Psychosocial adjustment to diabetes-related lower limb amputation

NewsBot · Sep 25, 2009

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Psychosocial adjustment to diabetes-related lower limb amputation
L. Coffey, P. Gallagher, O. Horgan, D. Desmond and M. MacLachlan
Diabetic Medicine Volume 26 Issue 10, Pages 1063 - 1067

Aim To examine psychosocial adjustment in persons with lower limb amputations related to diabetes.

Methods Thirty-eight participants with diabetes-related lower limb amputations, recruited from two limb-fitting centres, completed three psychological self-report assessments: the Trinity Amputation and Prosthesis Experience Scales (TAPES); the Hospital Anxiety and Depression Scale (HADS); and the Amputation Body Image Scale—Revised (ABIS-R).

Results Over 18% of participants scored above the normal range (> 8) for depression on the HADS and 18.5% scored above the normal range for anxiety. Both depression (ρ = 0.75, P < 0.01) and anxiety (ρ = 0.62, P < 0.01) scores were significantly associated with body image disturbance, as measured using the ABIS-R. Significant relationships were also observed between body image disturbance and three TAPES subscales measuring psychosocial adjustment [general adjustment (ρ = −0.48, P < 0.01), social adjustment (ρ = −0.51, P < 0.01), adjustment to limitations (ρ = −0.45, P < 0.05)].

Conclusions Individuals with diabetes-related amputations may be at elevated risk for psychological distress as a result of their co-morbid medical condition. Regular screening for anxiety and depression and the provision of appropriate follow-up care may therefore be advisable in this population.
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NewsBot · Sep 10, 2010

A systematic literature review of quality of life in lower limb amputees.
Sinha R, Van Den Heuvel WJ.
Disabil Rehabil. 2010 Sep 9. [Epub ahead of print]

Purpose. To systematically review studies on quality of life (QoL) in lower limb amputees.

Method. Computerised literature search of MEDLINE, CINAHL, PUBMED and PsycINFO databases was performed using the keywords, amputee, leg, knee, foot, amputation, QoL, prosthesis, orthopaedic equipment, ADL, phantom, mobility, rehabilitation, psychosocial, psychology and social. Eligible studies published from database inception through March 2009 were selected. The study was included if (1) the study population comprised of adolescent and adult lower-limb amputees as a group or a sub-group, and had ten or more subjects; (2) the study involved subjective assessment of QoL or self-appraisal of life or satisfaction with life; (3) the study was an empirical research study and (4) at least one of the study outcomes was QoL or self-appreciation of life, and QoL results were presented. The selected articles were assessed for study quality based on a standardised set of 19 criteria. The criteria list was pilot-tested for applicability and operationalisation by the authors. Objectives, study population description, QoL instruments used and study outcomes were summarised for the included studies.

Results. Twenty-six articles met the inclusion criteria. Fifteen studies were cross-sectional, four prospective, six retrospective and one mixed study-design. The studies were found to be heterogeneous with respect to the study objectives and instruments used to assess QoL. The summary quality score was 50% or more for ten studies, with the maximum being 81%.

Conclusions. Lacunas were found in the methodological and study population characteristics of most of the studies. Prospective longitudinal studies are envisaged to systematically study the events following amputation, and the change in QoL over time. To enable this, amputee specific standardised and validated QoL instruments are needed to capture the multitude of facets influencing QoL in amputees, and thereby, facilitating direct comparison across studies.
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NewsBot · Aug 19, 2011

Depression and incident lower limb amputations in veterans with diabetes.
Williams LH, Miller DR, Fincke G, Lafrance JP, Etzioni R, Maynard C, Raugi GJ, Reiber GE.
J Diabetes Complications. 2011 May-Jun;25(3):175-82

PROBLEM:
Depression is associated with a higher risk of macrovascular and microvascular complications and mortality in diabetes, but whether depression is linked to an increased risk of incident amputations is unknown. We examined the association between diagnosed depression and incident non-traumatic lower limb amputations in veterans with diabetes.

METHODS:
This was a retrospective cohort study from 2000-2004 that included 531,973 veterans from the Diabetes Epidemiology Cohorts, a national Veterans Affairs (VA) registry with VA and Medicare data. Depression was defined by diagnostic codes or antidepressant prescriptions. Amputations were defined by diagnostic and procedural codes. We determined the HR and 95% CI for incident non-traumatic lower limb amputation by major (transtibial and above) and minor (ankle and below) subtypes, comparing veterans with and without diagnosed depression and adjusting for demographics, health care utilization, diabetes severity and comorbid medical and mental health conditions.

RESULTS:
Over a mean 4.1 years of follow-up, there were 1289 major and 2541 minor amputations. Diagnosed depression was associated with an adjusted HR of 1.33 (95% CI: 1.15-1.55) for major amputations. There was no statistically significant association between depression and minor amputations (adjusted HR 1.01, 95% CI: 0.90-1.13).

CONCLUSIONS:
Diagnosed depression is associated with a 33% higher risk of incident major lower limb amputation in veterans with diabetes. Further study is needed to understand this relationship and to determine whether depression screening and treatment in patients with diabetes could decrease amputation rates.
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NewsBot · Jan 11, 2016

Quality of life in persons with partial foot or transtibial amputation: A systematic review
Matthew Quigley, Michael P Dillon
Prosthet Orthot Int February 2016 vol. 40 no. 1 18-30

Study design: Systematic review.
Background: Common beliefs about quality of life in people with partial foot and transtibial amputation are often described as passing comments in the literature with seeming little research evidence. A clear understanding of the research evidence is important to inform decisions about amputation level from a quality of life perspective.
Objective: To systematically gather and appraise research evidence comparing quality of life between persons with partial foot and transtibial amputation.
Methods: A comprehensive suite of databases (e.g. Cochrane Library, MEDLINE and Web of Science) were searched using terms relating to amputation level and quality of life. Reference lists of articles that met the inclusion criteria were hand searched. Included studies reported quantitative data for persons with partial foot and transtibial amputation secondary to peripheral vascular disease and diabetes. Studies were appraised using the McMaster University Critical Review form.
Results: There is insufficient evidence comparing quality of life in people with partial foot and transtibial amputation. The available evidence suggests that quality of life may be very similar in people with partial foot and transtibial amputation and the small differences are not likely to be clinically meaningful.
Conclusion: Without adequate evidence comparing quality of life in people with partial foot and transtibial amputation, it is difficult to inform decisions about amputation level from a quality of life perspective.
Clinical relevance There is insufficient evidence about differences in QoL between persons with PFA or TTA. Contrary to common belief, the available evidence suggests that QoL may be similar in persons with PFA and TTA. Further research is needed to inform decisions about amputation level from a QoL perspective.
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NewsBot · Jan 31, 2016

Self-Reported Cognitive Concerns in People with Lower Limb Loss
Sara J. Morgan, CPO, PhD, Valerie E. Kelly, PT, PhD, Dagmar Amtmann, PhD, Rana Salem, MA, Brian J. Hafner, PhD
Archives of Physical Medicine and Rehabilitation; Article in Press

Objective
To investigate differences between self-reported cognitive concerns in people with lower limb loss (LLL) and normative data derived from the U.S. general population. A secondary aim was to determine if there were cognitive differences based on amputation etiology or age.

Design
Survey.

Setting
General community.

Participants
A volunteer sample of 1086 persons with LLL resulting from trauma or dysvascular complications who regularly use a prosthetic limb.

Interventions
Not applicable.

Main Outcome Measure
The Quality of Life in Neurological Disorders Applied Cognition General Concerns v1.0 Short Form (Neuro-QoL ACGC), an eight-item self-report measure of general cognitive concerns.

Results
People with LLL reported significantly more cognitive concerns than the Neuro-Qol normative sample. Mean Neuro-QoL ACGC scores were significantly lower than normative values (p<0.001) across subgroups defined by age (i.e., <40, 40-49, 50-59, 60-69, and 70+ years) and subgroups defined by etiology (i.e., traumatic and dysvascular LLL). However, there were no significant differences in cognitive concerns among age subgroups (p=0.84) or between the etiology subgroups (p=0.58).

Conclusions
When compared to the Neuro-QoL normative sample, individuals with LLL report greater concerns with cognitive health. Cognitive concerns were not differentially affected by age or cause of amputation. The presence of cognitive concerns in people with LLL suggests a need to assess perceived cognitive function in order to tailor education and training in prosthetic use and care.
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NewsBot · Nov 2, 2017

Perceived Concerns of Patients at Risk for Lower Extremity Amputation.
Cornell RS, Meyr AJ
Wounds. 2017 Oct 20. pii: WNDS20171020-1.

Despite a good understanding of risk factors for amputation and the development of multidisciplinary amputation prevention teams, thousands of lower limb amputations are performed on a daily basis. These amputations are often transformative events in the lives of patients with functional, psychological, social, and economic implications.
OBJECTIVE:
The objective of this investigation is to qualitatively and quantitatively explore the perceived concerns of patients with chronic wounds at risk for lower extremity amputation.
MATERIALS AND METHODS:
A guided, physician-administered survey was completed by consenting participants. The survey consisted of both open-ended questions and a 10-point scale for specific questions on a variety of potential patient concerns.
RESULTS:
Although some questions resulted in relatively high and low mean scores, 9 of the 13 specific questions produced a range of responses on a 10-point modified Likert scale. This indicates that there are not necessarily universal patient concerns and that every patient is different and should be treated as such. With that being said, however, the highest levels of concern (mean measurements ≥ 7/10) had to do with recurrence, function, walking, and self-sufficiency. The lowest levels of concern (mean measurement ≤ 5/10) had to do with pain, shoe gear considerations, cost, and cosmetic appearance of an amputation.
CONCLUSIONS:
It is the authors' hope that this investigation provides wound care professionals with information that will benefit their approach to the education and treatment of patients at risk for amputation as well as lead to future investigations into the emotional and psychological state of patients with chronic lower extremity wounds.
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NewsBot · Dec 24, 2017

Does First Ray Amputation in Diabetic Patients Influence Gait and Quality of Life?
Aprile I et al
J Foot Ankle Surg. 2018 Jan - Feb;57(1):44-51. doi: 10.1053/j.jfas.2017.07.015.

It has recently been suggested that first ray amputation in diabetic patients with serious foot complications can prolong bipedal ambulatory status, and reduce morbidity and mortality. However, no data are available on gait analysis and quality of life after this procedure. In the present case-control study (6 amputee and 6 nonamputee diabetics, 6 healthy non-diabetic), a sample of amputee diabetic patients were evaluated and compared with a sample of nonamputee diabetic patients and a group of age-matched healthy subjects. Gait biomechanics, quality of life, and pain were evaluated. Compared with the other 2 groups, amputee patients displayed a lower walking speed and greater variability and lower ankle, knee, and hip range of motion values. They also tended to have a more flexed hip profile. Pain and lower quality of life were related to worsening biomechanical data. Our study results have shown that gait biomechanics in diabetic patients with first ray amputation are abnormal, probably owing to the severity of diabetes and the absence of the push-off phase provided by the hallux. Tailored orthotics and rehabilitation programs and a specific pain management program should be considered to improve the gait and quality of life of diabetic patients with first ray amputation.
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