Gender Differences in Psychosocial and Physical Outcomes in Haitian Amputees

Quality of life in young people with limb loss: a systematic review

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.

Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review

PURPOSE

To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA).

METHODS

A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis.

RESULTS

One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations.

CONCLUSION

Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.

Mental health and psychosocial support during physical rehabilitation in Eastern Democratic Republic of Congo: a retrospective cohort study

PURPOSE

This study explores the relevance of integrating mental health and psychosocial support (MHPSS) into physical rehabilitation services in conflict settings.

MATERIAL AND METHODS

Symptoms of psychological distress and daily functioning of 132 physical rehabilitation service users in Eastern Democratic Republic of Congo were assessed before and after MHPSS. Logistical regression models were used to identify factors associated with these symptoms.

RESULTS

Prior to receiving MHPSS, "extreme" symptoms of depression were reported by 64% of the service users. Amputation predicted high levels of depression (aOR 5.12, p = 0.021), anxiety (aOR 7.09, p = 0.004) and stress (aOR 3.37, p = 0.035), while having witnessed violence predicted high symptoms of stress (aOR 3.65, p = 0.014). Lack of social support was associated with high symptoms of stress prior to MHPSS (aOR 3.17, p = 0.046) as well as a large reduction in symptoms of depression following MHPSS (aOR 3.91, p = 0.019). Most physical rehabilitation service users reported a reduction in symptoms of depression (100.00%), anxiety (98.03%) and stress (100.00%) along with improved functioning (81.13%) after MHPSS.

CONCLUSION

MHPSS needs of physical rehabilitation service users in conflict settings stem from the combined impact of disability and exposure to violence. MHPSS care, particularly the mobilization of peer support, appears necessary and relevant.Implications for rehabilitationIn conflict settings, mental health and psychosocial support (MHPSS) needs of physical rehabilitation service users must address the combined impact of physical disability and exposure to violence.Physical rehabilitation service users who lacked social support prior to receiving MHPSS were more likely to report a large reduction in symptoms of depression following MHPSS.The study underlines the importance of social support, particularly peer support, in addressing MHPSS needs.

Quality of Life in Lower-Limb Amputees 10 Years After the 2008 Sichuan Earthquake: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to investigate the long-term outcome of quality of life (QOL) in the lower-limb amputees 10 years after the 2008 Sichuan earthquake.

METHODS

In the cross-sectional study, 66 lower-limb amputees were recruited. The prosthetics-related QOL was assessed using the Prosthetic Evaluation Questionnaire (PEQ) in terms of the scales of utility, appearance, sounds, residual limb health, perceived response, frustration, social burden, ambulation, and well-being. The score of each PEQ subscale was calculated and compared among the cohorts with different demographic characteristics.

RESULTS

The PEQ scores showed that the scales of sounds, residual limb health, and frustration were still low in the lower-limb amputees 10 years after the 2008 Sichuan earthquake. The comparison of PEQ scales among cohorts with different demographic characteristics indicated that the potential demographic risk factors, namely, age, marital status, educational level, living independence, and comorbidity, were associated with prosthesis-related QOL.

CONCLUSIONS

The prosthesis-related QOL of the lower-limb amputees 10 years after the 2008 Sichuan earthquake has been partly documented in this study. The potential demographic risk factors associated with QOL of amputees were also identified. These findings could enhance the understanding of prosthesis-related QOL of lower-limb amputees sustained in an earthquake and facilitate the optimization of post-disaster rehabilitation strategies.

American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary for Limb Salvage or Early Amputation

Clinical Practice Guideline for Limb Salvage or Early Amputation is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to address treatment for severe lower limb trauma below the distal femur by either amputation or limb salvage by providing evidence-based recommendations for key decisions that affect the management of patients with lower extremity trauma. This guideline contains 11 recommendations to evaluate the decision factors important for limb salvage versus early amputation. In addition, the work group highlighted the need for better research in the treatment and the shared decision making process of high-energy lower extremity trauma.