A Systematic Review of Functional and Quality of Life Assessment after Major Lower Extremity Amputation

Hawkins, Alexander T.; Henry, A. F. X.; Crandell, David; Nguyen, Louis L.

doi:10.1016/j.avsg.2013.07.011

Cited by 56 publications

(58 citation statements)

References 99 publications

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“…19 Well established instruments, such as SF-36, also could be used to examine profiles of health indicators and the studies using such instruments have described worse health indicators in people with LLL compared to those without LLL. 20,21 However, some domains of SF-36 and related instruments (e.g., SF-12) are different from those included in PROMIS 29. In addition, PROMIS-29 domains can be administered using computer adaptive testing, which increases the precision of the score while minimizing respondents’ burden.…”

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confidence: 99%

Health-Related Profiles of People With Lower Limb Loss

Amtmann

Morgan

Kim

et al. 2015

Archives of Physical Medicine and Rehabilitation

102

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Objective To construct profiles of self-reported health indicators to examine differences and similarities between people with lower limb loss (LLL) and a normative sample (hereafter called the norm), and to compare health indicators between subgroups based on level and etiology of limb loss. Design Survey Setting General community Participants Adults with unilateral lower limb loss (n=1091) participated in this study. Eligibility criteria included LLL resulting from trauma or dysvascular complications and regular use of a prosthesis. Interventions Not applicable Main Outcome Measures Patient-Reported Outcomes Measurement Information System 29-item profile (PROMIS-29) version 1.0 measures physical function, pain interference, fatigue, sleep disturbance, anxiety, depression and satisfaction with participation in social roles. The norms are based on 5,239 individuals representative of the U.S. general population in gender, age, race, ethnicity and education. Results People with LLL reported statistically significantly worse physical function, pain interference and satisfaction with participation in social roles and significantly less fatigue than the norm. People with transfemoral (i.e., above-knee) amputation significantly differed from people with transtibial (i.e., below-knee) amputation on physical function. Similarly, people with amputation due to trauma and dysvascular etiology significantly differed on physical function and satisfaction with social roles after adjusting for relevant clinical characteristics. Conclusions People with LLL generally report worse physical function, pain interference and satisfaction with social roles when compared to norm. People with dysvascular amputation reported worse physical function and satisfaction with social roles than people with traumatic amputation. Health indicator profiles are an efficient way of providing clinically meaningful information about numerous aspects of self-reported health in people with LLL.

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confidence: 99%

Health-Related Profiles of People With Lower Limb Loss

Amtmann

Morgan

Kim

et al. 2015

Archives of Physical Medicine and Rehabilitation

102

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“…The following broad domains are measured: physical health, psychological health, social relationships, and environment. 11,25 In this study, the physical and psychological domains are used, which together consist of 13 items. The validated SF-12 was used to determine HS.…”

Section: Methodsmentioning

confidence: 99%

“…26,27 It is the short version of the 36-Item Short Form Health Survey and provides information about physical and mental functioning. 11 Patients who did not answer all questions of a domain did not reach an overall score for that particular questionnaire.…”

Section: Methodsmentioning

confidence: 99%

“…So in our opinion, the importance of HS measures in CLI patients is doubtful when approximately half of the vascular amputees are not able to walk one year after amputation. 11 At the moment, prospective data related to suitable patient-oriented outcomes is missing in elderly vascular amputees. 7,11 In clinical practice a subjective appraisal of wellbeing would be more valuable to patients and health care providers.…”

Section: Introductionmentioning

confidence: 99%

“…11 At the moment, prospective data related to suitable patient-oriented outcomes is missing in elderly vascular amputees. 7,11 In clinical practice a subjective appraisal of wellbeing would be more valuable to patients and health care providers. As mentioned above, the WHOQOL-BREF gives more insight into the patient's opinion about QoL.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Peters

Vries

Lodder

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT DOES THIS STUDY/REVIEW ADD TO THE EXISTING LITERATURE AND HOW WILL IT INFLUENCE FUTURE CLINICAL PRACTICEIn elderly patients with critical limb ischaemia (CLI), guidelines about the definition of quality of life and the instruments that measure quality of life are sparse. Often quality of life is confused with health status. This study provides evidence that there is a discrepancy between quality of life and health status in elderly CLI patients undergoing major amputation. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. We advocate the use of distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, in future research.Objectives: A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation. Methods: Patients suffering from CLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not.The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL.The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up. Results: Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45),p ¼ 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46),p ¼ 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57;-0.63),p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78; À2.23),p ¼ 0.003). Conclusions: There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when as...

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Validating a fear‐of‐falling–related activity avoidance scale in lower limb prosthesis users

Rosenblatt,

Major,

Manesh

et al. 2023

PM&R

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IntroductionLimited available data suggests fear of falling (FoF) may be common among lower limb prosthesis users (LLPUs) and associated with negative rehabilitation outcomes. The impact of FoF on outcomes may be exacerbated when fear leads to self‐imposed declines in activity. There is a need to identify the validity of fear‐of‐falling‐related activity avoidance scales in LLPUs .ObjectiveTo evaluate the convergent, discriminant and known‐group construct validity of the modified Survey of Activities and Fear of Falling in the Elderly (mSAFE) for LLPUs. Secondarily, we sought to determine if the mSAFE scale could be reduced without losing information regarding construct validity.DesignOn‐line surveySettingNot applicableParticipantsFifty‐nine persons with unilateral or bilateral amputation at the transtibial or transfemoral level, with ≥6 months experience using a definitive prosthesis for activities other than transfers.InterventionParticipants completed an online survey that consisted of the mSAFE and questions to assess FoF (yes/no), fear‐of‐falling related activity avoidance (yes/no) as well as previously validated scales capturing related and unrelated constructs. T‐tests were used to compare mSAFE score between yes/no respondents for known‐group construct validity. Correlations between mSAFE and previously validated surveys assessed convergent and discriminant validity. Analyses were repeated on a reduced number of mSAFE items following a redundancy analysis.Main outcome measuresNot applicableResultsSignificant correlation coefficients of |0.440‐0.825| were found for convergent validity with evidence of known‐group construct validity (p<0.021 for all comparisons). There was evidence for discriminant validity, with non‐significant associations for two‐of‐three correlations. Results from validity analyses were similar for a shortened six‐item mSAFE as for the full scale.ConclusionThis study provided initial evidence regarding validity of the mSAFE as a measure to assess fear‐of‐falling‐related activity avoidance in LLPUs. A 6‐item scale may be appropriate if the full scale would be taxing or time consuming.This article is protected by copyright. All rights reserved.

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A Systematic Review of Functional and Quality of Life Assessment after Major Lower Extremity Amputation

Cited by 56 publications

References 99 publications

Health-Related Profiles of People With Lower Limb Loss

Health-Related Profiles of People With Lower Limb Loss

Quality of Life and not Health Status Improves After Major Amputation in the Elderly Critical Limb Ischaemia Patient

Validating a fear‐of‐falling–related activity avoidance scale in lower limb prosthesis users

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