A Depiction of Rehabilitation Patients 65 Years and Younger With Dysvascular Lower Extremity Amputation

Quality of life following non-dysvascular lower limb amputation is contextualized through occupations: a qualitative study

PURPOSE

To understand how persons with non-dysvascular lower limb amputation (LLA) use occupations to contextualize their quality of life (QoL).

METHODS

A qualitative study using an interpretative description approach was conducted. Analysis of the interviews was guided by an occupational perspective, which considers the day-to-day activities that are important to an individual.

RESULTS

Twenty adults with an adult-acquired non-dysvascular amputation (e.g., trauma, cancer or infection) were interviewed. Following thematic analysis, two main themes were developed: (1) sense of self expressed through occupations; and (2) sense of belonging with others influenced by occupations. Participants expressed the way they felt about themselves through their activities and placed high value on whether they could participate in certain occupations. Participants also described how their sense of belonging was changed through the context of their changing occupations.

CONCLUSION

The findings from this work can be leveraged by clinicians and researchers alike to improve care for this population. Rehabilitation programs should consider interventions and programming that help to restore occupations or develop new ones given the importance placed on occupations by persons with non-dysvascular LLA.

Health utility in community-dwelling adults with dysvascular lower limb loss

PURPOSE

Adults with dysvascular lower extremity amputation (LEA) experience a large number of secondary health conditions yet there is a gap in the literature on health utility scores for this population. A health utility score relates to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). This study aimed to provide a descriptive account of health utility scores in community-dwelling adults with dysvascular LEA.

METHODS

Participants were adults with dysvascular LEA who were 3 months post-amputation. Data collected included socio-demographic characteristics, the Special Interest Group in Amputee Medicine (SIGAM) grades, the dysvascular conditions scale (DCS), which is a scale developed for this study, and the Short Form-36 (SF-36). SF-6D health utility scores were derived from the SF-36 using a software algorithm. Participants were grouped into low-impact and high-impact groups based on self-reported severity of symptoms using the DCS. Health utility scores were compared between the low-impact and high-impact groups using independent t-tests.

RESULTS

A total of 231 participants were enrolled in the study. The mean SF-6D health utility score was 0.689 (0.127). A significant association was found between health utility score and SIGAM grade (p < 0.001, η2 = .09). Health utility was positively associated with age (r = 0.137, p = 0.037) and months post-amputation (r = 0.141, p = 0.032), and negatively associated with DCS severity (r = -0.526, p < 0.001). Health utility scores were lower for participants in the DCS high-impact groups for conditions such as diabetes mellitus, phantom limb pain, musculoskeletal pain, back pain, psychological distress, depression, vision problems, and other pain.

CONCLUSION

Cost-utility analyses rely on health utility estimates and our findings provide data for future economic evaluations that may assist policy makers in evidence informed allocation of healthcare resources for this population.