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

Abstract

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...

Health-Related Profiles of People With Lower Limb Loss

“…Such differences in self-reported physical function between people with and without LLL are consistent with previous findings. 1–3 Additionally, participants with TTA and traumatic etiologies had higher physical function scores than participants with TFA and dysvascular etiologies.…”

“…10 Conversely, greater participation in social experiences is positively associated with mobility outcomes, such as walking distance. 3 Assessment of health indicators in clinics is important as monitoring and addressing physical, mental and social function may improve rehabilitation outcomes in people with LLL. 1 Despite the recognized importance of physical, mental, and social issues related to the rehabilitation of people with LLL, 15 health providers typically focus rehabilitation efforts on patients’ physical health and may not adequately assess psychosocial functioning.…”

Explaining modified 2-min walk test outcomes in male Veterans with traumatic or nontraumatic lower-limb amputation

“…Ambulatory mobility is one of the single greatest predictors of quality of life in people with LLA [1] and is associated with improved social function [2]. Many factors contribute to ambulatory mobility after LLA, including preoperative function; presence of comorbidities; and modifiable factors related to rehabilitation, such as prosthetic fit/function and spatiotemporal parameters of movement [3].…”

Pszichológiai alkalmazkodás alsóvégtag-amputációt követően. Kvantitatív és kvalitatív kutatási eredmények

“…6 és 18 hónapos után-követéskor az életminőség számos aspektusa javulást mutatott a műtét előtti állapothoz képes. A fi zikai funkcionálás azonban még másfél évvel később is jelentősen negatívabb volt az átlaghoz képest [17]. További vizsgá-latok szükségesek ahhoz, hogy egyértelmű képet alkothassunk az amputációt követő életminőségről, az azt befolyásoló tényezőkről, valamint arról, hogy hogyan változik az amputáció óta eltelt idő folyamán.…”