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Rehabilitation and the long-term outcomes of persons with trauma-related amputation
Abstract
To examine the long-term outcomes of persons undergoing trauma-related amputations, and to explore factors affecting their physical, social, and mental health and the role of inpatient rehabilitation in improving such outcomes.
Abstracted medical records and interview data sought for a retrospective cohort of persons who had undergone a lower-limb trauma-related amputation.
Patients identified with a principal or secondary diagnosis of a trauma-related amputation to the lower extremity at the University of Maryland Shock Trauma Center between 1984 and 1994. Patients with spinal cord injury or traumatic brain injury were excluded.
Of 146 patients who had trauma-related amputations to the lower limb at the University of Maryland Shock Trauma Center during the study period, nearly 9% died during the acute admission and 3.5% died after discharge. About 87% of all trauma-related amputations involved males, and roughly three quarters involved white persons. About 80% of all amputations occurred before age 40. The health profile of traumatic amputee subjects interviewed in the study (n = 78, 68% response rate) was systematically lower than that of the general US population for all SF-36 scores. The differences in profiles were largest among SF-36 scales sensitive to differences in physical health status, particularly physical functioning, role limitations due to physical health, and bodily pain. About one fourth of persons with a trauma-related amputation reported ongoing severe problems with the residual limb, including phantom pain, wounds, and sores. The number of inpatient rehabilitation nights significantly improved the ability of patients with amputation to function in their physical roles, increased vitality, and reduced bodily pain. Inpatient rehabilitation was also significantly correlated with improved vocational outcomes.
These findings suggest a substantial effect of inpatient rehabilitation in improving long-term outcomes of persons with trauma-related amputations.
... 2 Traumatic amputations can lead to lifelong functional limitations and injury in young as well as adolescents. 3 They lead to irreversible disability and can change one's life and functions immensely, which is experienced more by individuals with lower-limb amputations. 4 Additionally, challenges like learning to care, walking with an amputated leg, and adapting and coping with the loss of a limb are experienced by people with lower-limb amputations. ...
... Amputation is a major life event that is known to affect QOL many years after the event. 3 Various factors which affect the QOL are employment status, use of assistive device or prosthesis and problems associated with it, comorbidities, phantom limb pain, depression, age and societal support and social activity participation. 4,5 The number of males with lower-limb amputations in the present study was 119, which comprises more than threefourths of the population. ...
... 4,5 The number of males with lower-limb amputations in the present study was 119, which comprises more than threefourths of the population. Several other studies 3,4,5,8 have also observed a higher prevalence of amputations among males. Nearly two-thirds of all individuals in the present study underwent amputation due to trauma, which is in line with various studies 9-12 that report trauma to be the main cause of amputation in developing countries. ...
Background: Large number of individuals live with various disabilities in India. Amputation is a major disability which causes irreversible changes and drastically alters everyday functioning. Quality of Life (QOL) in persons with lower limb amputations has been found to be affected. This study aimed to assess the QOL in persons with lower limb amputations using SF-36 via telephone. Methods: This was an observational study. Individuals with lower limb amputations who were enrolled in an orthotic and prosthetic clinic in Vadodara, Gujarat, were interviewed on the telephone to assess their QOL. Individuals with lower limb amputations, 18 years and above and both genders were included and those with impaired vision, hearing, cognition and upper limb amputations were excluded. QOL was assessed using SF-36 questionnaire on the telephone. Results: Total 140 individuals: 119 males, 21 females. 123 had unilateral and 17 had bilateral amputation. There was a significant difference found between unilateral and bilateral amputations in the Energy/Fatigue component of QOL (p=0.017) and between males and females in the Physical Functioning and General Health component of QOL (p=0.001) and (p=0.038) respectively. No significant difference was found in the QOL based on the levels of amputation in individuals with unilateral and bilateral amputation. Conclusions: Physical Functioning and the General Health components of QOL were better in males as compared to females. Individuals with bilateral amputations had more energy compared to individuals with unilateral amputations and hence had a better QOL.
... A limb amputation greatly impacts the physical and psychosocial functioning of an individual [1]. As a result of co-morbidities, the physical condition of a person with a lower limb amputation (LLA) is often poor before a LLA. ...
... (1) and reduced stability, "…the more energy returned, the harder to control it." (1). Therefore, it seemed that a lighter prosthetic sports foot required more muscle control to compensate for the decreased stability. ...
... It makes me feel helpless when it takes so long to get a new prosthetic sports foot." (1). However, participants were generally satisfied with the speed of service from prosthetists and found certain prosthetists very dedicated to their jobs, mostly because they were allowed to contact their prosthetists any hour of the day. ...
Background
Special feet connected to a prosthesis, prosthetic sports feet, enable athletes with a lower limb amputation to run. The selection of a prosthetic sports feet is usually based on body weight and preferred sports performance. The selection of a prosthetic sport feet is also based on clinicians who likely have limited experience due to a small number of athletes with a lower limb amputation.
Hypothesis
Athletes with a lower limb amputation are not satisfied with the use and service associated with prosthetic sports feet due to a lack of prosthetic sports feet provision guidelines, poorer function of prosthetic sports feet compared to the anatomical foot and ankle, and limited experience of clinicians.
Evaluation of hypothesis
A mixed-methods study in 16 athletes with a lower limb amputation using a prosthetic sport foot from Össur or Otto Bock, included semi-structured interviews and quantitative analysis. Three dimensions of prosthetic sports feet were investigated: 1) use, 2) provision process, and 3) cosmetics. Qualitative data were analyzed to identify factors influencing consumer satisfaction. Quantitative data were analyzed to investigate satisfaction and perceived relative importance of the dimensions.
Results
Participants were satisfied with the prosthetic sports feet use. However, they were not satisfied with the process prior to provision. The prosthetic sport feet use was perceived as the most important dimension. Sports performance was the critical element in the prosthetic sports feet use and was influenced by stability, confidence and fear, safety, focus, energy return, and comfort. Cosmetics were unimportant. Motivation to purchase the prosthetic sports feet was the key element for the prosthetic sports foot acquisition. Satisfaction about the process prior to provision was negatively influenced by poor support of professionals during rehabilitation, the complexity and duration of the purchase process, and lack of information and accessibility of prosthetic sports feet.
Conclusion
The most important dimension of the prosthetic sports feet was its use, which was directly influenced by performance. To further increase the satisfaction with prosthetic sports feet, clinicians should establish how to meet the desired sports performance level of athletes with a lower limb amputation. Improving the process prior to the provision process may increase satisfaction. We suggest increasing the support of professionals during rehabilitation and training through cooperation between involved services, organizing prosthetic sports feet try-out sessions, and increase the accessibility of the prosthetic sports feet. In this way, individuals with a lower limb amputation may become and stay more physically active and participate in sports.
... Restricted mobility and the lack of prosthetic rehabilitation to restore functional mobility were noted as 2 possible factors influencing the return to employment. 10 Prosthetic rehabilitation is defined as the restoration of function through the utilization of a prosthesis. 13 Emphasis has been placed on the return to employment rate for young patients with traumatic amputation who mostly fall below 64 years, [14][15][16] but very few studies exist on the employment rate for people with diabetic/dysvascular amputation regardless of age. Doukas et al 17 reported that in a sample of veterans with LLA attributed to trauma, the employment rate after amputation was 43.4% at the time of the survey. ...
... Doukas et al 17 reported that in a sample of veterans with LLA attributed to trauma, the employment rate after amputation was 43.4% at the time of the survey. Pezzin et al 15 found that in a sample of mostly young men with traumatic amputation, 97% of individuals were employed before amputation, and after amputation, only 58% were employed at the time of the interview. One notable limitation for some of the above studies was that the authors failed to mention the number of patients with or without a prosthesis. ...
Background:
For individuals with a disability, an increase in functional mobility may improve their quality of life and well-being. Greater understanding is needed on how factors such as gender, geography, and employment may play a role in mobility levels among individuals with lower limb amputation.
Objectives:
To assess the relationship between gender, geography, and employment status on mobility among lower limb prosthesis users.
Methods:
A cross-sectional analysis of 7,524 patient mobility outcomes completed across the United States was performed. The regression model included the independent variables, such as age, gender, region, employment status, and amputation level. Mobility was entered as the dependent variable.
Results:
Individuals who were employed had 3.6 times the odds of reaching increased mobility (Prosthetic Limb Users' Survey of Mobility ≥ 50) than those unemployed (odds ratio 3.56, 95% confidence interval 3.10-4.09). Gender and geography were significantly associated with mobility as well.
Conclusions:
Being employed is associated with greater odds of reaching increased mobility. Addressing factors such as returning to employment may aid in improving mobility levels among prosthesis users.
... The number of lower limb amputation (LLA) cases is reported to be growing globally, particularly among the economically active adults. [1][2][3] Road traffic accidents are a leading cause of LLA across the world, particularly in the rapidly motorizing and urbanizing countries such as Bangladesh. 4 It has been estimated that road traffic accidents leave around 426,320-639,480 people injured in Bangladesh annually. 4 The same study also reported that road traffic injuries contributed to most LLA cases in Bangladesh. 4 Peripheral vascular disease is on the rise as well in developing countries and has been reported to be the second dominant cause of amputation in Bangladesh. ...
... 4,5 LLA continues to have a strong impact on the mobility and functional abilities of the affected individuals for the rest of their lives. 2,3 Therefore, prosthetic rehabilitation is offered to compensate for the loss of the whole or a part of a limb, recuperate locomotion, and most importantly regain some level of functional independence that was present before the amputation. 2 Among others, Bilodeau et al 2 stated that the use of a lower limb prosthesis reduces the stress put on the sound lower limb and on the back enabling individuals to be more functionally independent in their everyday lives. ...
Objective:
This study aimed to assess factors related to prostheses use among individuals with lower limb amputation in Bangladesh.
Methods:
Data related to prosthesis use, functional capabilities (as measured with the Locomotor Capabilities Index [LCI]), and user satisfaction were collected using telephone interviews between January 2014 and October 2016. Descriptive and regression analyses were performed.
Results:
This study involved 183 participants (89.6% male); the mean (SD) age was 49.5 (10.7) years. Most of the participants (95.6%) used prostheses daily, and the mean (SD) duration of use was 7.0 (4.1) hours per day. The mean (SD) basic LCI score, advanced LCI score, and total LCI score were 25.1 (4.9), 20.8 (8.3), and 45.9 (12.2), respectively. Among them, 36.7% were dissatisfied with the weight of the prosthesis. Having a below knee amputation (odds ratio 2.6 and confidence interval 1.3, 5.3) and absence of comorbidities (odds ratio 2.1; confidence interval 1.0, 4.4) were associated significantly with an increased use of prosthesis.
Conclusion:
Factors such as weight of the prosthesis, amputation level, and presence of comorbidities are important considerations while planning for prosthetic rehabilitation and optimize utilization of the prosthetic devices.
... 8,9 Aspects of rehabilitation causing problems for individuals with amputations have been explored, noting clear trends. In 2000, four themes were identified in the study conducted by Pezzin et al 10 : fit of the socket with the residual limb, aspects of the prosthesis' mechanical functioning, other prosthesis qualities, and adaptation and support. The results overlap with those identified in the study conducted by Van der Linde et al, 11 which identified service demand, prosthetic prescription, living with a prosthesis, and prosthetic aftercare as themes. ...
... When comparing care provision, it may be more pertinent to assess factors such as the number of nights in inpatient rehabilitation, particularly because a previous study for those with trauma-related amputations found a correlation with high functional outcomes, irrespective of the funding body. 10 This was hinted at in this study, with one participant stating how successful their inpatient rehabilitation was for them. However, given this was mentioned only once, it is difficult to evaluate other factors that may have influenced their fast rehabilitation. ...
Background:
Successful rehabilitation is essential to improve the physical and mental outcomes of people with lower limb amputation(s). Individuals have different goals and expectations of successful rehabilitation and experience issues that affect their quality of life.
Objectives:
To determine factors affecting lower limb prosthetic rehabilitation from people with amputation(s), important for studies focusing on prosthetic and socket design and fitting because they provide context of need and user issues.
Study design:
Thematic analysis of semistructured interviews.
Methods:
Ten people with amputation(s) were self-selected from a survey identifying factors affecting lower limb prosthetic rehabilitation. The telephone interviews were semistructured exploring the biggest impactors on and frustrations with rehabilitation and the socket. A thematic analysis was completed by following the undermentioned steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and reporting.
Results:
Five distinct but interrelated themes were identified: External to Prosthesis, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Work and Social Impact. Those living with amputation(s) mentioned prosthetic-related issues affecting their work and social life, including difficulties wearing their prosthesis all day, the socket's rigidity, and the ability to participate in hobbies.
Conclusions:
The study provides new insights into the issues experienced during prosthetic rehabilitation, highlighting impacts beyond just physical health consequences. The study provides an evidence base for areas of the rehabilitation journey which could be improved to improve the quality of life of people with amputation(s).
... 60,63 Adjustment and social function after major extremity amputation was reported by 14 articles, predominantly using social subscales of multidimensional surveys. In total, 10 studies used the SF-36, 9,10,13,35,51,56,[64][65][66][67] one used the TAPES, 46 and four used the SIP. 10,42,43,68 ...
... 9 The average PCS score as reported by seven studies was 46.63 out of 100, where scores higher than 50 indicated better QOL. 10,33,35,56,66,70,71 The average Mental Component Scale score as reported by five studies was 47.92. 10,35,56,71,72 The average physical functioning sub-score was 60.45, social functioning sub-score was 78.36, and mental health sub-score was 65.84. ...
Background:
Outcomes after traumatic major lower extremity amputation (MLEA) have focused on surgical complications, despite the life-altering impact on patients. With advances in the surgical management of MLEA, a heightened need for consistent reporting of patient-centered outcomes (PCO) remains. This meta-analysis assesses articles for the prevalence and methods of PCO reporting among traumatic MLEA studies.
Methods:
An electronic database search was completed using Ovid MEDLINE for studies published between 2000 and 2020. Studies were included that reported any outcome of traumatic MLEA. Weighted means of outcomes were calculated when data were available. The prevalence of PCO was assessed in the categories of physical function, quality of life (QOL), psychosocial, and pain. Trends in PCO reporting were analyzed using Pearson's chi-squared test and analysis of variance when appropriate.
Results:
In total, 7001 studies were screened, yielding 156 articles for inclusion. PCO were evaluated in 94 (60.3%) studies; 83 (53.2%) reported physical function and mobility outcomes, 33 (21.2%) reported QOL and satisfaction measures, 38 (24.4%) reported psychosocial data, and 43 (27.6%) reported pain outcomes. There was no change in prevalence of PCO reporting when comparing 5-year intervals between 2000 and 2020 (P = 0.557).
Conclusions:
Optimization of function and QOL following traumatic MLEA has become a cornerstone of surgical success; however, only 60% of studies report PCO, with no trend over the last two decades suggesting improvement. As healthcare progresses toward patient-centered care, this inconsistent means of reporting PCO calls for improved inclusion and standardization of instruments to assess function, QOL, and other patient-focused measures.
... Extremity injuries account for the majority of injuries sustained both in combat and in civilian trauma with approximately 15 million fractures per year in the United States. [1][2][3][4][5] Long-term impairments are often substantial with research demonstrating moderate to severe levels of disability, low rates of return to employment, and chronic pain up to 7 years after the injury. [6][7][8][9][10] Physical therapy positively affects functional recovery after traumatic injury. ...
... [13] Furthermore, in patients with traumatic amputations, a focused rehabilitation protocol results in substantial functional benefit and improved rate of return to work or duty. [4,11,12,14] Physical therapy also has a favorable impact on pain in patients with painful musculoskeletal conditions. [15][16][17][18] Despite the established positive effect of physical therapy (PT) on functional recovery after traumatic injury, between 50% and 70% of patients who would benefit do not receive therapy due to access barriers. ...
Introduction:
Traditional physical therapy (PT) requires patients to attend weekly in-office supervised physical therapy appointments. However, between 50% and 70% of patients who would benefit do not receive prescribed PT due to barriers to access. Virtual Reality (VR) provides a platform for remote delivery of PT to address these access barriers.
Methods:
We developed a VR-PT program consisting of training, games, and a progress dashboard for 3 common lower extremity physical therapy exercises. We enrolled orthopaedic trauma patients with lower extremity injuries. Patients completed a VR-PT session, consisting of training and one of the exercise-based games. Pre- and post-VR-PT questionnaires were completed.
Results:
We enrolled 15 patients with an average age of 51 years. Fourteen patients said they would enroll in a randomized trial in which they had a 50% chance of receiving VR-PT vs receiving standard of care. When asked to rate their experience using the VR-PT module on a scale from 0-10-with 0 being anchored as "I hated it" and 10 being anchored as "I loved it"-the average rating was 7.5. Patients rated the acceptability of VR-PT as a 3.9 out of 5, the feasibility as a 4.0 out of 5, and the usability as a 67.5 out of 100.
Conclusion:
The response to VR-PT in this pilot study was positive overall. A VR-based PT program may add value for both patients and clinicians in terms of objective data collection (to aid in compliance monitoring, progression toward goals and exercise safety), increased engagement and increased access.
... 5 It is difficult to determine the influence of upper-limb amputation on current employment trends as most previous studies occurred more than 15 years ago. 1,3,4,[6][7][8][9][10][11][12][13][14] According to the Organization for Economic Cooperation and Development (OECD), there has been a dramatic shift in the US job structure over the past few decades toward positions, with a "greater dependence on knowledge, information, and high skill levels." 15 There are multiple theories that explain this shift in employment trends, including the effects of computerization and increased use of technology. ...
... Nevertheless, the employment rate in our sample population falls within that of previously reported studies (40%-80%). 4,[7][8][9][10][11]13,19 Because these studies took place in different locations, such as Canada, 17 Scotland, 6 Spain, 3 and Korea, 13 the national unemployment rates differ. However, there was a general consensus that the percentage of individuals who were not employed in the population with upper-limb amputation is higher than their national average. ...
Introduction
After upper-limb amputation, employment opportunities may be limited. Given the dramatic shift in the job market in the United States in the recent years, there is a need to examine the updated employment rates and the types of occupations to which individuals with amputation can return to. In this study, we assessed current employment status for people with upper-limb loss and determined whether these individuals needed to change jobs as a result of limb loss. Second, we examined whether demographic or impairment-specific factors were correlated with employment status or the need to switch jobs.
Materials and methods
Individuals with upper-limb amputation provided personal and employment information in an online survey. We explored the bivariate relationships between employment status and 11 personal factors (e.g., age at amputation, highest education level). Using the significant factors from this analysis, we built a logistic regression model for postamputation employment status. We also explored the relationship between these same 11 factors and the individuals' need to switch jobs after limb loss.
Results
A total of 199 and 160 respondents were deemed eligible for the employment status and job switch analyses, respectively. Of the working-aged respondents, 60.8% (121/199) were employed at the time of survey. Twenty-nine percent (47/160) reported needing to change jobs because of their amputation. Factors negatively associated with employment included having a bilateral amputation, lower education level, older age at amputation, higher pain frequency, and wearing a prosthesis less frequently. Higher education level was the only significant predictor of successful employment in the logistic regression model. There were no significant relationships between any factor and the need to change jobs after amputation.
Conclusions
The results suggest that individuals with upper-limb amputation have a lower employment rate than the national average. Future work should focus on understanding the reasons behind employment challenges in this population.
... Pezzin et al reported 23 below knee to 10 above knee amputee cases. Stump pain was [6] experienced by 7 out of 40 patients . 10% of below knee amputees and 20% of above knee amputees experienced stump pain. ...
... Walker et al reported 65% below knee and 73% above knee amputees had phantom pain. Pezzin et al reported 22% below knee and 12% above knee amputees experienced phantom [6] pain. 92% of below knee and 70% of above knee amputees had a mobility of more than 450 metres. ...
Introduction- Amputation surgery can be change life. Its surgery used to control pain and disease process in the affected limb. Amputation is the most common obtain disorder. Up to age of 55 years, trauma and malignancy remains the great causes of amputation. Amputations following trauma declining in developed countries. Lower extremity amputation (LEA) cause serious physical disability and it is intuitive that adjustment to the conditions of amputation is impulsive to psychological distress. Material and methods- All trauma patients with zero delay were resuscitated under ATLS protocol. Patient vitals which involve pulse, blood pressure, respiratory rate and oxygen saturation are recorded and two large-bore cannulae are inserted and venous sample for blood grouping and typing, cross match, complete blood count, and viral markers Hbsag, HIV, HCV were sent. Primary survey includes assessment of Airway, Breathing and ventilation, Circulation with Hemorrhage control, Exposure Result and analysis-Quality of life measured by SF12 score revealed signicant lowering of physical component score (PCS) of below knee amputees (43.84) compared to that of above knees (38.47) amputees. Mental component score (MCS) revealed a lower score of above knee amputees (39.43) compared to that of above knee amputees Conclusion- below knee amputees had better quality of life and successful rehabilitation of an amputee on a prosthesis depends on stump quality, maintaining ideal stump length is not much important in rehabilitation of an amputee.
... There is a series of events and medical conditions that result in the amputation of the limb, like diabetes, secondary infection, peripheral vascular disease, tumor and psychiatric conditions. There are different types of amputation: foot, ankle, transtibial, through knee, and transfemoral [2]. ...
... Thus, it seems that ROJOST © 2020 amputation mainly occurs in adults/elderly aged over 50 years (80.6% of the patients in our sample galled within this age category). Furthermore, patients suffering from amputations were rather males (64.5% of the total sample), a characteristic confirmed by other studies [2], married, living in urban areas, had a primary, lower-secondary or high school education level and most of them were retied. In terms of certain behaviors associated with an unhealthy lifestyle that could have led to such health problems, the data indicated that alcoholism was not prevalent among such patients -only 16.1% indicated that their relatives suggested they drank too much. ...
Amputation of the limb is a major psychological health issue that was not fully studied. Patients and their families struggle with symptoms of depression, posttraumatic stress disorder, anxiety, phantom limb phenomena, etc. There is also a tremendous impact on the person's quality of life. Aim: This study aimed to assess the psychological symptoms of depression, anxiety, and the quality of life among persons suffering from amputation of the limb. Methods: 31 respondents agreed to participate in the study. They were recruited from the. The medical conditions and the socio-demographic data (i.e., gender, marital status, income, etc.) along with the assessment of the psychological conditions and quality of life were contributions to the statistical analysis of the study. Results: This study showed that levels of depression are moderate to severe for a significant percent of the population (i.e., a "moderate to severe" or "severe" level of depression was presented by 29% of the patients according to the PHQ-9 test, and 16.1% of the patients according to Beck's Depression Inventory). Moreover, the levels of anxiety were relatively higher than those of the general population (i.e., severe anxiety was confirmed by the GAD-7 test in the case of 38.7% of the patients) and for most of them the quality of life was impaired. Discussion: Amputation occurs mainly in adults/ elderly aged over 50 years, married, living in urban areas, with different levels of depression and anxiety. At least half of them had a self-perceived health condition that was deteriorated, their physical and role functioning being primarily affected. Conclusion: There is a need for psychological support of the patients suffering from limb amputation as most of the studies showed high prevalence of depression and anxiety. Socio-demographic factors also represent important elements in defining the quality of life of those patients.
... There is a series of events and medical conditions that result in the amputation of the limb, like diabetes, secondary infection, peripheral vascular disease, tumor and psychiatric conditions. There are different types of amputation: foot, ankle, transtibial, through knee, and transfemoral [2]. ...
... Thus, it seems that ROJOST © 2020 amputation mainly occurs in adults/elderly aged over 50 years (80.6% of the patients in our sample galled within this age category). Furthermore, patients suffering from amputations were rather males (64.5% of the total sample), a characteristic confirmed by other studies [2], married, living in urban areas, had a primary, lower-secondary or high school education level and most of them were retied. In terms of certain behaviors associated with an unhealthy lifestyle that could have led to such health problems, the data indicated that alcoholism was not prevalent among such patients -only 16.1% indicated that their relatives suggested they drank too much. ...
Amputation of the limb is a major psychological health issue that was not fully studied. Patients and their families struggle with symptoms of depression, posttraumatic stress disorder, anxiety, phantom limb phenomena, etc. There is also a tremendous impact on the person’s quality of life.
Aim: This study aimed to assess the psychological symptoms of depression, anxiety, and the quality of life among persons suffering from amputation of the limb.
Methods: 31 respondents agreed to participate in the study. They were recruited from the Department of Orthopaedics and Traumatology, University Emergency Hospital, Bucharest, Romania. The medical conditions and the socio-demographic data (i.e., gender, marital status, income, etc.) along with the assessment of the psychological conditions and quality of life were contributions to the statistical analysis of the study.
Results: This study showed that levels of depression are moderate to severe for a significant percent of the population (i.e., a “moderate to severe” or “severe” level of depression was presented by 29% of the patients according to the PHQ-9 test, and 16.1% of the patients according to Beck’s Depression Inventory). Moreover, the levels of anxiety were relatively higher than those of the general population (i.e., severe anxiety was confirmed by the GAD-7 test in the case of 38.7% of the patients) and for most of them the quality of life was impaired.
Discussion: Amputation occurs mainly in adults/elderly aged over 50 years, married, living in urban areas, with different levels of depression and anxiety. At least half of them had a self-perceived health condition that was deteriorated, their physical and role functioning being primarily affected.
Conclusion: There is a need for psychological support of the patients suffering from limb amputation as most of the studies showed high prevalence of depression and anxiety. Socio-demographic factors also represent important elements in defining the quality of life of those patients.
... Amputation of an extremity is a life-changing event for each patient and has a negative impact on their quality of life (QoL) due to physical barriers and psychological distress. 1 When discussing a patient's QoL after an amputation, the reason for the amputation, the level of amputation, and physical and psychological conditions, as well as the patient's comorbidities have to be taken into consideration. In Germany, trauma and tumours are the most common causes of transfemoral amputation (TFA) in adults aged younger than 60 years. 2 Vascular disease is the most common cause of TFA in older individuals and is often accompanied by several comorbidities. ...
... 4 In order to use the prosthesis for the whole day, it is important that the prosthesis fits the patient well and the residual limb is painfree. 1,5 If the socket does not fit well, walking is difficult, the risk of falling is increased, energy consumption is increased and QoL is reduced. 4,6,7 Common side effects of socket prostheses (SPs) include pressure-related skin problems, hyperhidrosis, eczema, lymphedema, candidiasis, and pain while wearing the prosthesis. ...
Background
Until recently, no study had compared the quality of life of persons with transfemoral amputation treated with osseointegration to socket prosthesis users.
Objectives
Comparison of quality of life in two types of prostheses users: a cohort of patients with osseointegration and patients equipped with a socket prosthesis who were group-matched for age, body mass index and mobility grade.
Study design
A cross-sectional study that compared
Methods
The quality of life of 39 participants (22 in the osseointegration group and 17 in the socket prosthesis group) was measured using the Questionnaire for Persons with Transfemoral Amputation (Q-TFA) and European Questionnaire 5-dimension 3-level (EQ-5D-3L) surveys.
Results
Compared with the socket prosthesis group, the osseointegration group had a significantly higher ‘Global’ score ( p = 0.022) and a significantly lower ‘Problem’ score ( p < 0.001) of the Q-TFA. The ‘Mobility’ ( p = 0.051) and ‘Use’ scores ( p = 0.146) of the Q-TFA, the EQ-5D-3L index ( p = 0.723), and EQ-5D visual analog scale ( p = 0.497) showed no significant differences between groups.
Conclusions
Patients with osseointegration experienced less prosthesis-associated problems than socket prosthesis users and had a higher prosthesis-associated quality of life when assessed with the Q-TFA. General quality of life, as assessed with the EQ-5D-3L, was not different between groups.
... In this study the majority of the participants (65%) are between the age of 18-45 years and the mean age was 47.6 (±14.9). This result tallies with the idea of Pezzin et al. (18), who mentioned that in their study 80% of the amputations occurred before 40 years of age specially due to trauma. The result is further agreeing with Mohammed and Shebl (16) who reported that their population had an average age of 48 years. ...
A below knee amputation is a surgical procedure to remove all or part of a limb that can be lifesaving yet negatively affect the health-related quality of life of the patient. This study was conducted to determine the effects of social and clinical factors on the mental and physical health-related quality of life (HRQOL) in individuals with unilateral below knee amputations. In this descriptive cross-sectional study interviewed 223 unilateral below knee amputees using the validated version of SF-36 health survey questionnaire.
... Lower limb amputation is life-changing changing event and the impact on quality of life can be debilitating for many years [6][7][8][9]. After a lower-leg amputation or amputation-like injury, treatment options include stump provision, early prosthesis fitting, or replantation. ...
Background
The majority of published literature clinically assesses surgical outcomes after lower limb replantation for traumatic amputations. However, patients’ satisfaction and quality of life may not be accurately measured through rigid scoring using standardized patient reported outcome measures.
Purpose
The aim of this study was to qualitatively assess patient satisfaction and factors associated with achieving good outcomes after successful lower limb replantation surgery.
Methods
A semi-structured interview was conducted with 12 patients who underwent lower limb replantation surgery following traumatic amputation injuries. The interview focused on the patients’ experience and satisfaction throughout their injury, surgical journey, rehabilitation and reintegration into their communities. An inductive and deductive thematic analysis was applied using the recorded transcripts to evaluate the overall satisfaction of the patients after lower limb replantation surgery.
Results
The following observations emerged from the structured themes among all the patients interviewed: (1) Family and social support was significantly associated with improved qualities of life and satisfaction after lower limb replantation; (2) Patients were generally satisfied with their outcomes despite limitations in physical capabilities; (3) Satisfaction was associated with acceptance of their cosmetic deformity; (4) Social integration and being able to participate in a meaningful manner was associated with greater satisfaction after recovery.
Conclusions
Patients who undergo lower limb replantation can have a significantly improved quality of life if they have strong social support, are able to contribute in a meaningful manner to their communities after surgery, and are accepting of their cosmetic deficiencies.
... This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Lower limb amputation (LLA) is a life-changing event which significantly affects physical functioning, health, quality of life, and psychosocial well-being. [1][2][3] An estimated 28.9 million people worldwide are believed to have undergone unilateral traumatic LLA, and another 6.4 million bilateral traumatic LLA. 4 The lifetime prosthetic costs projected for service members with traumatic LLA have been estimated to be between $1.4 and $1.8 million USD. 5 Between 2006 and 2012, 6% of amputations across Canada occurred because of trauma. 6 Although this accounts for a relatively small proportion of LLAs, traumatic LLAs pose distinct occupational and psychosocial challenges compared with amputations resulting from other causes 7,8 that warrant further exploration. ...
... Beyond amputation etiology, characteristics of the LLP user sample (e.g., age, amputation level, and perceived mobility) were largely consistent with those reported in large national studies of LLP users (i.e., n = 146-1568) [89][90][91][92][93]. While the results of this study may therefore generalize to the broader population of established unilateral non-dysvascular LLP users, they are limited to the characterization of isometric hip muscle function by peak torque at a single joint angle. ...
Abstract Background Hip muscles play a prominent role in compensating for the loss of ankle and/or knee muscle function after lower limb amputation. Despite contributions to walking and balance, there is no consensus regarding hip strength deficits in lower limb prosthesis (LLP) users. Identifying patterns of hip muscle weakness in LLP users may increase the specificity of physical therapy interventions (i.e., which muscle group(s) to target), and expedite the search for modifiable factors associated with deficits in hip muscle function among LLP users. The purpose of this study was to test whether hip strength, estimated by maximum voluntary isometric peak torque, differed between the residual and intact limbs of LLP users, and age- and gender-matched controls. Methods Twenty-eight LLP users (14 transtibial, 14 transfemoral, 7 dysvascular, 13.5 years since amputation), and 28 age- and gender-matched controls participated in a cross-sectional study. Maximum voluntary isometric hip extension, flexion, abduction, and adduction torque were measured with a motorized dynamometer. Participants completed 15 five-second trials with 10-s rest between trials. Peak isometric hip torque was normalized to body mass × thigh length. A 2-way mixed-ANOVA with a between-subject factor of leg (intact, residual, control) and a within-subject factor of muscle group (extensors, flexors, abductors, adductors) tested for differences in strength among combinations of leg and muscle group (α = 0.05). Multiple comparisons were adjusted using Tukey’s Honest-Difference. Results A significant 2-way interaction between leg and muscle group indicated normalized peak torque differed among combinations of muscle group and leg (p
... Annually, due to factors such as disease, trauma, and birth defects, about 211 to 511 million amputations are performed (6). Phantom pain has negative effects on daily activities and quality of life (7,8). Half of patients experience severe pain for about a week every month and more than 25% experience pain for more than 15 hours a day (9). ...
Objective
Phantom pain is very common in amputations and is associated with severe pain followed by distress and poor quality of life. The aim of this study is to evaluate the effectiveness of botulinum toxin injection in reducing phantom pain in patients referred to Imam Hossein Hospital.
Materials and Methods
In this double-blinded placebo study, 30 patients with phantom pain referred to Imam Hossein Hospital were included. The participants were divided into two groups of 15 intervention and placebo. In the intervention group, botulinum toxin A was injected to reduce pain in patients and normal saline was injected in placebo group. Patients' pain relief was assessed at 0, 2, 4, 8, and 16 weeks of the treatment. Data were analyzed using SPSS 23 software.
Results
Botulinum toxin A injection significantly reduced phantom pain in intervention group at 0, 2, 4, 8, and 16 weeks of the treatment p<0.05. This reduction was also seen in regard to the cause of amputation, such as war, accidents, and unknown causes.
Conclusion
The use of botulinum toxin A seems to be effective in reducing pain in patients with phantom pain. Comparative studies and comparisons of the effect of botulinum toxin with common treatments are recommended.
... Individuals who underwent lower limb amputations exhibited worse QOL when compared to the entire population. This result has been supported by several additional research, suggesting that amputation is a major life event that can have long-term effects on QOL [30][31][32][33]. Amputation of a limb is a life-altering event having social, mental, psychological, and spiritual consequences [1]. ...
Introduction
The impact of amputation on patients' social and psychological well-being has been demonstrated. However, the experiences and requirements of amputees during the adjustment phase vary between amputees.
Methods
This study aimed to assess how amputation affects psychosocial life and the quality of life (QOL) in the amputees, the psychosocial processes involved in adjusting to amputation and a prosthesis, and the burden of amputees on caregivers in Saudi Arabia. A cross-sectional study was placed from November 2021 to February 2022, and it included all amputees and caregivers available at the time of the study.
Result
A total of 239 amputees and 219 caregivers were included in the study. The average level of the physical component score (PCS) was 63.5% ± 14.6% and 57.3% ± 12.9% for the mental component score (MCS). There is a significant positive correlation between psychological adjustment total and satisfaction with prosthesis with PCS and MCS dimension of QOL. Considering the QOL, PCS mean score was significantly higher among prosthetics users than among non-users (68.2 ± 15.5 vs. 59.9 ± 12.8, respectively; P=.001). Also, the MCS score was significantly higher among prosthetics users than among non-users (59.5 ± 12.4 vs. 55.5 ± 13.0, respectively; P=.001). A total of 15.1% of caregivers experienced a high burden, while 23.3% had a mild to moderate burden, but 61.6% had no or little burden.
Conclusion
Our finding shows there are correlations between psychological adjustment total and satisfaction with prosthesis with PCS and MCS dimension of QOL. The findings emphasize the importance of psychological and social support to be considered in caregivers’ health assessments. Also, the physical health of the caregivers should be fundamental in their lives as it minifies the caregiver burden. Further studies should be considered with a larger sample of amputees and longitudinal studies to evaluate the adaptation changes over time, caregiving burden, and family functioning.
... Women with LEA report poorer physical functioning and worse health-related quality of life compared to men with LEA. 4,[9][10][11][12] These outcomes are intertwined with prosthetic practice. Studies of women with amputation found that they were less likely to use a prosthetic limb than men and reported greater dissatisfaction with their prostheses. ...
Background
Women Veterans with amputation are a group with unique needs whose numbers have grown over the last 5 years, accounting for nearly 3% of all Veterans with amputation in 2019. Although identified as a national priority by the Veterans Health Administration, the needs of this population have remained largely underrepresented in amputation research.
Objective
To describe the experiences of women Veterans with lower extremity amputation (LEA) related to prosthetic care provision and devices.
Design
National qualitative study using semi-structured individual interviews.
Participants
Thirty women Veterans with LEA who had been prescribed a prosthesis at least 12 months prior.
Approach
Inductive content analysis.
Key Results
Four key themes emerged: (1) a sense of “feeling invisible” and lacking a connection with other women Veterans with amputation; (2) the desire for prosthetic devices that meet their biological and social needs; (3) the need for individualized assessment and a prosthetic limb prescription process that is tailored to women Veterans; the current process was often perceived as biased and either dismissive of women’s concerns or failing to adequately solicit them; and (4) the desire for prosthetists who listen to and understand women’s needs.
Conclusions
Women Veterans with LEA articulated themes reminiscent of those previously reported by male Veterans with LEA, such as the importance of prostheses and the central role of the provider-patient relationship. However, they also articulated unique needs that could translate into specific strategies to improve prosthetic care, such as integrating formal opportunities for social support and peer interaction for women Veterans with LEA, advocating for administrative changes and research efforts to expand available prosthetic component options, and ensuring that clinical interactions are gender-sensitive and free of bias.
... Dean encontrou maior incidência de etiologia traumática em indivíduos com menos de 60 anos, enquanto Pezzin observou que 80% das amputações traumáticas ocorriam antes dos 40 anos. 14,18 Diferentemente da literatura 3, 5-9, 11, 15, 17, 18 , o nível de amputação de membro inferior predominante em nossa revisão foi o transfemoral, provavelmente pelas mesmas causas já apontadas com relação a idade. ...
Foi realizado um estudo retrospectivo através da revisão de 262 prontuários de pacientes amputados do Lar Escola São Francisco – São Paulo, no período de janeiro de 1998 a dezembro de 2002, com o objetivo de traçar o perfil epidemiológico do serviço. Houve predomínio do sexo masculino (71%), de amputações de membro inferior (85,9%), sendo a acima do joelho predominante (52,4%). A etiologia vascular foi a principal causa de amputação em pacientes com mais de 50 anos (72,9%). Observou-se demora no início da reabilitação (média de 19,6 meses) e que o tempo médio de tratamento (10,7 meses) é maior que o descrito na literatura. Além disso, um número pequeno de pacientes adquire prótese (25,2%). Posteriormente, correlacionamos nossos dados com 02 estudos anteriores realizados neste mesmo serviço, visando comparar os resultados obtidos em três períodos diferentes e observamos progressos no processo de reabilitação dos pacientes amputados atendidos em nossa Instituição.
... Results suggest that hip extension and abduction strength are significantly and consistently associated with body mass x thigh length in unilateral LLP users, which when adjusted for, alters the interpretation of between limb differences in hip extension strength, as well as the relationship between hip abduction strength and balance ability. Except for amputation etiology and sex, participant characteristics (e.g., age, amputation level, PLUS-M T-scores,) were largely consistent with those reported in large national studies of LLP users (i.e., n = 146-1568) (Ehde et al., 2000;Hafner et al., 2016;Pezzin et al., 2000;Wurdeman et al., 2018;Ziegler-Graham et al., 2008). The results of this pilot study may therefore generalize to the broader population of established unilateral non-dysvascular LLP users. ...
Background
Valid comparisons of muscle strength between individuals or legs that differ in size requires normalization, often by simple anthropometric variables. Few studies of muscle strength in lower-limb prosthesis users have normalized strength data by any anthropometric variable, potentially confounding our understanding of strength deficits in lower-limb prosthesis users. The objective of this pilot study was to determine the need for as well as effectiveness and impact of normalizing hip strength in lower-limb prosthesis users.
Methods
Peak isometric hip extension and abduction torques were collected from 28 lower-limb prosthesis users. Allometric scaling was used to determine if hip torque values were significantly associated with, and therefore needed to be adjusted for, body mass, thigh length, or body mass x thigh length, and whether normalization was effective in reducing any associations. Between limb differences in peak hip torque, and correlations with balance ability, were inspected pre- and post-normalization.
Findings
Hip torques were consistently and significantly associated with body-mass x thigh length. Associations between peak hip torque and body-mass x thigh length were reduced by normalization. After normalization by body-mass x thigh length, between limb differences in hip extension torque, as well as the correlation between hip abduction torque and balance ability, changed from non-significant to significant.
Interpretation
In the absence of normalization, hip strength (i.e., peak torque) in lower-limb prosthesis users remains dependent on basic anthropometric variables, masking relationships between hip strength and balance ability, as well as between limb differences.
... The most common physical disability is a result of limb amputation that is typically performed as a life-saving procedure in the management of victims of natural disasters, all types of accidents, illnesses such as peripheral vascular diseases, diabetes mellitus, and malignancies (Moxey et al., 2011;Penn-Barwell, 2011;Yaşar et al., 2017). However, amputation changes the body structure and influences body activities and participation (Pezzin et al., 2000;Burger and Marincek, 2007) and leads to social and psychological dysfunction (Cervelli et al., 2008). The use of a prosthesis is one of the options for rehabilitation after amputation. ...
Introduction
The stump site of amputees is clinically vulnerable and prone to various skin diseases. Data regarding the impact on quality of life (QoL) of amputees with amputation stump skin disease (ASSD) and risk factors of ASSD and stump fungal infection in the Shanghai area are yet unknown.
Objective
This study aims to evaluate the QoL of amputees with ASSD and explore the risk factors of ASSD and stump fungal infection in the Shanghai area.
Methodology
A total of 104 amputees from Shanghai Hebin Rehabilitation Hospital, Otto Bock (China) Industries Co., Ltd., Shanghai Tongji Hospital, and Shanghai Rehabilitation and Vocational Training Center for the Disabled were enrolled in this study. We collected demographic, clinical, and skin fungal examination data from these amputees from April 2015 to May 2021. Dermatology life quality index (DLQI) questionnaire was used to evaluate the QoL. The risk factors for ASSD and fungal skin infection were analyzed by the univariate analyses.
Results
The median age of the 104 amputees was 57.9 ± 11.9 years with an average amputation time of 17.7 ± 15.1 years, and 73% of cases were men. The mean DLQI score of amputees with ASSD was13.6, suggesting the severe impairment of QoL. Among amputees, 41 (39.4%) had confirmed ASSD, of whom 24 (58.5%) suffered from fungal skin infection and the remaining were subjected to intertriginous dermatitis and eczema (22%), cutaneous keratosis (12.2%), and others (7.3%). Aspergillus (50.0%) was the most common species. The other fungal organisms included Trichophyton rubrum (33.3%), Candida krusei (8.3%), T. mentagrophytes (4.2%), and C. albicans (4.2%). ASSD rather than non-ASSD was more common in men (80.4%) and summer (46.3%). Summer (OR = 3.31, 95% CI = 1.19–9.17) was an established risk factor for ASSD compared to spring. The daily artificial limb wearing time > 8 h was associated with stump fungal infection.
Conclusion
The QoL of amputees with ASSD was severely affected and the ASSD was characterized by fungal infection (tinea), intertriginous dermatitis, eczema, and skin keratosis. Summer and daily prosthesis wearing > 8 h was a risk factor for ASSD. Aspergillus was the most common fungal species, especially when the stump was exposed in summer.
... 10) Psychological Adjustment scores and Depression & Anxiety scores indicating that higher the Psychological Adjustment, lower the Depression and Anxiety. Previous research demonstrated that prevalence of anxiety and depression in amputees was 29.9 and 13.4%. ...
... The problem of preserving the health and efficiency of combatants participating in military conflicts is the main task of medical and psychological rehabilitation. However, the social and psychological aspects of the content and peculiarities of the implementation of complex programs of medical and psychological rehabilitation, focused on certain categories of wounded, on the specifics of manifestations of somatic and mental disorders among the combatants, are not developed enough today [13][14][15][16][17][18][19]. ...
Objective:
The aim of the study was on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the combatants, to develop the principles and program of their medical and psychological rehabilitation.
Patients and methods:
Materials and methods: The study was attended by 153 people at the sanatorium and resort stage of treatment, of which 98 people were combatants and 55 people were civilians. The study used a set of methods aimed at the study of emotional disorders (HDRS, BDI, Spielberger Scale, "Asthenic state scale"), individual psychological features (Multilevel personal questionnaire "Adaptability," Test questionnaire G. Shmishek, K. Leonhard), features of psychosocial functioning (Mississippian scale of PTSD-military version) and quality of life (WHOQOL-BREF).
Results:
Results: At the stage of sanatorium treatment of combatants is important readaptation to peaceful living conditions. A clinical and psychological analysis of combatants showed that the presence of experienced state of subjective distress and emotional disorder leads to a decrease in the productivity of adaptation to a stressful event. The stress factor disrupted the integrity of the micro-social network of combatants and their system of social support and social values, with the prevailing sense of inability to overcome problems and build plans. A detailed analysis of the nature of depressive and anxiety manifestations was carried out, which allowed to determine the predictors of the violation of adaptation in combatants. Thus, on the basis of the study of clinical manifestations and mechanisms of the formation of disorders of psychological adaptation among the participants of hostilities, the principles of their medical and psychological rehabilitation at the sanatorium and resort stage of treatment are developed.
Conclusion:
Conclusions: The peculiarities of stress response in combatants as a component of personal potential play a role in the formation of predictors of psychological adaptation disorders among combatants. Psychological intervention at the tertiary stage of rehabilitation (sanatorium-resort) should be targeted, taking into account individual-psychological characteristics (preventors) and psychosocial factors (predictors).
... 3,5,6 Existing evidence suggests that the prevalence of falls in LLP users places them at a high risk for adverse health outcomes that include activity limitations and participation restrictions, 1,7,8 injuries, 1,9 and reduced quality of life. 10 The ability to identify those individuals at greatest risk for falls, and thus most likely to require preventative interventions, is therefore essential to mitigate the incidence of future falls in LLP users. ...
Objective:
Falls are a frequent and costly concern for lower limb prosthesis (LLP) users. At present, there are no models that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, therefore, remains a challenge. The purpose of this study was to test whether easily accessible clinical attributes and measurements predict the incidence of future falls in LLP users.
Methods:
In this prospective observational study, a secondary analysis of data from 60 LLP users was conducted. LLP users reported the number of falls that they recalled over the past year before prospectively reporting falls over a 6-month observation period via monthly telephone calls. Additional candidate predictor variables were recorded at baseline. Negative binomial regression was used to develop a model intended to predict the incidence of future falls.
Results:
The final model, which included the number of recalled falls (incidence rate ratio = 1.13; 95% CI = 1.01 to 1.28) and Prosthetic Limb Users Survey of Mobility T-scores (incidence rate ratio = 0.949; 95% CI = 0.90 to 1.01), was significantly better than a null model at predicting the number of falls over the next 6 months (χ22 = 9.76) and fit the observed prospective fall count data (χ256 = 54.78).
Conclusion:
The number of recalled falls and Prosthetic Limb Users Survey of Mobility T-scores predicted the incidence of falls over the next 6 months in established, unilateral LLP users. The success and simplicity of the final model suggests that it may serve as a screening tool for clinicians to use for assessing risk of falls. Additional research to validate the proposed model in an independent sample of LLP users is needed.
Impact:
Owing to its simplicity, the final model may serve as a suitable screening measure for clinicians to ascertain an initial evaluation of fall risk in established unilateral LLP users. Analyzing falls data as counts rather than as a categorical variable may be an important methodological consideration for falls prevention research.
... Of these demographic variables, age seemed to be the most important consideration because several low-quality studies indicated that increased age at the time of injury was correlated with higher disability, 25 higher pain scores, 41 and lower return to work rates. 26,42 Lack of employment and low income show limited evidence across multiple studies. Body mass index was also shown to be associated with increased pain after musculoskeletal injury in a single moderate-quality study. ...
The Clinical Practice Guideline for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to improve outcomes after adult orthopaedic trauma by evaluating, and addressing, the psychosocial factors that affect recovery. This guideline contains one recommendation to address eight psychosocial factors after military and civilian adult orthopaedic trauma that may influence clinical, functional, and quality of life recovery. Furthermore, it addresses additional factors that may be associated with greater biopsychosocial symptom intensity, limitations, and/or diminished health-related quality of life. However, this guideline did not evaluate effective treatment strategies for the treatment or prevention of psychosocial factors. This guideline cannot be fully extrapolated to the treatment of children or adolescents. In addition, the work group highlighted the need for additional research because studies of general traumatic injuries do not always generalize to specific orthopaedic populations.
... 14 The impact of trauma extends beyond the initial hospitalization, as post-discharge care can play an important role in mitigating the burden associated with injury. [15][16][17][18][19] Those who survive the inciting event remain at risk for complications, including in-hospital mortality and life-altering morbidity. The CDC estimates the combined cost of lost work for patients who are treated for injuries in the emergency department (ED) or hospitalized after trauma to be more than $250 billion. 1 Functional recovery is a factor in determining the likelihood of returning to work after sustaining an injury, which makes an increase in access to rehabilitative services an important target for not only improving quality of life, but also mitigating the financial burden associated with trauma. ...
Background
Low-income young adults disproportionately experience traumatic injury and poor trauma outcomes. This study aimed to evaluate the effects of the Affordable Care Act's Medicaid expansion, in its first 4 years, on trauma care and outcomes in young adults, overall and by race, ethnicity, and ZIP code-level median income.
Study Design
Statewide hospital discharge data from 5 states that did and 5 states that did not implement Medicaid expansion were used to perform difference-in-difference (DD) analyses. Changes in insurance coverage and outcomes from before (2011-2013) to after (2014-2017) Medicaid expansion and open enrollment were examined in trauma patients aged 19 to 44 years.
Results
Medicaid expansion was associated with a decrease in the percentage of uninsured patients (DD –16.5 percentage points; 95% CI, –17.1 to –15.9 percentage points). This decrease was larger among Black patients but smaller among Hispanic patients than White patients. It was also larger among patients from lower-income ZIP codes (p < 0.05 for all). Medicaid expansion was associated with an increase in discharge to inpatient rehabilitation (DD 0.6 percentage points; 95% CI, 0.2 to 0.9 percentage points). This increase was larger among patients from the lowest-compared with highest-income ZIP codes (p < 0.05). Medicaid expansion was not associated with changes in in-hospital mortality or readmission or return ED visit rates overall, but was associated with decreased in-hospital mortality among Black patients (DD –0.4 percentage points; 95% CI, –0.8 to –0.1 percentage points).
Conclusions
The Affordable Care Act Medicaid expansion, in its first 4 years, increased insurance coverage and access to rehabilitation among young adult trauma patients. It also reduced the socioeconomic disparity in inpatient rehabilitation access and the disparity in in-hospital mortality between Black and White patients.
... Amputation rates are higher in men than in women. Men who work with machines are at especially high risk of amputation; 87% of patients with trauma are male, of whom 80% are in their 40s [10]. While amputation rates in women are lower than in men, there are many amputations related to more serious medical conditions, which tend to lead to worse recovery than that for men [11]. ...
Amputation changes the lives of patients and their families. Consequently, the patient must adapt to altered body function and image. During this adaptation process, psychological problems, such as depression, anxiety, and posttraumatic stress disorder, can occur. The psychological difficulties of patients with amputation are often accepted as normal responses that are often poorly recognized by patients, family members, and their primary physicians. Psychological problems can interfere with rehabilitation and cause additional psychosocial problems. Therefore, their early detection and treatment are important. A multidisciplinary team approach, including mental health professionals, is ideal for comprehensive and biopsychosocial management. Mental health professionals could help patients set realistic goals and use adaptive coping styles. Psychiatric approaches should consider the physical, cognitive, psychological, social, and spiritual functions and social support systems before and after amputation. The abilities and limitations of physical, cognitive, psychological, and social functions should also be considered. To improve the patient's adaptation, psychological interventions such as short-term psychotherapy, cognitive behavioral therapy, mindfulness meditation, biofeedback, and group psychotherapy can be helpful.
... This study provided different results, demonstrating that WBV exercise significantly improved participants' physical fitness and static and dynamic balance. We consider that age might be a factor; young people exhibit better functional recovery in rehabilitation after stroke and amputation (39)(40)(41). However, studies on the rehabilitation of young patients on dialysis and comparison of the effects of rehabilitation on different age groups of people on dialysis are required to support this assumption. ...
Objective:
To evaluate the effect of whole-body vibration training on working-age people on haemodialysis.
Design:
Consecutive case series study.
Subjects:
Seventeen working-age participants on maintenance haemodialysis were enrolled.
Methods:
A 12-week whole-body vibration training programme, including different postures, was designed. The study evaluated and compared physical fitness, including a list of tests such as the 5-repetition sit-to-stand test, hand grip test, 2-min step test, and 8-foot up-and-go test; modified Berg balance scale; static and dynamic balance function; and quality of life, using a quality of life questionnaire before and after the training.
Results:
All physical fitness parameters, except grip strength on the left side, improved after whole-body vibration training. For balance, the modified Berg balance scale demonstrated enhanced scores for equilibrium, with eyes closed on a stable surface and eyes open on an unstable surface, and movement velocity under the fast condition along the left and right directions (p=0.011). No significant improvements in quality of life were found.
Conclusion:
Whole-body vibration exercise training enhanced physical fitness and static and dynamic balance control in working-age participants on haemodialysis.
... Les appuis étant localisés sur des zones précises, les contraintes sur le membre résiduel peuvent être importantes et amener à de l'inconfort voir des douleurs (Radcliffe et al., 1957;Pezzin et al., 2000;Dillingham et al., 2001). ...
L’emboîture fait le lien entre la prothèse et le membre résiduel des personnes amputées. Pour les amputations transfémorales, elle doit permettre le transfert des actions mécaniques tout en étant confortable. Cependant, sa conception reste principalement qualitative. Les pressions à l’interface emboîture/membre résiduel peuvent cependant permettre d’évaluer les emboîtures grâce à la méthode des éléments finis (EF) Toutefois la conception de tels modèles est un défi tant pour la reconstruction des géométries, la caractérisation du comportement des tissus ou la définition du chargement. Ce travail présente un modèle EF personnalisable de l’interaction du membre résiduel et de l’emboîture. Des mesures pour la caractérisation du comportement des tissus mais aussi pour la définition du chargement, grâce à un modèle musculosquelettique, alimentent le modèle EF. Celui-ci a été comparé à la littérature puis exploité pour l’estimation de l’influence de certains paramètres sur les pressions.
... [11] The results of this study are supported by the study of Fukuniski et al(33.9%). [16] The low level of Phantom Limb Phenomenon are supported the study of Ebrahimzadeh et al. [17] Our study is further supported by Melzack [18] and Pezzin et al. [19] who reported that with time phantom limb sensations decrease. Apart for surgery, the following points need to be taken care of so that a patient once done with amputation can do well both physically as well psychologically. ...
Mechanical vibration can be defined as the regular or irregular repetitive movement that makes the body leave its resting state. Mechanical vibrations have an important role in keeping the bones and joints healthy. This review study aimed to investigate the effect of mechanical vibration in the evaluation and replacement of bone cement-anchored implants in human bone. The empirical studies related to mechanical vibrations and bone cement-anchored implants were reviewed. The combinations used to search for studies related to the topic included mechanical vibrations, evaluation, replacement, bone, cement-anchored implants, and human bone. The reviewed studies show that mechanical vibration, either local or whole-body, promotes bone growth in and around the implant. The stimulation of bone growth is important for the strength and durability of cement-anchored bone implants. Through the reviewed studies, it was concluded that local or whole-body mechanical vibration improves the stability and durability of bone and bone implants. Mechanical vibration achieves this effect by increasing bone formation in and around the implants and by improving the contact between the implant and the bone.
Data on the distribution of forces acting on the phalanges in individual hand grips are sparse and are usually based on expensive human experiments or time-consuming computer calculations. However, they are essential for the proper design of prosthetic hands. Our goal was to create a simplified model to determine the dependence of these forces on the static coefficient of friction between the cylindrical cylinder held by the hand model, replicating the edgewise objects of everyday use, and the inner surface of the prosthetic phalanges. We created a CAD model of human hand kinematics based on literature data. The cylindrical grip was tested for a 70 mm diameter cylinder mimicking a 1 L bottle. The results showed that the relationship between the tested static friction coefficient and finger-cylinder forces is nonlinear. In the next stages, we plan to validate the obtained force results and use the data in the mechanical design of the prosthesis.
Objectives
Individuals with lower-limb amputations (LLA) often have deficits in balance and community walking ability. As a result, people with LLA are often sedentary. The aim of this study was to explore perceptions of physical activity from the perspective of people with LLA.
Methods
A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semistructured interviews were held by telephone or in person with adults living with major LLAs recruited from rehabilitation hospitals and advertisements on social media. Individuals were included if they were age 18 years and older with a major LLA. Purposive sampling was used to ensure variation by sex, cause, and level of amputation.
Results
Thirty-three people with LLA participated (22 men/11 women; median age 63 years). The majority of individuals had a unilateral, transtibial amputation (∼50% dysvascular LLA). Three main themes were developed to characterize participants’ perceptions of physical activity: (1) physical activity is perceived as important but can be challenging after amputation; (2) physical activity has physical and mental health benefits; and (3) physical activity is a means to maintain independence and engagement in community and social life.
Conclusions
Obtaining the perspectives of individuals with LLA about physical activity helps us understand how they think about it, what motivates them, and how we can optimize physical activity levels. Future research is needed to evaluate the effectiveness of interventions to enhance physical activity in this population.
A amputação de um membro se reveste de maior dramaticidade e limitações sensório-motoras em pacientes jovens, assim como, na população adulta ou idosa com comorbidades. Objetivo: Traçar o perfil demográfico e epidemiológico dos pacientes atendidos em um grande centro de referência em reabilitação em Pernambuco. Métodos: Realizou-se um estudo de corte transversal com revisão de prontuários ativos. Os resultados foram tratados pelo Microsoft Excel® e o programa utilizado para os cálculos estatísticos foi o IBM® SPSS® na versão 23. Resultados: Observou-se idade média de 48,36 anos, gênero masculino (76,6%), casados (47,7%), ensino fundamental (64,8%) e oriundos de todas as regiões do estado. Quanto à amputação, sem predileção por lado, mais frequente nos membros inferiores transfemoral (55,1%), cotos de comprimento variável e causas vasculares e traumáticas mais frequentes. No exame físico, cotos em condições de reabilitação, utilização de aditamento comunitário ou domiciliar na primeira consulta e sem uso prévio de prótese. Em 83,6% dos casos, os pacientes usavam sua prótese mais de 7h/dia e 58,6% possuíam marcha independente na comunidade, com durabilidade da prótese em até 36 meses (75,8%). Conclusão: A amputação ocorre em idade jovem, sendo os homens mais acometidos, as doenças vasculares e acidentes envolvendo veículos motorizados são as principais causas, as cirurgias ocorrem mais nas diáfises ósseas. O tempo de terapias foi efetivo. Fazem-se necessárias políticas públicas que agilizem o acesso do paciente a centros especializados e desses aos centros de reabilitação e para melhoria dos materiais e componentes que compõem as próteses oferecidas pelo SUS.
Purpose:
To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA).
Methods:
An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis.
Results:
Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants.
Conclusion:
ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA.
Purpose:
The purpose of this study was to explore healthcare professionals' (HCPs) perceptions and experiences related to 3D scanning and 3D printing for fabricating lower limb prosthetic sockets.
Materials and methods:
This study used a qualitative descriptive approach. Participants were recruited through HCPs' professional associations, social media posts, and snowball sampling. Purposive sampling was used to attain variation in provider type. One-on-one telephone interviews were conducted using a semi-structured interview guide. Inductive thematic analysis was performed to identify the main themes.
Results:
Three themes were identified: (1) 3D scanning of the residual limb for designing prosthetic sockets is perceived as clean, quick, and convenient; (2) concerns about the strength and safety of 3D printed sockets for long-term use; (3) Adoption of 3D scanning and 3D printing technology for fabricating prosthetic sockets.
Conclusion:
We identified perceived benefits and challenges with digital technologies for fabricating prosthetic sockets. To increase adoption, more research demonstrating its efficacy compared to conventional methods, increasing 3D printing material quality, and improving software training programs are needed.Implications for Rehabilitation3D printing and 3D scanning are emerging digital technologies that can be used as alternative methods for prosthetic socket manufacturing in the field of rehabilitation.Our research identified perceived benefits of using digital technologies for fabricating prosthetics sockets (3D scanning is perceived as clean, quick, and convenient) and perceived challenges (concerns about the strength and safety of 3D printed sockets for long-term use and a prolonged learning curve).To increase adoption of these digital technologies, more training should be provided to prosthetists and support provided to integrate new processes into staff workloads.
Purpose:
Life after any amputation can be significantly altered and can have a significant impact on quality of life (QoL). However, most of the evidence base involves older aged amputees, therefore there is a lack of understanding about the impact of amputation on QoL and the factors that predict QoL in younger amputees. The aim of this review is to identify the factors that predict QoL in young amputees.
Methods:
MEDLINE, CINAHL, EMBASE, PsycINFO, Web of Science were searched to identify articles that measured QoL in young amputees. Articles were independently assessed by two assessors. Data was extracted from the selected articles and a narrative synthesis performed.
Results:
18 articles were included in this review. QoL outcome measures varied between studies. The quality of evidence was generally low. This review identified, gender, age, cause of amputation, level of amputation, phantom pain, ability to use a prosthesis, physical function, depression, anxiety, body image, type of prosthesis as predictors of QoL.
Conclusion:
This review identified modifiable and non-modifiable predictors of QoL in young amputees. Future research needs to focus on exploring the modifiable predictors of QoL as these are the aspects that can be improved to enhance QoL.
A study of socio-demographic characteristics, aetiology, types of tinnitus, and modes of management among patients referred for tinnitus treatment in a tertiary referral Malaysian hospital 45
Purpose
Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation.
Methods
Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA).
Results
Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT.
Conclusions
Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content.
•
IMPLICATIONS FOR REHABILITATION
• Following lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression.
• Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population.
• The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.
Introduction
Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations.
Materials and Methods
This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t -test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution.
Results
Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology.
Conclusions
This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase.
Clinical Relevance
Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.
Introduction:
Advanced technologies have made available the development of microprocessor prosthetic knee (MPK) to improve autonomy of patients with lower limb amputation.
Aim:
In the present systematic review, we aimed to evaluate the impact of the use of all types of MPK on patients' functional status and quality of life.
Evidence acquisition:
We conducted this review according to the PRISMA Guidelines on Medline (via Ovid), Scopus and SportDiscuss. All identified articles were screened for their eligibility by two reviewers using Covidence software. The Cochrane Risk of Bias (RoB) or the NIH Quality Assessment Tool were used to assess the quality of the studies.
Evidence synthesis:
Eighteen articles were included in the present review (7 randomized controlled trials - RCT), 6 cross-sectional and 5 follow-up studies). Number of participants included varied from 20 to 602, protocols' length varied from a single session to 12 weeks of use of MPK. Taken together, MPK users compared to NMPK users tend to present better functional status and mobility. Quality of life was also positively impacted in MPK users. On the other hand, the superiority of more advanced MPKs such as the Genium® is less clear, especially given the improvements over time of other MPKs such as the C-leg® and the Rheo knee®.
Conclusions:
Based on our results, while it is clear that MPKs outperform NMPKs both for functional status and quality of life, additional benefits of one MPK over another is less clear. Future studies are needed to clarify these aspects.
Background
Falls are common and consequential events for lower limb prosthesis (LLP) users. Currently, there are no models based on prospective falls data that clinicians can use to predict the incidence of future falls in LLP users. Assessing who is at risk for falls, and thus most likely to need and benefit from intervention, remains a challenge.
Objective
To determine whether select performance-based balance tests predict future falls in established, unilateral transtibial prosthesis users (TTPU).
Design
Multisite prospective observational study.
Setting
Research laboratory and prosthetics clinic.
Participants
Forty-five established, unilateral TTPU.
Intervention
Not applicable.
Main Outcome Measures
The number of falls reported over a prospective 6-month period. Timed Up-and-Go (TUG) and Four-Square Step Test (FSST) times, as well as Narrowing Beam Walking Test scores were recorded at baseline, along with the number of falls recalled over the past 12 months and additional potential fall-risk factors.
Results
The final negative binomial regression model, which included TUG (P = .044) and FSST (P = .159) times, as well as the number of recalled falls (P = .009), was significantly better than a null model at predicting the number of falls over the next 6 months (X²[3] = 11.6, P = .009) and fit the observed fall count data (X²[41] = 36.12, P = .20). The final model provided a significant improvement in fit to the prospective fall count data over a model with fall recall alone X²(1) = 4.342, P < .05.
Conclusion
No combination of performance-based balance tests alone predicted the incidence of future falls in our sample of established, unilateral TTPU. Rather, a combination of the number of falls recalled over the past 12 months, along with TUG and FSST times, but not NBWT scores, was required to predict the number of “all-cause” falls over the next 6 months. The resulting predictive model may serve as a suitable method for clinicians to predict the incidence of falls in established, unilateral TTPU.
Introduction
With advances in surgical approach like osteomyoplastic amputation, it is unknown whether outcomes of walking at different speeds or carrying performance by men with an osteomyoplastic transfemoral limb (OTFL) are comparable with those of intact controls.
Materials and Methods
Otherwise healthy men with unilateral OTFL and intact controls consented to participate. All were independent walkers without history of diabetes or other dysvascular condition. All underwent 2-minute walk tests (2MWTs) at self-paced and brisk-paced speeds and 25-ft carry-to-capacity testing as part of a multiyear work performance study. For the current report, investigators compared walking and carrying baseline outcomes between OTFL and control groups.
Results
Six men with OTFL (mean age, 33.7 ± 14.8 years) and 20 controls (mean age, 31.7 ±11.1 years) completed the study. No initial differences between groups were found in age, height, weight, heart rate, blood oxygen saturation, hemoglobin A 1c , overall reported pain, or report of perceived exertion scores. However, the OTFL group walked shorter mean distances at self-paced (137.2 ±18.1 m) and brisk-paced (167.8 ± 20.3 m) 2MWTs than the controls did (self-paced, 155.7 ± 19.9 m, P = 0.015; brisk paced, 211.7 ± 3.0 m, P < 0.0001) and demonstrated less 25 ft-carry capacity (18.1 ± 9.7 kg) than the controls did (26.8 ± 3.1 kg; P = 0.001). Reported pain by the OTFL group was greater only during carry testing ( P < 0.046).
Conclusions
Despite receiving similar, well-fitted prosthetic limbs and standard rehabilitation after osteomyoplastic amputation, the OTFL group demonstrated lower walking and carrying capacities than a comparable control group. Results may reflect that the OTFL group may still be at risk of injury, demonstrating the need for further investigation of gait and other work performance outcomes by work-eligible men with OTFL and standard rehabilitation approaches.
Background:
The aim of this scoping review is to identify and summarize patient-reported outcome measures (PROMs) that are being used to track long-term patient-reported outcomes (PROs) after injury and can potentially be included in trauma registries.
Methods:
Online databases were used to identify studies published between 2013-2019, from which we selected 747 articles that involved survivors of acute physical traumatic injury aged 18 or older at time of injury and used PROMs to evaluate recovery between six months and 10 years post-injury. Data was extracted and summarized using descriptive statistics and a narrative synthesis of the results.
Results:
Most studies were observational, with relatively small sample sizes, and predominantly on traumatic brain injury or orthopedic patients. The number of PROs assessed per study varied from one to 12, for a total of 2052 PROs extracted, yielding 74 unique constructs [physical health: 25 (34%), mental health: 27 (37%), social health: 12 (16%), cognitive health: 7 (10%), and quality of life: 3 (4%)]. These 74 constructs were assessed using 355 different PROMs. Mental health was the most frequently examined outcome domain followed by physical health. Health-related quality of life, which appeared in more than half of the studies (n=401), was the most common PRO evaluated, followed by depressive symptoms. Physical health was the domain with the highest number of PROMs used (N= 157), and lower extremity functionality was the PRO that contributed most PROMs (N=33).
Conclusion:
We identified a wide variety of PROMs available to track long-term PROs after injury in five different health domains: physical, mental, social, cognitive, and quality of life. However, efforts to fully understand the health outcomes of trauma patients remain inconsistent and insufficient. Defining PROs that should be prioritized and standardizing the PROMs to measure them will facilitate the incorporation of long-term outcomes in national registries to improve research and quality of care.
Level of evidence:
IV.
Objective:
To describe the frequency and severity of phantom limb pain (PLP) in veterans with major upper limb amputation and determine the association between PLP and person, amputation, and prosthesis characteristics.
Design:
Cross-sectional design.
Setting:
National survey of veterans living in the community.
Participants:
U.S. military veterans (N = 776) with major upper limb amputations.
Main outcome measures:
Frequency and intensity of PLP, person characteristics such as age and gender, amputation characteristics such as level and etiology, and prosthesis characteristics such as type and intensity of prosthesis use.
Results:
Respondents were 97% male with a mean age of 63 years and a mean time since amputation of 31 years. The most common amputation level was transradial (36%) and 62% reported accident as the amputation etiology. 73% of amputees reported PLP with a mean intensity score of 4.2 (standard deviation 3.4). PLP frequency in the daily to always category was reported in 42% of amputees. Weekly and more frequent residual limb pain was associated with having any PLP. Amputation at the shoulder (odds ratio [OR] 3.78 [1.93, 7.39]), amputation at the transhumeral level (OR 1.76 [1.10,2.81]), and amputation due to cancer (OR 5.33 [1.15, 24.81]) were also associated with any PLP. Moderate (β = 1.34, P = < .001) and severe (β = 3.31, P < .001) residual limb pain intensity was associated with higher PLP intensity among those with pain. Amputation at the shoulder level was associated with a 1.5 points higher average pain intensity score (P < .001) compared to the transradial level. Multivariable models failed to show an association between PLP prevalence and amputation of the dominant limb (P = .08) and PLP was not associated with intensity of daily prosthesis use in bivariate analyses.
Conclusion:
This study of a large cohort of veterans with major upper limb amputation highlights the long-term persistence of moderate frequency and intensity PLP.
Background
Many people with lower limb amputation experience mobility impairment and reduced quality of life. Mobility clinics are designed to improve mobility and quality of life for people with lower limb amputation, but their effectiveness is unknown.
Objectives
To compare changes in mobility prior to, and 12 weeks following participation in mobility clinic for people with lower limb amputation, and to explain whether changes in mobility explained changes in quality of life. To determine whether the PLUS-M™ was sensitive to the effects of participation in the mobility clinic, and to estimate the sample size required for a definitive study.
Study design
Longitudinal observational.
Methods
Electronic versions of the PLUS-M and SF-36v2 ® were completed by people living in the community with lower limb amputation prior to, and 12 weeks following participation in a mobility clinic.
Results
There was a significant increase in mobility from baseline to 12 weeks post participation in the clinic ( p = 0.012). Changes in mobility explained a significant proportion of variance in the SF-36v2 mental component summary ( p = 0.024) but not the physical component summary ( p = 0.804).
Conclusion
For people with lower limb amputation, mobility increased after participation in the clinic and this explained improvements in SF-36v2 mental component summary. The PLUS-M was sensitive enough to detect a change in mobility over time.
Clinical relevance
This preliminary data indicated that participation in a mobility clinic improved mobility and the mental components of quality of life for people living with lower limb amputation. The PLUS-M™ seems sensitive to changes in mobility as a result of participation in a mobility clinic.
Objectives:
To determine which demographic, amputation, and health-related factors were associated with health-related quality of life (HR-QoL) in people living with partial foot amputation (PFA) or transtibial amputation (TTA).
Design:
Cross-sectional survey.
Setting:
Community.
Participants:
Adults (N=123) with unilateral PFA (n=42) or TTA (n=81).
Intervention:
Not applicable.
Main outcome measure:
Medical Outcome Short Form (SF-36) version 2.
Results:
Variation in the SF-36 Physical or Mental Component Summary scores were associated with complex interactions between factors, including: time since amputation, fatigue, anxiety, depression, pain interference, and physical function. Level of amputation (ie, PFA or TTA) did not explain a significant part of the variation in either the SF-36 Physical or Mental Component Summary scores.
Conclusions:
Given the complex interactions between factors associated with the physical and mental health components of HR-QoL, there are opportunities to consider the long-term holistic care required by people living in the community with PFA or TTA.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
In 1964 Dr. Glattly published the results of a survey of new amputees which he conducted with the assistance of members of the American Orthotic and Prosthetic Association (AOPA) between 1961 and 1963. Data were obtained on more than 12,000 amputees who presented themselves for fitting of an artificial limb for the first time. The study was the first of its kind, and the results have been of interest and use to many practitioners, research workers, and administrators. In 1973-1974, the Committees on Prosthetics Research and Development and Prosthetic Orthotic Education (CPRD CPOE) conducted an identical study to determine whether the characteristics of the current amputee population were any different from those recorded by Glattly. In his study, there was no change in the ratios obtained when data from the first 5,000 cases were compared with those obtained from the total sample of 12,000. In the 1973-1974 study, data from the first 1,654 cases were analyzed and compared later with data from 5,830 cases. Because there were no practical differences in the ratios obtained, the study was concluded.
One hundred thirty-four lower extremity amputees were evaluated from six months to 12 years postamputation by means of retrospective questionnaires. Patient population was similar to that of the "Amputee Census" in terms of sex, amputation level and cause of amputation. Information was gathered on activities generally considered essential for daily living, vocation and recreation, living arrangements and adjustments therein, as well as feedback on the patients' beliefs concerning what rehabilitation personnel should be doing to improve amputees' lifestyle. The relationship of functional outcome to age, amputation level, and cause of amputation was also evaluated. Results showed that most amputees did not resume a completely normal lifestyle and many modifications were made. The most popular recreational activities were fishing and swimming. Activities that amputees found most difficult were running and walking long distances. Patients requested better communication between professional staff and themselves. Below-knee amputees were significantly more independent than above-knee and bilateral amputees, but the differences between above-knee and bilateral amputees were statistically insignificant. Tumor patients did better than the other three etiologic groups. As age increased, functional independence decreased.
To assess the current epidemiological situation concerning lower limb amputations in southern Finland the data on all amputations made in the catchment area of the Helsinki University Central Hospital were analysed for the period 1984-85. During the two-year period, 880 amputations of lower limbs were performed on 705 patients. The amputation rate was 32.5 per 100,000 inhabitants in 1984 and 28.1 in 1985. Patients requiring amputation were arteriosclerotics in 43.1 per cent. and diabetics in 40.7 per cent. Diabetics underwent amputation 3 years younger on average than the arteriosclerotics. The most common site of unilateral amputations was above-knee (42.0 per cent) followed by below-knee (27.7 per cent) and toe amputations (22.2 per cent). The level of amputation tended to become more proximal with increasing age of the patients. The overall mortality figure during three postoperative months was 27.0 per cent. Amputation incidence increased sharply with increasing age. On the base of predictions, the overall age structure of the Finnish population will shift upward causing an increase in the proportion of elderly age groups. A 50% increase in amputation rate is expected in Finland within the next 20-30 years.
More than 1,000 industrial amputees at the Ontario Workers' Compensation Board were reviewed. The study investigated the current employment status of amputees and the factors that influenced successful return to work post-amputation. The data obtained from a mailed questionnaire was analysed by the Statistical Analysis System. The results revealed that 89% of amputees returned to work after an amputation. The average follow-up post-amputation was 14 years with a range of one to 64 years. At the time of review the current employment status of amputees was as follows: 51% full time employed, 5% part-time employed, 25% retired and 8% unemployed. The remainder were engaged in a vocational activity, still recovering or were not seeking work. The data revealed that amputees typically changed jobs when returning to the work force. Amputees returned to jobs that were less physically demanding, but required greater intellectual skills in occupations such as clerical and service industries. Factors including prosthetic use, vocational services, and a younger age at the time of amputation were identified as being positively associated with a return to work. Those factors that were negatively related to successful employment included stump and phantom limb pain and multiple limb amputations. The study concluded that the majority of the amputees reviewed were successful in returning to work. The authors suggest that amputees benefit from treatment programmes that include medical, prosthetic and vocational services.
Motivation for work, level of physical disability, period of incapacity, completion of an employment rehabilitation course
and unemployment in the general population are the major determinants of an early return to stable employment in the disabled.
In a study of 350 men and 29 women with limb injuries who were discharged from three rehabilitation centres, those with only
soft tissue injuries were less disabled, incapacitated for shorter periods and completed employment rehabilitation courses
compared with those with fractures, dislocations or amputations. There was, however, no association between the type of injury
and motivation for work. Return to work after rehabilitation was unrelated to the type or site of injury. In this group of
patients, motivation for work appeared to have a greater influence on the outcome of rehabilitation than other known predictors
The goal of rehabilitation of the person with spinal cord inury is to enable the individual to live successfully in the community. This implies that persons are prepared to care for themselves (or to direct others in their care) and are independent to the greatest extent possible. They are also able to maintain a healthy and adjusted social and vocational life. Independent living centers, providing access to services such as attendant care, have allowed the most severely disabled perons to live indenpendently in the community.
To review the prosthetic history, prosthetic charges, and functional status of traumatic, isolated, unilateral below-knee amputees at select intervals following amputation.
This descriptive study was conducted among patients admitted to Harborview Medical Center between 1980 and 1987 who survived initial trauma, and who required an isolated, below-knee amputation. Hospital and prosthetist records were abstracted to calculate the number of prostheses fabricated and the prosthetic charges since initial amputation. Functional outcomes were determined by personal interview and self-administration of the SF-36 Health Status Profile.
The average age of patients was 36 with the age range extending from 19 to 59 years. The prosthetic history and prosthetic charges were determined from the medical record and the billing records of the prosthetist. Exact charges were determined for 15 of the 20 patients. During the first 3 years, the mean number of prostheses acquired per patient was 3.4 (range 1-5), with average total prosthetic charges of $10,829 (range $2,558-$15,700). Over the first 5 years the mean number of prostheses acquired per patient was 4.4 (range 2-8), with average total prosthetic charges of $13,945 (range $6,203-$20,070). The SF-36 Health Status Profile scores were significantly decreased from published normal aged-matched scores in the categories of physical function and role limitations because of physical health problems and pain. Scores were not significantly different from published normal aged-matched scores in the other five categories: role limitations due to emotional problems, social functioning, mental health, energy/fatigue, and health perception.
This study was undertaken to determine the percentage of soldiers who remain on active duty after undergoing a Physical Evaluation Board (PEB) for an amputation. The computerized records of all amputee soldiers who were presented to one of four Army PEBs during an 8-year period (October 1980 to September 1988) were reviewed. Only 11 of 469 soldiers (2.3%, 95% CI 1.2-4.2%) remained on active duty after amputation. Of those who returned to duty, most (6 of 11) sustained partial hand amputations, three had partial foot amputations, and two were below-knee amputees. Among those returning to duty, there were no female soldiers. We conclude that continuation on active duty is a rare event after amputation. Further studies on active duty is a rare event after amputation. Further studies are necessary to define the characteristics associated with active duty service as an amputee and the impact of an amputation on performance of military duties.
The annual number of major lower limb amputations in Denmark as a consequence of trauma was constant during the period 1978 through 1990, with about 70 (1.4 per 100,000 population) per year. The mean age of the amputation population was 49.4 years (males, 44.8 years; females, 58.8 years). Analysis of the age distribution shows characteristic differences between male and female patients. The average hospital stay was 49 days, and 56% of patients were discharged to their homes. The most prevalent amputation levels were transtibial and above-knee, which accounted for about 80% of all amputations. The only systematic change during the period under study was the increase in the number of through-knee amputations. The in-hospital mortality was related to sex, level of amputation, and age. The relative number of amputations varied in the different counties of Denmark and a positive correlation between population density and rate of amputation was found.
This retrospective review of the long-term problems of patients with lower extremity amputation from trauma fails to support the opinion that most traumatic amputees do well. Overall, anatomic problems involved 51% of the amputees, and social problems involved 56%. Attempting limb salvage with subsequent secondary amputation did not seem to compromise the long-term outcome for these problems. The surgeon performing the amputation should try to obtain the best possible stump and insure that the patient gets the careful follow up and multidisciplinary team support needed to manage the anticipated problems.
This study compared the Functional Independence Measure (FIM) scores of traumatic (n=12) and vascular (n=12) unilateral lower limb amputees at admission and discharge from a rehabilitation facility. FIM scores that were measured were amputation FIM subscores and total FIM scores. Comorbidity indexes were developed to weight the stump condition and comorbidities seen in both groups. The vascular group was significantly (P<0.01) greater stump comorbidity, but there was no significant difference with respect to length of stay, medical comorbidity score, and amputation and total FIM scores both at admission and discharge between the two groups. Medical comorbidity was significantly (P<0.05) correlated with amputation and total FIM scores at discharge for traumatic amputees with r = -0.64 and r = -0.66, respectively. Stump comorbidity was significantly (P<0.05) correlated with total FIM at discharge with r = -0.64 for vascular amputees. Medical comorbidity was a good predictor of discharge FIM scores for traumatic amputees, whereas stump comorbidity predicted discharge FIM scores for vascular amputees, although not as well. In conclusion, inpatient traumatic amputees may be younger than vascular amputees, but traumatic amputees may not necessarily be healthier or do better functionally at discharge than vascular amputees.
To examine patterns of trauma-related amputations over time by age and gender of the patient and by level and type of amputation, and to explore factors affecting acute care length of stay and discharge to inpatient rehabilitation.
Population-based hospital discharge data for Maryland from 1979 through 1993.
Patients (N = 6,069) discharged with either (1) a principal or secondary diagnosis of a trauma-related amputation to the upper or lower extremity or (2) a procedure code for a lower or upper limb amputation in combination with a principal diagnosis of an extremity injury or injury-related complication.
Incidence of major amputations declined 3.4% (p < .05) annually from 1.88 per 100,000 in 1979 to 1.07 per 100,000 in 1993. Incidence of minor amputations declined 4.8% (p < .05) annually from 10.8 per 100,000 in 1979 to 4.7 per 100,000 in 1993. Acute care length of stay for trauma-related amputations declined 40% over the study period and was significantly affected by the patient's payer source, amputation level, and injury characteristics. Of the patients with a major amputation, 15% were discharged to inpatient rehabilitation; 60% were discharged directly home. More proximal amputation levels, presence of severe injuries to other body systems, and acute care at a designated trauma center significantly increased the likelihood of disposition to inpatient rehabilitation. The leading causes of trauma-related amputation were injuries involving machinery (40.1%), powered tools and appliances (27.8%), firearms (8.5%), and motor vehicle crashes (8%).
Findings suggest a substantial decline in incidence rates of both major and minor amputations over the 15-year study period, a low rate of disposition to inpatient rehabilitation services of patients sustaining major amputations, and an apparent role of firearms as a cause of trauma-related amputations in patients younger than 25 years of age. The consequences of increasingly shorter acute care hospital stays and low rates of discharge to inpatient rehabilitation on the long-term outcomes of persons who have had traumatic amputation should be examined.
This represents the first statistical study of new amputees in this country. The data being accumulated will provide material for further more detailed evaluations of the reasons for, and the results of various types of amputations.
Rehabilitation of the patient with head injury
- White