Prevalence of back pain, its effect on functional ability and health-related quality of life in lower limb amputees secondary to trauma or tumour

Abstract

Background and Objectives: The prevalence of back pain and its effect on function and health-related quality of life across three levels of lower limb amputation secondary to trauma or tumour was studied. Study design: Cross-sectional survey. Methods: Forty-six lower limb amputees, aged 19-78 years, participated. The Roland Morris disability questionnaire (RMDQ) and the short form 36 health survey (SF-36) were used. Results: Participants reported more back pain after amputation than before (p < 0.001). There was a significant association between back pain daily or several times/week and severe or moderate disability reporting on the RMDQ (p ¼ 0.003). On the SF-36, the group as a whole scored significantly lower in health-related quality of life with regard to physical functioning, role physical, bodily pain, general health, social functioning and the physical component summary (PCS), and significantly higher in the mental component summary (MCS) compared to normative Swedish data. When all three levels of amputation were compared, no statistically significant differences were found in the RMDQ or SF-36 results. Conclusions: There was a high prevalence of back pain after amputation. Almost all participants having back pain daily or several times per week reported severe or moderate disability on the RMDQ. The group as a whole scored significantly lower for health-related quality of life in the PCS and significantly higher in the MCS compared to normative Swedish data. Clinical relevanceThe high prevalence of back pain, and the significant association between back pain daily or several times per week and severe or moderate disability on the RMDQ, and the negative correlation between RMDQ and SF-36, may have clinical relevance with regard to rehabilitation and follow-up of lower limb amputation.

Chronic Pain in People with Physically Disabling Conditions: A Review of the Application of Biopsychosocial Models

“…Most studies report on traumatically acquired amputations, although those related to vascular or other conditions are also relatively common. The most common type of pain problems reported in these studies is phantom limb pain and residual (or stump) pain, although it is also possible for people to develop musculoskeletal pain following amputation, for example in the back (Hammarlund, Carlström, Melchior, & Persson, 2011;Kooijman, Dijkstra, Geertzen, Elzinga, & van der Schans, 2000). Prevalence estimates suggest that phantom limb pain occurs in approximately 45 to 80% of people postamputation, depending partly upon whether those with upper or lower limb amputations are considered, with rates of residual pain similarly high but varying (Behr, et al, 2009;Desmond & Maclachlan, 2010;Dijkstra, et al, 2002;Ehde, et al, 2000;Kooijman, et al, 2000;Schley, et al, 2008).…”

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

“…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].…”

Change in health-related quality of life in the first 18 months after lower limb amputation: A prospective, longitudinal study

“…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)(7)(8)(9). HRQoL following LLA may improve over time; higher scores have been reported by individuals with a longer time since amputation (10,11).…”

“…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).…”

“…Looking at the influence of time on HRQoL, age should be explored further, as it may translate to different time-dependent HRQoL outcomes that can be targeted during rehabilitation and long-term care. the lack of differences by age and walking ability seen in the regression model may also be accounted for by the small sample size (although for a longitudinal study of LLA, the sample size can be considered relatively large).the elderly person with vascular LLA is often excluded from research, due to limitations in study designs, such as selection bias and recruitment settings (3,5,6,13). Investigations of HRQoL that include the elderly person with vascular LLA would not only increase the sample size, but also enable results to be more widely generalized.…”