Improved Quality of Life After Transtibial Amputation in Patients With Diabetes-Related Foot Complications

Abstract

The purpose of this study was to evaluate health-related quality of life after major lower-extremity amputation in a cohort of patients with diabetes mellitus. We evaluated 81 patients with diabetes and transtibial amputation (TTA) who had a minimum of 1 year of follow-up. Of these 81 patients, 50.6% completed the Short Form Survey (SF-36) and the Foot and Ankle Ability Measure (FAAM) preoperatively and postoperatively. Outcome measures before and after TTA were compared using Welch's ANOVA for continuous variables and Fisher's exact test for categorical variables. There was significant improvement in all 8 subscales of the SF-36, physical component summary (PCS) score, mental component summary (MCS) score, and the FAAM. The median SF-36 PCS score improved from 26.2 to 36.6 preoperatively versus postoperatively ( P < .0005). The postoperative PCS score improved in 75.6% of patients and worsened in 24.4%. The median SF-36 MCS score improved from 43.7 to 56.1 preoperatively versus postoperatively ( P < .0005). Both the FAAM activities of daily living (ADL; P < .005) and FAAM sports scores ( P < .05) improved significantly. The postoperative FAAM general/ADL score improved in 75.6% of patients and worsened in 24.4%. Patients who were nonambulatory postoperatively had significantly lower SF-36 general health subscale scores and lower FAAM scores than patients who were ambulatory postoperatively. In select patients with nonfunctional lower extremities resulting from instability and/or chronic infection, TTA can result in significant improvement in quality of life and lower-extremity function. We acknowledge that 25% of patients had a reduction in self-reported quality of life; however, 75% of patients improved their quality of life.

Psychosocial research in the diabetic foot: Are we making progress?

“…The Eurodiale study showed no QoL differences between minor amputation and conservative DFU treatment . Even a major, transtibial amputation does not necessarily compromise QoL in patients with preserved mobility . A systematic review of 12 studies aiming to identify the factors influencing QoL after lower limb amputation for peripheral arterial disease showed that ability to walk successfully with a prosthesis had the strongest positive impact on QoL .…”

“…8 Even a major, transtibial amputation does not necessarily compromise QoL in patients with preserved mobility. 9 A systematic review of 12 studies aiming to identify the factors influencing QoL after lower limb amputation for peripheral arterial disease showed that ability to walk successfully with a prosthesis had the strongest positive impact on QoL. 10 These studies employed generic QoL assessments, revealing a common pattern, that DFUs are associated predominantly with decrements in the domain of physical and not mental health.…”

Sarcopenia increases the risk for mortality in patients who undergo amputation for diabetic foot

“…This can be a hopeful message for patients who have undergone high level amputation. Wukich et al [ 30 ] reported a significant improvement of SF-36 (Short Form 36) and FAAM score after major amputation compared with before amputation. However, the functional score was not included in this retrospective study.…”

Pé diabético. Parte 1: Úlceras e Infecções*

“… 5 49 In some selected patients, amputation of a severely compromised extremity can significantly improve quality of life, even improving the physical capacity of the patients and allowing to maintain independent ambulation using lower limb prosthesis. 59 …”

“… 5 49 Em alguns pacientes selecionados, a amputação de uma extremidade gravemente comprometida pode melhorar significativamente a qualidade de vida, melhorando inclusive sua capacidade física e permitindo manter a deambulação independente com uso de prótese do membro inferior. 59 …”