-
8/18/2019 Sinha 2011
1/17
REVIEW
A systematic literature review of quality of life in lower limb
amputees
RICHA SINHA & WIM J. A. VAN DEN HEUVEL
Care and Public Health Research Institute, Maastricht
University, Maastricht, The Netherlands
Accepted August 2010
Abstract
Purpose. To systematically review studies on quality of life
(QoL) in lower limb amputees.
Method . Computerised literature search of MEDLINE,
CINAHL, PUBMED and PsycINFO databases was performedusing the
keywords, amputee, leg, knee, foot, amputation, QoL, prosthesis,
orthopaedic equipment, ADL, phantom,mobility, rehabilitation,
psychosocial, psychology and social. Eligible studies published
from database inception throughMarch 2009 were selected. The study
was included if (1) the study population comprised of adolescent
and adult lower-limbamputees as a group or a sub-group, and had ten
or more subjects; (2) the study involved subjective assessment of
QoL orself-appraisal of life or satisfaction with life; (3) the
study was an empirical research study and (4) at least one of the
study outcomes was QoL or self-appreciation of life, and QoL
results were presented. The selected articles were assessed for
study quality based on a standardised set of 19 criteria. The
criteria list was pilot-tested for applicability and
operationalisation by the authors. Objectives, study
population description, QoL instruments used and study outcomes
were summarised for theincluded studies.Results. Twenty-six
articles met the inclusion criteria. Fifteen studies were
cross-sectional, four prospective, sixretrospective and one mixed
study-design. The studies were found to be heterogeneous with
respect to the study objectivesand instruments used to assess QoL.
The summary quality score was 50% or more for ten studies, with the
maximum being81%.Conclusions. Lacunas were found in the
methodological and study population characteristics of most of the
studies.Prospective longitudinal studies are envisaged to
systematically study the events following amputation, and the
change inQoL over time. To enable this, amputee specific
standardised and validated QoL instruments are needed to capture
themultitude of facets influencing QoL in amputees, and thereby,
facilitating direct comparison across studies.
Keywords: Amputees, lower extremity, quality of life
Introduction
The prevalence of amputation varies country-wise.
There is no up-to-date published information avail-
able about the worldwide incidence. The National
Health Interview Survey 1996 (NHIS 1996) esti-
mated that approximately 1.2 million people were
living with limb loss in the United States of America
[1], and 185,000 persons undergo upper or lowerlimb amputations
each year [2]. In the Netherlands,
18–20 major lower limb amputations per 100,000 of
population are performed every year [3]. In France,
the incidence of lower limb amputation is estimated
at 6.6 per 100,000 inhabitants per year [4].
The causes of amputation vary, and mostly depend
on morbidity patterns, ageing of population, poor
infrastructure, war/civil conflicts, terrorism and
natural calamities. In patients up to 60 years, trauma
and cancer are the main causes of amputation [5,6].
Vascular disorders are the major contributors to
lower limb amputations in western countries [3,7],
whereas traumatic accidents are the major cause of
amputation in developing countries [5].
Irrespective of the cause, amputation brings a
dramatic change in the life situation of an individual
in almost all aspects of daily living and functioning.Quality of
life (QoL) of amputees gets affected due to
limitations posed by body function and structure,
which hinders the activity level and thereby partici-
pation, and further influenced by the environmental
and personal factors as envisaged in the International
Classification of Functioning, Disability and Health
(ICF) framework of World Health Organisation [8].
QoL is described as a multidimensional concept [9–
Correspondence: Mrs. Richa Sinha, MPH, Care and Public Health
Research Institute, Maastricht University, Maastricht, The
Netherlands.
E-mail: [email protected]
Disability and Rehabilitation, 2011; 33(11): 883–899
ISSN 0963-8288 print/ISSN 1464-5165 online ª 2011
Informa UK, Ltd.
DOI: 10.3109/09638288.2010.514646
-
8/18/2019 Sinha 2011
2/17
11], and as an emotional and cognitive judgment
about the person’s well being, life satisfaction,
morale, and happiness and as such may be best
assessed by the person himself [12]. Therefore, a
multitude of facets need to be taken into considera-
tion to comprehensively assess QoL.
In order to gain an understanding about QoL in
amputees, it’s important to study the factors influen-cing
amputees’ QoL and how the different facets of
QoL are measured, which determine the overall QoL
in amputees. This objective will be achieved by
systematically searching studies on QoL in lower
limb amputees, followed by the quality assessment of
included studies and summarising the study results.
Methods
Search strategy
Computerised search was performed using four
databases: MEDLINE database (1966 to March
2009), CINAHL database (1982 to March 2009),
EMBASE (1989 to March 2009) and PsycINFO
(1972 to March 2009). The search strategy was
developed taking into consideration the population
under study, namely lower limb amputees and the
outcome variable of interest, i.e., QoL. To include all
relevant studies, not only the primary keywords
namely, amputation and QoL, but also, other key-
words as potential factors affecting amputees’ QoL
were included. The search was restricted to the
citations with the keywords appearing in title,abstract or as
major or minor keywords.
The Medical Search History (MeSH) terms from
the thesaurus were primarily used as the keywords.
The major keywords or the synonyms used for search
were amputee, leg, knee, foot, amputation, QoL,
prosthesis, orthopaedic equipment, ADL, phantom,
mobility, rehabilitation, psychosocial, psychology
and social. Further narrow keywords derived from
the broad keywords were chosen from the search-
database, which were also thesaurus terms, like
psychosocial as the broad keyword and psychosocial
factors, psychosocial readjustment as the narrow
keywords, and prosthesis as the broad keyword andlimb
prosthesis, leg prosthesis, above-knee prosthesis
and below-knee prosthesis as the narrow keywords.
Combinations of keywords were made in order to
refine the search results.
Selection criteria
All citations obtained were screened for relevance by
one of the reviewers (RS) by studying the title and
abstract of each reference. A set of exclusion criteria
were developed for this review, which were: (1) the
study was published in a language other than
English, (2) the study was a case-study/review/
editorial/opinion papers/testimony/biography/inter-
view/book/progress report/discussion papers/guide-
lines, etc., (3) the article was related to amputation
but QoL was not being studied/measured, (4) the
article discussed QoL from others perspective, likehealth care
provider, care-giver, community mem-
bers, (5) the study involved development or valida-
tion of QoL instrument.
Next, two reviewers (RS and WvdH) read the
abstracts of the references included in the first step
and critically judged them for inclusion/exclusion
following the exclusion criteria. If the abstract of a
particular study was not available or it was difficult to
judge its relevance from the abstract, then the full
article was retrieved. A study was finally included if
(1) the study population comprised of adolescent
and adult lower-limb amputees as a group or a sub-
group, and had 10 or more amputees under study,
(2) the study involved assessment of QoL, (3) the
study was an empirical research study, and described
methods for measures of QoL, and (4) at least one of
the study outcomes was QoL or self-appreciation of
life and the outcomes were presented in the results.
Quality assessment
There are no strict guidelines for methodological
quality assessment of systematic reviews. Quality of a
study refers to measures of internal validity, externalvalidity
and statistical criteria, i.e. whether calcula-
tions can be made and conclusions can be drawn
independently to those of the original author(s) [13].
For this review, representative study population,
type of study, use of standardised and validated QoL
measures, appropriate statistical tests, control for
confounding variables, consideration of non-response
bias and data presentation of relevant outcome
measures were considered as quality criteria. The
criteria list for this systematic review was formulated
by
adopting and modifying criteria lists from other
systematic reviews for observational studies [14–16].
The criteria list was pilot-tested in two steps,
firstly with studies on QoL in kidney transplant patients,
and secondly with a selection of studies from the list
of potentially relevant articles selected for this review.
Following this two-step process, the operationalisa-
tion of the criteria list got more focussed, and the
definition of criteria more elaborated. Table A1 (in
Appendix) describes the final quality criteria list.
Finally, two reviewers (RS and WvdH) indepen-
dently assessed the quality of the included studies by
scoring the studies using the standardised quality
criteria list. In total, 19 criteria were used encompassing
884 R. Sinha & W. J. A. van den Heuvel
-
8/18/2019 Sinha 2011
3/17
three quality aspects: source population, study popula-
tion and methodological characteristics. The scoring
was solely based on the information provided in the
study. The scoring discrepancies for the respective
studies were discussed during consensus meetings to
reach an agreement.
Results
Search results and study selection
The literature search from various databases resulted
in identification of 2041 citations in total [CINAHL
508 (24.9%), EMBASE 844 (41.4%), MEDLINE
349 (17.1%), PsycINFO 340 (16.7%)]. There were
229 references, which were common in two or more
of the databases leading to 1812 non-duplicate
articles. After initial screening by one of the reviewers
(RS), 124 out of 1812 references (6.8%) remained.
Articles were excluded based on primary criteria
considering the language (151), study population
(661), study outcome (742), publication type (110),
and instrument development or validation (24).
Next, two reviewers (RS and WvdH) applied the
inclusion and exclusion criteria to the 124 references
from the initial screening by reading the abstracts or
the full article, if needed. Neither the abstract nor the
full article could be retrieved for four references, and
therefore they were excluded from the study. After
following these procedures, 25 out of 120 (21%)
studies got included. Studies in this step were
excluded based on primary criteria considering thelanguage (1),
study population (11), study outcome
(48), publication type (33), and instrument develop-
ment or validation (2). One extra study was retrieved
from back referencing the included 25 studies. Quality
assessment scoring was done for these 26 studies.
Figure 1 depicts the study eligibility flowchart.
Study quality assessment
Results of the quality assessment are presented in
Table I under the categories of source population,
study population and methodological characteristics,followed by
a summary score. The summary quality
score was 50% or more for 10 studies, with the
maximum being 81%.
Study characteristics
The main characteristics of the selected studies,
namely aim(s) of the study, study population, QoL
assessment methodology, study outcomes and sum-
mary quality score are outlined in Table II. Ten
studies [19,20,28,31–33,35,38,40,41] were pub-
lished during 1990–1999, and the remaining sixteen
[17,18,21–27,29,30,34,36,37,39,42] from 2000 on-wards. Thirteen
[19,20,23,26,28,29,31,34–38,42]
studies were focused on either critical limb ischemic
or diabetic foot ulcer patients, and four [23,30,
33,42] on cancer amputees.
Study population was recruited from hospitals,
limb-fitting centres and amputee support organisa-
tions. QoL was measured in conjunction with
other outcome variables in seven studies [23,27,
30,34,36,40,42], and was also used as an outcome
variable in eight studies [23,28,29,32,36–38,42]
to compare different groups of amputees or inter-
ventions.
The studies have assessed QoL using quantitativemeasures. The
generic QoL instruments used were:
SF-36 in seven studies [20,23–25,27,35,36],
RAND-36 in two studies [29,39], Nottingham
Health Profile (NHP) in three studies [22,27,34],
SIP (Sickness Impact Profile) in one study [34],
WHOQOL-Bref in one study [21], EuroQoL in two
studies [34,37], Prosthesis Evaluation Questionnaire
(PEQ) in one study [26], visual analogue scales in
four studies [17,32,37,41] and QoL ladder in one
study [19]. Disease-specific QoL scales were used in
three studies [18,30,42].
Figure 1. Study eligibility flow chart.
QoL in lower limb amputees 885
-
8/18/2019 Sinha 2011
4/17
T a b l e I . R e s u l t s o f q u a l i t y a s s e s s m e n t o f i n c l u d e d s t u d i e s .
S t u d y
S R C P O P *
S T U D P O P C H A R {
M E T H C H A R {
Q S
x
A
B
%
C
D
E
F
G
H
I
J
%
K
L
M
N
O
P
Q
R
S
%
%
A s a n o e t a l . ( 2 0 0 8 ) [ 1 7 ]
0
2
2
5 0
2
2
2
2
2
1
2
2
1 5
9 4
2
1
1
2
2
2
1
0
1
1 2
7 5
2 9
8 1
B e h e l e t a l . ( 2 0 0 2 ) [ 1 8 ]
0
1
1
2 5
2
2
0
0
2
0
2
2
1 0
6 3
0
1
0
1
2
2
1
0
1
8
5 0
1 9
5 3
C a r r i n g t o n e t a l . ( 1 9 9 6 ) [ 1 9 ]
0
2
2
5 0
2
2
0
0
0
1
0
2
7
4 4
0
1
0
1
2
1
0
0
1
6
3 8
1 5
4 2
C h e t t e r e t a l . ( 1 9 9 8 ) [ 2 0 ]
1
1
2
5 0
2
2
0
0
0
2
0
2
8
5 0
1
3
1
0
2
0
2
1
1
1 1
6 9
2 1
5 8
D e a n s e t a l . ( 2 0 0 8 ) [ 2 1 ]
0
2
2
5 0
1
2
2
0
2
0
0
2
9
5 6
0
1
1
2
1
0
0
0
1
6
3 8
1 7
4 7
D e m e t e t a l . ( 2 0 0 3 ) [ 2 2 ]
0
2
2
5 0
2
2
0
0
0
0
0
2
6
3 8
0
1
0
2
2
2
0
0
1
8
5 0
1 6
4 4
E i s e r e t a l . ( 2 0 0 1 ) [ 2 3 ]
0
2
2
5 0
2
2
0
0
0
0
0
1
5
3 1
0
1
0
1
2
1
2
0
1
8
5 0
1 5
4 2
H a g b e r g a n d B r a n e m a r k ( 2 0 0 1 ) [ 2 4 ]
0
2
2
5 0
1
2
0
2
0
1
0
1
7
4 4
0
2
0
1
1
0
1
0
1
6
3 8
1 5
4 2
H a g b e r g e t a l . ( 2 0 0 8 ) [ 2 5 ]
2
2
4
1 0 0
2
2
0
1
0
0
0
2
7
4 4
2
3
1
2
2
1
2
1
1
1 5
9 4
2 6
7 2
H a r n e s s a n d P i n z u r ( 2 0 0 1 ) [ 2 6 ]
0
2
2
5 0
2
2
0
0
0
0
0
2
6
3 8
0
1
0
2
2
0
0
0
1
6
3 8
1 4
3 9
H o g e n d o o r n a n d W e r k e n ( 2 0 0 1 ) [ 2 7 ]
1
2
3
7 5
1
2
0
0
0
0
0
2
5
3 1
1
2
0
2
1
0
2
0
1
9
5 6
1 7
4 7
J o h n s o n e t a l . ( 1 9 9 5 ) [ 2 8 ]
0
2
2
5 0
2
2
0
0
0
2
0
1
7
4 4
0
1
1
2
1
0
1
0
1
7
4 4
1 6
4 4
M c C u t c h e o n e t a l . ( 2 0 0 5 ) [ 2 9 ]
0
2
2
5 0
2
2
0
0
2
0
0
2
8
5 0
0
1
1
2
1
0
0
0
1
6
3 8
1 6
4 4
N a g a r a j a n e t a l . ( 2 0 0 4 ) [ 3 0 ]
1
2
3
7 5
2
2
2
0
2
0
1
2
1 1
6 9
0
1
1
2
2
1
0
0
1
8
5 0
2 2
6 1
P e l l e t a l . ( 1 9 9 3 ) [ 3 1 ]
1
2
3
7 5
0
0
0
0
0
0
0
1
1
6
2
1
0
2
2
1
2
1
1
1 2
7 5
1 6
4 4
P o s t m a e t a l . ( 1 9 9 2 ) [ 3 2 ]
0
1
1
2 5
2
2
0
0
0
0
0
2
6
3 8
0
2
0
2
1
0
2
0
1
8
5 0
1 5
4 2
R o u g r a f f e t a l . ( 1 9 9 4 ) [ 3 3 ]
2
2
4
1 0 0
1
2
0
1
0
1
1
1
7
4 4
0
2
1
1
2
1
0
0
1
8
5 0
1 9
5 3
S p i n c e m a i l l e e t a l . ( 2 0 0 0 ) [ 3 4 ]
0
2
2
5 0
2
2
0
0
0
2
0
1
7
4 4
0
3
1
2
2
0
0
0
1
9
5 6
1 8
5 0
T a n g e l d e r e t a l . ( 1 9 9 9 ) [ 3 5 ]
0
1
1
2 5
1
2
0
0
0
0
0
2
5
3 1
0
3
1
2
2
0
0
0
1
9
5 6
1 5
4 2
T e k i n e t a l . ( 2 0 0 9 ) [ 3 6 ]
0
2
2
5 0
2
2
0
0
0
0
0
2
6
3 8
0
2
1
2
2
1
2
0
1
1 1
6 9
1 9
5 3
T e n n v a l l a n d A p e l q v i s t ( 2 0 0 0 ) [ 3 7 ]
2
2
4
1 0 0
2
2
0
0
0
2
0
2
8
5 0
2
1
1
2
2
2
1
1
1
1 3
8 1
2 5
6 9
T h o m p s o n e t a l . ( 1 9 9 5 ) [ 3 8 ]
0
1
1
2 5
1
0
0
0
0
0
0
1
2
1 3
0
2
1
1
1
0
0
0
1
6
3 8
9
2 5
v a n d e r S c h a n s e t a l . ( 2 0 0 2 ) [ 3 9 ]
0
0
0
0
2
2
0
0
0
0
0
2
6
3 8
0
1
1
2
2
2
0
0
1
9
5 6
1 5
4 2
W a l t e r s a n d W i l l i a m s o n ( 1 9 9 8 ) [ 4 0 ]
0
2
2
5 0
2
2
2
0
2
0
1
2
1 1
6 9
0
1
0
1
2
1
0
0
1
6
3 8
1 9
5 3
W e i s s e t a l . ( 1 9 9 0 ) [ 4 1 ]
0
1
1
2 5
1
2
0
0
0
2
0
2
7
4 4
0
2
0
1
2
1
0
0
1
7
4 4
1 5
4 2
Z a h l t e n - H i n g u r a n a g e e t a l . ( 2 0 0 4 ) [ 4 2 ]
0
2
2
5 0
2
2
0
0
0
0
0
1
5
3 1
0
1
1
1
1
0
1
0
1
6
3 8
1 3
3 6
Q u a l i t y a s s e s s m e n t i t e m s a r e l a b e l l e d a s l i s t e d i n T a b l e A 1 i n a p p e n d i x ( A : S o u r c e p o p u l a t i o n d e s c r i p t i o n , B : I n c l u s i o n / e x c l u s i o n d e s c r i p t i o n , C - I : S o c i o - d e m o g r a p h i c c h a r a c t e r i s t i c s , J : D a t a
p r e s e n t a t i o n , K : R e p r e s e n t a t i v e n e s s , L
: S t u d y d e s i g n , M : P o p u l a t i o n s e l e c t i o n ,
N : M e a s u r i n g i n s t r u m e n t s , O : S t a t i s t i c a l m e t h o d s , P : C o n f o u n d i n g v a r i a b l e s c o n s i d
e r e d , Q : R e s p o n s e r a t e ,
R : C h a r a c t e r i s t i c s o f d r o p - o u t s , S : O u t c
o m e m e a s u r e s ) .
* S R C P O P ¼
S o u r c e P o p u l a t i o n .
{ S T U D P O P C H A R ¼
S t u d y P o p u l a t i o n C h a r a c t e r i s t i c s .
{ M E T H C H A R ¼
M e t h o d o l o g i c a l C h a r
a c t e r i s t i c s .
x Q S ¼
S u m m a r y Q u a l i t y S c o r e .
886 R. Sinha & W. J. A. van den Heuvel
-
8/18/2019 Sinha 2011
5/17
T a b l e I I . S u m m a r y
o f i n c l u d e d s t u d i e s c l a s s i fi e d a s p e r s t u d y d e s i g n .
S t u d y
A
i m o f s t u d y
Q o L
a s s e s s m e n t
S t u d y p o p u l a t
i o n d e s c r i p t i o n
S t u d y o u t c o m e s
Q S
A . C r o s s - s e c t i o n a l
A s a n o e t a l .
( 2 0 0 8 ) [ 1 7 ]
I d e n t i f y i n g f a c t o r s p r e d i c t i n g
i n d i v i d u a l ’ s s u b j e c t i v e q u a l i t y o f
l i f e ( Q o L ) a f t e r l o w e r l i m b
a m p u t a t i o
n
V i s u a l A n a l o g u e S c a l e ( V A S )
a ) 4 1 5 o u t o f 5 3 5 a b o v e - k n e e a n d
b e l o w - k n e e a m
p u t e e s
p a r t i c i p a t e d
D e p r e s s i o n w a s t h e
m o s t
i m p o r t a n t p r e d i c t o r o f Q o L
f o l l o w e d b y p e r c e i v e d p r o s t h e t i c
m o b i l i t y a n d s o c i a l s u p p o r t .
O t h e r p r e d i c t o r s
o f Q o L w e r e
c o m o r b i d i t y , p r o s t h e s i s
p r o b l e m s , a g e a n
d s o c i a l a c t i v i t y
p a r t i c i p a t i o n . L e s s d e p r e s s i o n
w a s a s s o c i a t e d w i t h h i g h e r Q o L .
S u b j e c t s r e p o r t e d
r e l a t i v e l y
h i g h e r Q o L ( 7 . 4 +
2 . 1 o u t o f
1 0 ) , w h i c h c o u l d
b e b e c a u s e
s u b j e c t s w o u l d i n
i t i a l l y r e p o r t a
r e d u c e d Q o L i m m e d i a t e l y a f t e r
a m p u t a t i o n , a n d
o v e r - t i m e t h e i r
r e s p o n s e m a y b e
m o d i fi e d d u e
t o a d a p t a t i o n t o t h e i r s i t u a t i o n
8 1
b ) P a t i e n t s r e c r u i t e d f r o m t w o
o u t p a t i e n t a m p u t e e c l i n i c s i n
S o u t h W e s t e r n O n t a r i o ,
C a n a d a
c ) M e a n a g e : 6 1 . 9 +
1 5 . 7 y e a r s
d ) A v g . t i m e s i n c e a m p u t a t i o n :
1 4 . 5 +
1 6 . 5 y e a r s
B e h e l e t a l .
( 2 0 0 2 ) [ 1 8 ]
E x a m i n i n g t h e r o l e o f f e e l i n g s o f
v u l n e r a b i l i t y i n p o s t - a m p u t a t i o n
a d j u s t m e n
t p r o b l e m s , s u c h a s
d e p r e s s i o n a n d d i m i n i s h e d Q O L
Q O L s c a l e – 3
i t e m s u b s c a l e f r o m
t h e H I V - P a t i e n t A s s e s s e d
R e p o r t o f S t
a t u s a n d E x p e r i e n c e
( H I V - P A R S
E )
a ) 8 4 o u t o f 1 1 2
l e g a m p u t e e s
p a r t i c i p a t e d
A g e , g e n d e r , t i m e s i n c e
a m p u t a t i o n , l e v e l o f a m p u t a t i o n ,
i n c o m e a n d v u l n e r a b i l i t y
p r e d i c t e d Q o L . A
h i g h l e v e l o f
v u l n e r a b i l i t y w a s
a s s o c i a t e d w i t h
h i g h e r l e v e l s o f d
e p r e s s i o n ,
l o w e r Q o L , a n d p o o r e r o v e r a l l
a d j u s t m e n t
5 3
b ) P a t i e n t s r e c r u i t e d f r o m 5
p r o s t h e t i c c l i n
i c s i n t h e C h i c a g o
M e t r o p o l i t a n a r e a , U S A
c ) M e a n a g e : 4 8 . 4 +
1 5 . 4 y e a r s
d ) A v g . t i m e s i n c e a m p u t a t i o n : 1 7
y e a r s ( 9 m o n t h s t o 4 9 y e a r s )
C a r r i n g t o n e t a l .
( 1 9 9 6 ) [ 1 9 ]
C o m p a r i n g
t h e Q O L b e t w e e n
d i a b e t i c p e o p l e w i t h c h r o n i c f o o t
u l c e r s o r l o w e r l i m b a m p u t a t i o n
a n d d i a b e
t i c c o n t r o l s
Q u a l i t y o f l i f e
l a d d e r , a s i m p l e
u n i d i m e n s i o
n a l , g e n e r i c s c a l e
u s e d a s a m e a s u r e o f l i f e
s a t i s f a c t i o n
a ) 1 3 d i a b e t i c u n i l a t e r a l l o w e r l i m b
a m p u t e e ( D A ) , 1 3 d i a b e t i c
u n i l a t e r a l c h r o
n i c f o o t u l c e r
p a t i e n t s ( D U )
a n d 2 6 d i a b e t i c
p e o p l e w i t h n o h i s t o r y o f
c h r o n i c f o o t u
l c e r a s c o n t r o l s
( D C )
T h e Q o L l a d d e r r e v e a l e d t h a t D U
w a s s i g n i fi c a n t l y m o r e
d i s s a t i s fi e d w i t h t h e i r p e r s o n a l
l i v e s t h a n D C , w
h e r e a s l i f e -
s a t i s f a c t i o n o f D A w a s m i d - w a y
b e t w e e n D U a n d
D C , b u t w a s
n o t s i g n i fi c a n t l y d i f f e r e n t f r o m
e i t h e r g r o u p . D A
a n d D U w e r e
s i g n i fi c a n t l y m o r e d e p r e s s e d
t h a n D C . D U a n
d D A h a d
s i g n i fi c a n t l y p o o r
e r p s y c h o s o c i a l
a d j u s t m e n t s t o t h
e i r s i t u a t i o n s
t h a n D C
4 2
b ) S t u d y o n U K
p o p u l a t i o n ( n o t
e x p l i c i t l y r e p o
r t e d )
c ) A g e r a n g e :
D C : 4 7 – 7 1 y e a r s
D A : 4 2 – 7 2 y e a r s
D U : 4 3 – 7 0 y e a r s
d ) T i m e s i n c e a m
p u t a t i o n : 6 – 1 8
m o n t h s
( c o n t i n u e d )
QoL in lower limb amputees 887
-
8/18/2019 Sinha 2011
6/17
T a b l e I I . ( C o n t i n u e d ) .
S t u d y
A
i m o f s t u d y
Q o L
a s s e s s m e n t
S t u d y p o p u l a t
i o n d e s c r i p t i o n
S t u d y o u t c o m e s
Q S
D e a n s e t a l .
( 2 0 0 8 ) [ 2 1 ]
D e t e r m i n i n g t h e r e l a t i o n s h i p
b e t w e e n q
u a l i t y o f l i f e a n d
r e s t r i c t i o n
o f p h y s i c a l a c t i v i t y i n
p e o p l e w i t h l o w e r - l i m b v a s c u l a r
a m p u t a t i o
n
W o r l d H e a l t h
O r g a n i z a t i o n
Q u a l i t y - o f - L
i f e S c a l e
( W H O Q O L
- B r e f )
a ) 2 5 o u t o f 7 5 t r a n s - t i b i a l o r t r a n s -
f e m o r a l u n i l a t e r a l a m p u t e e s d u e
t o p e r i p h e r a l v a s c u l a r d i s e a s e
p a r t i c i p a t e d
P h y s i c a l d o m a i n o f
Q o L w a s t h e
m o s t a f f e c t e d a n d
e n v i r o n m e n t a l
d o m a i n w a s t h e l e a s t a f f e c t e d .
A m p u t e e s g a v e h
i g h e r
i m p o r t a n c e o n s o
c i a l s t a n d i n g
a n d f r i e n d s h i p s w
i t h f a m i l y a n d
f r i e n d s t h a n o n p
h y s i c a l a b i l i t y
4 7
b ) P a t i e n t s r e c r u i t e d f r o m
G l a s g o w - b a s e d r e h a b i l i t a t i o n
a n d m o b i l i t y c e n t r e b a s e d i n
U K
c ) T h e r e w e r e 5
t r a n s - t i b i a l
a m p u t e e s 6 0
y e a r s , 1 7 4
6 0
y e a r s ; a n d 3 t r a n s - f e m o r a l
a m p u t e e s 4 6 0 y e a r s
d ) T i m e s i n c e a m
p u t a t i o n : 4 2
y e a r s
D e m e t e t a l .
( 2 0 0 3 ) [ 2 2 ]
A s s e s s i n g t h
e n a t u r e o f f a c t o r s
r e l a t e d t o
h e a l t h r e l a t e d q u a l i t y
o f l i f e ( H R Q L ) o f p e r s o n s w i t h
l i m b a m p u t a t i o n
P a r t 1 o f N o t t i n g h a m H e a l t h
P r o fi l e ( N H P )
a ) 5 3 9 o u t o f 1 0 1 1 p o t e n t i a l
r e s p o n d e n t s w
i t h m a j o r u p p e r
a n d l o w e r l i m b a m p u t a t i o n s
Y o u n g a g e a t t h e t i m e o f
a m p u t a t i o n a n d t r a u m a t i c o r i g i n
w e r e a s s o c i a t e d w
i t h b e t t e r
H R Q L . M e n h a d
b e t t e r H R Q L
t h a n w o m e n i n d
o m a i n s o f
p h y s i c a l d i s a b i l i t y , e n e r g y l e v e l ,
e m o t i o n a l r e a c t i o
n s a n d s o c i a l
i s o l a t i o n . Y o u n g
a g e w a s a l s o
a s s o c i a t e d w i t h b
e t t e r H R Q L i n
a l l t h e s e d o m a i n s . V a s c u l a r
a m p u t e e s h a d g r e a t e r p h y s i c a l
d i s a b i l i t y a n d g r e
a t e r s o c i a l
i s o l a t i o n
4 4
b ) P a t i e n t s r e c r u i t e d f r o m N a n c y
R e g i o n P r o s t h
e s i s C e n t r e o f
W a r V i c t i m s i n e a s t e r n F r a n c e
c ) M e a n a g e : 6 6 . 1 +
1 4 . 1 y e a r s
d ) M e a n a g e a t t h e t i m e o f
a m p u t a t i o n : 2
9 . 9 +
2 0 . 2 y e a r s
E i s e r e t a l .
( 2 0 0 1 ) [ 2 3 ]
I n v e s t i g a t i n g Q o L , b o d y i m a g e a n d
d a i l y c o m p e t e n c e o f p a t i e n t s a s a
c o n s e q u e n c e o f l i m b s a l v a g e
s u r g e r y ( L
S S ) , p r i m a r y o r
s e c o n d a r y
a m p u t a t i o n , a n d
v i e w s o f p
a t i e n t s f o l l o w i n g
s e c o n d a r y
a m p u t a t i o n
S F - 3 6 H e a l t h S u r v e y
a ) 3 4 o u t o f 3 7 p
a t i e n t s f r e e o f
d i s e a s e a n d o n e y e a r p o s t -
p r i m a r y o r s e c
o n d a r y
a m p u t a t i o n d u e t o
o s t e o s a r c o m a
o r E w i n g ’ s
s a r c o m a . S e m
i - s t r u c t u r e d
i n t e r v i e w w a s
d o n e i n 1 0 o f 1 1
p a t i e n t s u n d e r g o i n g s e c o n d a r y
a m p u t a t i o n
R e g a r d l e s s o f s u r g e
r y , p a t i e n t s ’
t r e a t e d f o r a b o n e t u m o u r r e p o r t
p o o r e r Q o L t h a n
e x p e c t e d
p o p u l a t i o n n o r m s , e x c e p t i n
e m o t i o n a l f u n c t i o n i n g a n d
m e n t a l h e a l t h . M
e n r e p o r t e d
b e t t e r p h y s i c a l f u
n c t i o n i n g t h a n
w o m a n . B e t t e r b o d y i m a g e a n d
e v e r y d a y c o m p e t e n c e w e r e
a s s o c i a t e d w i t h g r e a t e r Q o L . N o
d i f f e r e n c e i n Q o L
i n
A m p u t a t i o n v s . L
S S g r o u p ,
4 2
b ) P a t i e n t s r e c r u i t e d f r o m t h e
R o y a l o r t h o p a
e d i c s h o s p i t a l ,
B i r m i n g h a m , U K
( c o n t i n u e d )
888 R. Sinha & W. J. A. van den Heuvel
-
8/18/2019 Sinha 2011
7/17
-
8/18/2019 Sinha 2011
8/17
T a b l e I I . ( C o n t i n u e d ) .
S t u d y
A
i m o f s t u d y
Q o L
a s s e s s m e n t
S t u d y p o p u l a t
i o n d e s c r i p t i o n
S t u d y o u t c o m e s
Q S
r o l e l i m i t a t i o n c a
u s e d b y
e m o t i o n a l h e a l t h . S o c i a l
f u n c t i o n i n g , e m o
t i o n a l
w e l l - b e i n g , a n d r o l e l i m i t a t i o n s
c a u s e d b y e m o t i o
n a l p r o b l e m s
w e r e a r e a s i n w h i c h P V A a n d
C D p a t i e n t s e x p e r i e n c e d p o s t -
o p e r a t i v e i m p a i r m
e n t
b ) P r a c t i c e s o f v a r i o u s g e n e r a l
s u r g e o n s , g a s t
r o e n t e r o l o g i s t s
a n d o r t h o p a e d
i c s u r g e o n s b a s e d
i n U S A
c ) M e a n a g e :
C D : 4 5 . 5 y e a r s
P V A : 6 2 . 2 y e a r s
d ) T i m e s i n c e a m
p u t a t i o n : N o t
r e p o r t e d
N a g a r a j a n e t a l .
( 2 0 0 4 ) [ 3 0 ]
A s s e s s i n g s e
l f - r e p o r t e d f u n c t i o n
a n d Q o L
a m o n g l o n g - t e r m
s u r v i v o r s o f c h i l d h o o d l o w e r
e x t r e m i t y
b o n e t u m o u r s
Q o L f o r C a n c e r S u r v i v o r s
( Q o L - C S )
a ) 5 2 8 o u t o f 6 2 9 a d u l t l o n g t e r m
s u r v i v o r s o f p a e d i a t r i c l o w e r
e x t r e m i t y b o n e t u m o u r s
p a r t i c i p a t e d
O v e r a l l s u r v i v o r s r e
p o r t e d
e x c e l l e n t Q o L a n
d f u n c t i o n i n g .
A m p u t e e s w e r e n
o t m o r e l i k e l y
t o h a v e l o w e r f u n
c t i o n a n d Q o L
a s c o m p a r e d t o l i m b s p a r i n g
p r o c e d u r e . F e m a
l e s r e p o r t e d
s i g n i fi c a n t l y l o w e
r Q o L , b u t n o t
m o r e d i s a b i l i t y . B
e i n g f e m a l e ,
l o w e r e d u c a t i o n a n d o l d e r
c u r r e n t a g e h a d a n e g a t i v e
i n fl u e n c e o n Q o L
, f u n c t i o n a n d
d i s a b i l i t y . S e l f - p e
r c e p t i o n o f
d i s a b i l i t y w a s a f f e
c t e d b y g e n e r a l
h e a l t h s t a t u s , l o w
e r e d u c a t i o n ,
o l d e r a g e a n d b e i n g f e m a l e
6 1
b ) R e c r u i t m e n t s
o u r c e n o t
e x p l i c i t l y r e p o
r t e d
c ) M e a n a g e : 3 4 . 8 y e a r s
d ) A v e r a g e y e a r s
f r o m d i a g n o s i s t o
q u e s t i o n n a i r e
c o m p l e t i o n : 2 0 . 8
P e l l e t a l .
( 1 9 9 3 ) [ 3 1 ]
A s s e s s i n g t h
e o v e r a l l e f f e c t o f
a m p u t a t i o
n o n q u a l i t y o f l i f e ,
i n c l u d i n g
p s y c h o - s o c i a l
f u n c t i o n i n
g a s w e l l a s m o b i l i t y ,
a n d m e a s u r e s o f t h e e x t e n t t o
w h i c h o u t
c o m e s a r e i n t e r - r e l a t e d
N o t t i n g h a m H
e a l t h P r o fi l e ( N H P )
a ) 1 4 9 a l i v e p a t i e
n t s o u t o f 6 4 8
m a j o r l o w e r l i m b a m p u t e e s
A m p u t e e s h a d s i g n i fi c a n t l y m o r e
p r o b l e m s i n a l l d
o m a i n s o f Q o L
s u c h a s m o b i l i t y ,
s o c i a l i s o l a t i o n ,
e n e r g y , p a i n , s l e e
p a n d
e m o t i o n a l d i s t u r b a n c e t h a n
c o n t r o l s ; h o w e v e r m o b i l i t y w a s
t h e o n l y o u t c o m e f o r w h i c h t h e
d i f f e r e n c e b e t w e e
n t h e t w o
g r o u p s r e m a i n e d
s i g n i fi c a n t a f t e r
s t e p w i s e l o g i s t i c r e g r e s s i o n .
O v e r a l l Q o L f o l l o w i n g
a m p u t a t i o n f o r p e r i p h e r a l
4 4
b ) P a t i e n t s r e c r u i t e d f r o m
E d i n b u r g h R o
y a l I n fi r m a r y , a n d
a g e a n d s e x m
a t c h e d c o n t r o l
g r o u p s e l e c t e d
f r o m t h e r e g i s t e r
o f a g e n e r a l p r a c t i c e i n L o t h i a n ,
U K
c ) M e d i a n a g e : 7
3 y e a r s
d ) M e d i a n t i m e s i n c e l a s t
a m p u t a t i o n : 3
8 m o n t h s
( c o n t i n u e d )
890 R. Sinha & W. J. A. van den Heuvel
-
8/18/2019 Sinha 2011
9/17
-
8/18/2019 Sinha 2011
10/17
T a b l e I I . ( C o n t i n u e d ) .
S t u d y
A
i m o f s t u d y
Q o L
a s s e s s m e n t
S t u d y p o p u l a t
i o n d e s c r i p t i o n
S t u d y o u t c o m e
