Health-related quality of life and the ability to perform activities of daily living: a cross-sectional study on 1079 war veterans with ankle-foot disorders

Patient-Reported Outcome Measures With Secondary Lower Limb Lymphedemas: A Systematic Review

Background

Patient-reported outcome measures are measures of patients' health-related quality of life. They should be added to other lymphedema measurements. With an improved disease-free survival of secondary lower limb lymphedema, attention must focus on such assessments.

Objective

The objectives of this study were to locate and critically appraise suitable patient-reported outcomes measures for lower limb lymphedemas and search for existing valid translations for native German speakers.

Methods

A systematic literature research was conducted. 20 semantical categories for qualitative analysis were evolved. Six questionnaires available in English and some in validated translations remained for analysis.

Results

Lower limb lymphedema patients experience poor quality of life, and one of the most critical denominators is skin quality. To establish skin care and prevent cellulitis, patients must learn about skin problems. Only two tools asked for past infections. This is considered crucial because of knowledge building and prophylactic behavior. Questions on movement restrictions were available in one questionnaire. As these have a close connection to one's ability to perform activities of daily life, they can affect quality of life. Afflicted patients have problems with the choice and availability of clothing. Only three questionnaires asked questions about clothing or shoes. Lymphedema patients are exposed to more psychological stress than healthy subjects, but only three questionnaires covered questions about this burden. There was a lack of reporting on psychometric data (Cronbach's alpha, intraclass correlation), which hinders the external validity. Analyzed questionnaires were available in English but only one in German.

Conclusions

The analyzed questionnaires were in English, and only one was adapted and tested for native German speakers. For clinical practice, Devoogdt's questionnaire is recommended despite some shortcomings. There is a need for validated lymphedema questionnaires in German.

Chronic musculoskeletal pain, phantom sensation, phantom and stump pain in veterans with unilateral below-knee amputation

Background and aims

Many individuals with lower limb loss report concerns about other musculoskeletal symptoms resulting from amputation. The objective of this study was to assess chronic musculoskeletal pain in Iranian veterans with unilateral below-knee amputation.

Methods

The participants agreed to take part in a health needs assessment and were interviewed face-to-face by trained interviewers. The assessment consisted of demographic information, wearing a prosthesis, pain locations in extremities, stump complications, severity of pains related to amputation and low back pain.

Results

Of 247 unilateral below knee amputees, 97.9% wore a prosthetic limb and times walking or standing with the prosthesis were 12.47 ± 3.84 and 4.22 ± 3.53 h a day, respectively. Low soft tissue coverage of the stump (15.4%) and symptomatic osteoarthritis in the contralateral lower extremity (40.1%) were the most common complications. The prevalence of stump pain, phantom sensations, phantom pain, low back pain, and knee pain was 84.2%, 77.3%, 73.7%, 78.1%, and 54.7% respectively. The odds ratio of stump pain in amputees with phantom pain was 2.22 times higher than those who did not experience phantom pain [OR = 2.22 (CI: 1.19–4.17); p = 0.012] and the odds ratio of low back pain was higher in amputees with stump pain [OR = 3.06 (CI: 1.50–6.21); p = 0.002].

Conclusions

This research enhances our understanding of comorbid musculoskeletal problems in below-knee amputees which can help health providers to identify rehabilitation needs and emphasizes the importance of regular assessments.

Implications

These findings underline the importance of paying closer attention to different dimensions and aspects of musculoskeletal complications in veterans with unilateral below-knee amputation.

Capacidade funcional e qualidade de vida de pacientes com feridas crônicas

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Functional capacity and quality of life of patients with chronic wounds

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Health concerns of veterans with high-level lower extremity amputations

BACKGROUND

The aim of the study was to identify health concerns of veterans with high-level lower extremity amputations.

METHODS

Through a cross-sectional study, general practitioners, an orthopedic specialist, psychologists, psychiatrists, physiotherapist and prosthetists examined 100 veterans using a short-form health-related quality of life questionnaire (SF-36) that assessed their ability to perform activities of daily living (ADL), instrumental activities of daily living (IADL) and life satisfaction (SWLS) after hip disarticulation or hemi-pelvectomy amputations. The assessment tool was designed to gather statistically useful information about their health needs.

RESULTS

The means of the Physical Component Summary (PCS), Mental Component Summary (MCS), SWLS, ADL and IADL were 48.58 ± 29.6, 33.33 ± 22.0, 19.30 ± 7.7, 48.10 ± 10.5 and 5.08 ± 1.8, respectively. Somatization, depression, and anxiety were the most prevalent disorders; among the veterans who were visited by psychiatrists, 11.6% had a history of hospitalization in a psychiatry section, and 53.2% had a psychiatric visit. Regardless of their injury in battle, 34% of veterans were hospitalized. Hearing problems were common, and about four-fifths of the participants suffered from at least one orthopedic condition. Neuroma (49%) was the most common stump-related complication during orthopedic evaluations, though the prevalence of phantom pain was 81% during the pain assessment. A total of 87% of the participants had a history of wearing a prosthesis, but only 29% wore a prosthesis at the time of the present study. The Canadian-type of prosthesis was uncomfortable and not useful (27%) and excessively heavy (10%) according to the amputees.

CONCLUSIONS

Understanding veterans' characteristics and special needs are important to make sure that enough facilities and services are afforded to them. These findings emphasize the importance of paying close attention to different dimensions of health in veterans and can help health providers identify health needs and make regular assessments.