Psychosocial characterization of a Portuguese lower limb amputee population

Abstract

This study aims to describe psychosocial status in lower limb amputees referred to a Physical and Rehabilitation Medicine (PRM) department of a central Portuguese Hospital. Cross-sectional study of 45 consecutive patients with lower limb amputation, referred to PMR consultation after hospital discharge. Of the initial sample, two patients were excluded from the analysis, and four patients refused to participate in the study. The socio-demographic, medical and surgical history were obtained through structured questionnaire, and clinical information regarding the characteristics of the amputation was abstracted from medical records. Functional capacity was assessed with the Amputee Mobility Predictor (AMP), quality of life through short-form 36 (SF36), and depressive and anxious symptoms by the Hospital Anxiety and Depression Scale (HADS). Out of 39 patients analyzed, 32 (82.1%) were men, aged [average (standard deviation): 67, 6 (12.57)] years, 28 (71.8%) were married, 30 (76.9%) were retired, 3 (7.7%) were unemployed, 4 (10.3%) were on sick leave, and 2 (5.1%) were active. Regarding the cause of amputation, 36 (92.3%) were of vascular etiology, 1 (2.6%) caused by an infection, and 2 (5.1%) due to bone tumours, 23 (59%) had a transfemoral amputation, 10 (25.6%) had a transtibial amputation, and 6 (15.4%) had foot amputations of the foot. In the sample studied, 14 (35.9%) had pathological levels of anxiety (HADS-anxiety ≥ 8) and 15 (38.5%) had clinical depression (HADS-depression ≥ 8). The evaluation of quality of life and general perception of health status, showed lower than average score especially in the physical dimensions with a physical component summary score of the SF36 [P50 (P25-P75): 31.4 (26.8-39.4)], and in the mental component summary of SF36 [P50 (P25-P75): 41.9 (31.8-48.3)]. In this sample, the data showed the AMP score [P50 (P25-P75): 8 (4-16)], ranging from 0 to 27. This sample has a high prevalence of depressive/anxious symptoms. Considering that these mood changes have a major impact on the adherence to the rehabilitation program, functional outcome and quality of life, its early identification and treatment should be part of their overall management.