Objective: (1) To identify significant changes in disability and quality of life (QoL) across three time points (T1 = admission to rehabilitation, T2 = six weeks post-discharge, T3 = six months post-discharge) in individuals with lower limb amputation, and (2) to examine whether goal pursuit and goal adjustment at T1 were predictive of these outcomes at T3.Design: Prospective cohort study.
Setting: Inpatient rehabilitation.Participants: Consecutive sample of 64 persons aged 18 years and over with major lower limb amputation.Interventions: Not applicable.
Main Outcome Measures: World Health Organisation Disability Assessment ScheduleVersion 2.0 (WHODAS 2.0); World Health Organisation Quality of Life Questionnaire-Brief
Version (WHOQOL-BREF).Results: Mean WHODAS 2.0 scores were in the 95 th percentile at each time point. Scores on the WHODAS 2.0 and the physical, psychological and social relationships domains of the WHOQOL-BREF remained stable across the study period. Environmental QoL scores decreased from T1 to T2, but returned to near-baseline levels between T2 and T3. Having a greater tendency towards goal pursuit at T1 was predictive of higher physical and psychological QoL at T3, while having a stronger disposition towards goal adjustment at T1 predicted lower disability and higher environmental QoL at T3.
Conclusions:High levels of disability were experienced from admission to rehabilitation up to six months post-discharge. QoL in the physical, psychological and social relationships domains remained stable over the study period. Stronger goal pursuit and goal adjustment 3 tendencies on admission predicted lower disability and higher QoL six months postdischarge. and health classification system that offers a generic framework for describing the consequences of illness and disability and the dynamic interplay of personal and environmental factors (5), and has been applied to a number of conditions, including LLA (5, 6). The ICF classifies functioning and disability into two components: (1) body functions and structures (at the level of the body or body part), which are interpreted through changes in physiological systems or anatomical structures; and (2) activities (at the level of the whole person) and participation (at the level of the whole person in a social context), which are interpreted through capacity and performance.The primary goal of rehabilitation is to achieve optimal functioning (as appropriate to the individual) at each of these levels (7). Recent reviews indicate that most rehabilitation outcomes research among persons with LLA has been at the level of body functions and structures (2) or specific activities such as mobility (6) Theories of self-regulation may help to increase understanding of adjustment to LLA (17, 18). According to this perspective, human behaviour is organised around the pursuit of goals, which energise activities and give structure and meaning to people's lives and are thus closely linked with their subjective well-being (19-21). Indeed, negative associations hav...