further research.Key words: amputation; quality of life; mobility; prospective studies; longitudinal studies. J Rehabil Med 2013; 45: 587-594Guarantor's address: Lauren V. Fortington, Department of Rehabilitation Medicine, University Medical Centre Groningen, PO Box 30.001, Accepted Dec 21, 2012; Epub ahead of print Apr 25, 2013 IntRoDuctIon Lower limb amputation (LLA) not only results in permanent physical change to an individual, but also has an impact on psychological and social well-being. It can therefore affect a range of factors that contribute to a person's health-related quality of life (HRQoL) (1, 2). HRQoL is an important indicator of overall health. Research into subjects with LLA reflects the growing emphasis on HRQoL and its increasing use as an outcome measure (3).HRQoL in people with LLA is generally lower than in control subjects, and lower than population norm values (4, 5), particularly with regard to physical components (6-9). HRQoL following LLA may improve over time; higher scores have been reported by individuals with a longer time since amputation (10, 11). However, most studies of HRQoL following LLA have been cross-sectional in design and have included a majority of subjects who have lived with their amputation for at least 2 years (4)(5)(6)(7)(11)(12)(13). there remains a gap in research concerning post-operative response and adjustment early after amputation (3,14,15). Longitudinal studies extending beyond the post-acute period are needed to substantiate or refute previous cross-sectional findings.Walking distance is thought to play a key role in independence and HRQoL for people with LLA (13). the abil...

The purpose of this qualitative study was to explore the impact of an amputation and of phantom pain on the subjective well-being of amputees. Sixteen lower-limb amputees were interviewed. A semi-structured interview and two Visual Analogue Scales were used. To interpret the results, a new socio-medical model joining two models, 'The Disablement Process model' and the 'Social Production Function theory', was used. Questions were asked concerning the factors influencing patients' subjective well-being prior to, at the time of and after an amputation. These factors were patients' medical history, their phantom sensations and phantom pain, their daily activities, the social support they received, and the influence of an amputation and phantom pain on long-term behaviour and on their subjective well-being. All factors were found to have an influence on the individual's subjective well-being. All these factors, however, seemed to reinforce each other. Therefore, the greatest influence of factors on subjective well-being occurred when more than one factor was involved. Substituting certain activities by others then becomes less and less effective in inducing a sense of subjective well-being.