A study on quality of life among lower limb amputees at a tertiary prosthetic rehabilitation center

Reporting of Rehabilitation Outcomes in the Traumatic Lower Limb Amputation Literature: A Systematic Review

OBJECTIVE

To synthesize the outcomes reported in the rehabilitation and community literature for adults with traumatic lower limb amputation (LLA).

DATA SOURCES

The search strategy was conducted in 3 databases (Medline, EMBASE, and CINAHL) from inception to April 2022.

STUDY SELECTION

To be eligible, articles could be of any design but were required to have at least 50% adult individuals with traumatic LLA and had to report on interventions and outcomes in either a rehabilitation or community setting.

DATA EXTRACTION

The extracted outcomes were classified using Dodd's framework, which is designed for organizing research outcomes. Heterogeneity was observed in the outcome measures (OMs) used for evaluation. Two reviewers independently conducted the data extraction, which was verified by a third reviewer.

DATA SYNTHESIS

Of the 7,834 articles screened, 47 articles reporting data on 692 individuals with traumatic LLA, met our inclusion criteria. Four core areas encompassing 355 OMs/indicators were identified: life effect (63.4%), physiological/clinical (30.1%), resource use (5.1%), and adverse events (1.4%). Physical functioning (eg, gait, mobility) was the most frequently reported outcome domain across studies, followed by nervous system outcomes (eg, pain) and psychiatric outcomes (eg, depression, anxiety). Domains such as global quality of life and role/emotional functioning were seldomly reported.

CONCLUSION

The study provides a list of outcome indicators explicitly published for adults with traumatic LLA, highlighting inconsistent reporting of outcome indicators. The lack of a standardized set of OMs is a barrier to performing meta-analyses on interventions, preventing the identification of effective care models and clinical pathways. Developing a core outcome set that includes OMs relevant to the needs of the traumatic LLA population may address these issues.

Lower limb amputation rehabilitation status in India: A review

Rehabilitation of lower limb amputation in developing countries is quite challenging. Though there are basic to highly advanced prostheses available in India, the set-up is still facing difficulties in developing countries. Prosthetic management is difficult due to lack of availability of prostheses and reduced affordability among low income populations. In this review we highlighted the lower limb amputation and prosthetic rehabilitation status in India. Currently, India is advancing well in the rehabilitation field, but further studies are required to provide more evidence and recommendation.

Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient's general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

Old and Novel Predictors for Cardiovascular Risk in Diabetic Foot Syndrome—A Narrative Review

Diabetic foot syndrome (DFS) is a complication associated with diabetes that has a strong negative impact, both medically and socio-economically. Recent epidemiological data show that one in six patients with diabetes will develop an ulcer in their lifetime. Vascular complications associated with diabetic foot have multiple prognostic implications in addition to limiting functional status and leading to decreased quality of life for these patients. We searched the electronic databases of PubMed, MEDLINE and EMBASE for studies that evaluated the role of DFS as a cardiovascular risk factor through the pathophysiological mechanisms involved, in particular the inflammatory ones and the associated metabolic changes. In the era of evidence-based medicine, the management of these cases in multidisciplinary teams of “cardio-diabetologists” prevents the occurrence of long-term disabling complications and has prognostic value for cardiovascular morbidity and mortality among diabetic patients. Identifying artificial-intelligence-based cardiovascular risk prediction models or conducting extensive clinical trials on gene therapy or potential therapeutic targets promoted by in vitro studies represent future research directions with a modulating role on the risk of morbidity and mortality in patients with DFS.

Quality of Life in People With Unilateral Lower Limb Amputation at a Tertiary Rehabilitation Centre in Northern India: A Cross-Sectional Study

Background and purpose The patients after amputation undergo a sudden transformation in their quality of life. In India, amputation done at the appropriate time is a rare phenomenon because usually, the patients present themselves at the later stages. The surgeons, however, while performing amputation surgeries, primarily consider saving the life of a patient under adverse conditions when patients report to them very late that the surgeries are carried out urgently. Assessing the quality of life (QOL) and the various sociodemographic factors affecting the QOL paves the way for future rehabilitation programs. Aims and objectives To evaluate the quality of life of subjects with unilateral lower limb amputation among the North Indian population. Materials and methods This cross-sectional study was conducted in the tertiary rehabilitation center. A total of 106 Subjects were recruited. Informed consent was taken. WHOQOL-BREF contains 26 items covering four important aspects of QOL. The WHOQOL-BREF self-administered free questionnaire was used as a data collection tool, and the Hindi version downloaded from the WHO website was also used for those who can't understand English. Results The range of the physical domain, psychological domain, social domain, and environmental domain were 0 and 100. The mean score of different QOL transformed domain scores (on a scale of 100) were 47.91±20.12, 57.37±20.46, 59.36±25.32 and 51.50±21.96, respectively. Trauma was the leading cause of amputation, followed by diabetes mellitus, cancer, peripheral vascular disease, and other causes. Transtibial amputees were more in number compared to transfemoral. The percentage of male and female amputees was 78.30%, and 21.70%, respectively. Conclusion The physical domain was the most affected domain, followed by the psychological, social, and environmental domains. A delay in the prosthesis fitment aggravates the physical burden of amputees. Early prosthesis & psychological counseling will improve the QOL significantly.

Physiotherapy Rehabilitation in an Above-Knee Amputee Following Compartment Syndrome in Post-tibial Plateau Fracture: A Case Report

Proximal tibia fractures are generally open fractures resulting in life-threatening complications. There is an increase in the prevalence of compartment syndrome post-tibial fractures. Though fasciotomy and wound debridement is the choice of treatment in such conditions, amputation becomes a necessity when there is widespread muscle and tissue damage. Specifically, compartment syndrome involving the lower limb is distressing as its symptoms can be misleading at times resulting in delayed diagnosis and hence life-threatening complications. A 48-year-old male met with a road accident and presented to the hospital with complaints of pain and an open wound over the anterior aspect of the right lower leg 14 days ago. He was managed by Ilizarov external fixator. Later he developed compartment syndrome as a complication of tibial plateau fracture, for which decompressive fasciotomy was performed. But due to irreversible tissue loss and gangrene, he had to undergo above-knee amputation followed by physiotherapy rehabilitation. We mainly focused on postoperative/pre-prosthetic rehabilitation. During postoperative rehabilitation, we concentrated on reducing phantom limb pain, preventing complications, and improving strength and endurance. Current literature claims that mirror therapy is effective in reducing phantom limb pain in post amputees, but there are only a few case reports emphasizing mirror therapy in particularly lower limb amputees. Therefore, we emphasized using mirror therapy for phantom limb pain in this case of lower limb amputation. It resulted in positive outcomes. Our broader aim was to strengthen the upper limbs and the intact lower limb so that the patient's overall functional independence can be enhanced. Further prosthetic rehabilitation was planned in which we focused on gait and balance training. Physiotherapy rehabilitation improved the patient's quality of life and independence.

Social Aspects of Diabetic Foot: A Scoping Review

Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM). Patients with DFU have increased mortality and morbidity as well as decreased quality of life (QoL). The present scoping review aims to study the social issues of diabetic foot. Following PRISMA guidelines, the review was conducted in two databases (Scopus and Pubmed) with the use of the following keywords: “social aspects and diabetic foot”, “social characteristics and diabetic foot”, “social issues and diabetic foot”, “demographic profiles and diabetic foot”, “social determinants and diabetic foot”, “social capital and diabetic foot”, “social characteristics and gender and diabetic foot”, “social profiles and diabetic foot”, “social relationships and diabetic foot” and “social risk and diabetic foot”, from July to August 2021. Predetermined exclusion and inclusion criteria were selected. Forty-five studies (quantitative and qualitative) were eligible for inclusion in this review. Gender problems, socioeconomic status, social capital, and medical problems were the most important negative variables for diabetic foot. All the included variables reveal that the social impact of diabetic foot is the most important factor for management and prevention, in terms of aggravation and more, of the diabetic foot.

Physical activity and quality of life in adults and elderly individuals with lower limb amputation

OBJECTIVE

The aim of this study was to investigate the levels of physical activity (PA) and quality of life (QOL) in adults and elderly individuals with lower limb amputation (LLA).

METHODS

This was a cross-sectional observational study. Participants completed three surveys as follows: a demographic survey, the International Physical Activity Questionnaire, and the World Health Organization Quality of Life. Thirty-six individuals with lower limb amputation were separated into two different groups as follows: Adults-lower limb amputation (n=12), composed of individuals with lower limb amputation who aged from 18-59 years, and Elderly-lower limb amputation (n=24), composed of individuals with lower limb amputation who aged 60 years and above. Statistical differences were determined as p<0.05.

RESULTS

Age and number of individuals with a low level of functional independency were higher in the Elderly-lower limb amputation group (p<0.05). The International Physical Activity Questionnaire scores were reduced in the Elderly-lower limb amputation group (p<0.05). The Pearson's correlation test between low metabolic equivalent task (MET), time since amputation, and family income presented positive significant results in the Elderly-lower limb amputation (p<0.05). Adults-lower limb amputation just presents a positive significant correlation with the low family income (p<0.05).

CONCLUSION

Elderly individuals with lower limb amputation are more susceptible to present negative health outcomes than adults with lower limb amputation.

Change in Domains that Influence Quality of Life after Major Lower Limb Amputation in Patients with Peripheral Arterial Disease

BACKGROUND

Recent guidelines raise the concept of the importance of health-related quality of life (QoL). Change in QoL after amputation in ischemic patients is not well described. We aim to evaluate the change in quality of life after major limb amputation in patients with peripheral arterial disease.

METHODS

We retrospectively identified all patients submitted to above-knee amputation (AKA) and below-knee amputation in our vascular surgery department in a 2-year period. Trauma excluded. A vascular amputee adapted QoL questionnaire was administered comparing the last 2 weeks to the 2 weeks before amputation. It included subjective and objective questions adapted from WHOQoL-BREEF and SF-36 divided into specific domains of QoL (physical health, role physical, pain, social, and psychological health) that were compared to 2 global items (overall QoL and general health). Independent samples tests and linear correlations were calculated.

RESULTS

A total of 106 patients were included, 30-day mortality rate 16.3% and 1-year 39.1%. Patients had an increase in mean total score after amputation of 14.35 out of 100 points, with an improvement of 52.1 points in pain and 11 points in social and psychological health out of 100 (P<0.001). Physical health and role physical scores decreased after amputation. Overall QoL was correlated with total score (P<0.001). Mean QoL total score after amputation was 79.0% ± 12.6. In general, amputees scored higher in the domains social and psychological health. Older people, women, AKA and bilateral amputees had lower physical health scores (P<0.05), prosthesis was correlated with improvement in physical health after amputation (P = 0.026). Elderly and married people had big improvement in overall QoL after amputation (P = 0.008 and P = 0.056, respectively).

CONCLUSIONS

QoL does not seem to diminish in advanced ischemic patients after amputation. Older people value more a decrease in pain and family support over physical health. Therefore, patient oriented treatments should be preferred. Future research should be made to validate a disease-specific questionnaire for this population.