Factors affecting quality of life in lower limb amputees

Abstract

Background: Quality of life (QoL) is increasingly being recognized as an important outcome for rehabilitation programs, and has mainly been used to compare the efficacy of interventions or to compare amputees with other diseased populations. There is relatively a limited number of studies primarily focusing on analyzing the multitude of factors influencing QoL in amputees. Objectives: To identify important background and amputation related factors which affect quality of life (QoL) in lower limb amputees, and to compare QoL profile of amputees' to that of general population. Study design: Cross-sectional. Methods: Lower limb amputees 18 years and above from a rehabilitation centre, a limb-fitting centre and four limb-fitting camps were interviewed (n ¼ 605). Structured questionnaires included patient background and amputation characteristics, and the MOS short-form health survey (SF-36) for assessing QoL. The SF-36 was administered to a general adult population using purposive sampling (n ¼ 184). Results: SF-36 PCS and MCS scores were found to be significantly lower for amputees when compared to those for the general population. In this study, employment status, use of an assistive device, use of a prosthesis, comorbidities, phantomlimb pain and residual stump pain were found to predict both PCS and MCS scores significantly, and explained 47.8% and 29.7% of variance respectively. Age and time since amputation accounted for an additional 3% of variance in PCS scores. Conclusions: The abovementioned factors should be addressed in order to ensure holistic reintegration and participation, and to enable the amputees to regain or maintain QoL. Prospective longitudinal studies are recommended to systematically study the change in QoL over time and to assess its determinants. Clinical relevanceProper appraisal of abovementioned factors in the rehabilitation programme would assist in establishing a treatment protocol, which would adequately address QoL in amputees.

Long-term activity in and among persons with transfemoral amputation

“…As a result, evaluation of individual participation is traditionally accomplished using global surveys or self-report instruments [2,[28][29][30]. These subjective tools have suggested that restrictions are common among persons with lower-limb loss [31][32][33][34][35][36]. However, differences between self-report and assessed mobility outcomes in this population [25] suggest that surveys alone may be insufficient to fully characterize restrictions experienced by persons with TFA.…”

Temporal adaptations in generic and population-specific quality of life and falls efficacy in men with recent lower-limb amputations

“…However, psychological issues, such as how an amputee feels about his or her amputation and prostheses, are also important factors. Previous reports have suggested that in order to provide a complete assessment of the benefits of an intervention, evidence of its effect on health-related quality of life (QOL) must be reported [6][7][8]. People with recent lower-limb amputations will continue to adapt to using a prosthetic limb during ADLs as they rejoin the work place and participate in recreational activities including sport and exercise [9][10].…”

“…Reports of QOL have varied, with people with lowerlimb amputation being equal to or higher [11][12] and lower [8][9][10][13][14] than normative reference data, indicating that no general consensus exists on how amputation affects QOL. However, a higher level of amputation (e.g., transfemoral vs transtibial) has been associated with decreased QOL [15].…”

“…Mental health is reportedly higher than physical health in people with lower-limb amputations, although studies have found physical health is more closely related to overall QOL [9][10][11][12][13][16][17][18]. Factors affecting mental health include depression, which is considered an important predictor of QOL [11], as well as the aesthetics of the prosthesis [13,16] and employment status [8]. Studies have also shown QOL to be highly related to both the physical [13][14] and social [19] aspects of an amputee's life, as well as being closely associated to the functioning of his or her prosthesis [8,[12][13].…”

“…Factors affecting mental health include depression, which is considered an important predictor of QOL [11], as well as the aesthetics of the prosthesis [13,16] and employment status [8]. Studies have also shown QOL to be highly related to both the physical [13][14] and social [19] aspects of an amputee's life, as well as being closely associated to the functioning of his or her prosthesis [8,[12][13].…”