Lower Limb Amputee Patients Research Articles

Prognostic Significance of Atrial Fibrillation in Lower Limb Amputee Patients

In patients with risk factors or established atherothrombosis, atrial fibrillation (AF) is associated with a poor prognosis compared with patients without AF. The aim of this study was to evaluate the prevalence of AF in patients with lower limb amputation (LLA) and its association with cardiovascular death and adverse cardiovascular events in long-term follow-up. Observational prospective study of consecutive patients after index major (transfemoral and transtibial) LLA. The primary endpoint was cardiovascular death and secondary endpoint was a composite of adverse cardiovascular events at follow-up (acute myocardial infarction, contralateral lower limb amputation, and ischaemic stroke). Of 282 patients with LLA, 46 (16.3%) patients had AF. AF patients were significantly older compared with patients without AF (median 74.0, IQR 13.0 vs. median 67.0, IQR 14.8 years, p< .001). Diabetes and smoking on the other hand were significantly less prevalent in patients with AF compared with those without AF (41.3% vs. 72.0%, p< .001 and 56.5% vs. 76.3%, p=.01, respectively). 54.3% of patients with AF were on oral anticoagulation therapy. At a median follow-up of 24.0 months (IQR 19.0-32.0), 28.3% patients with AF died of cardiovascular causes versus 17.8% without AF (HRR 1.8, 95% CI 1.0-3.4, p=.06). Adverse cardiovascular events occurred in 32.6% of patients with AF during follow-up versus 22.0% without AF (HRR 1.9, 95% CI 1.0-3.3, p=.03). In multivariate Cox regression analysis, AF (HRR 2.3, 95% CI 1.3-4.2, p=.01) and diabetes (HRR 2.1, 95% CI 1.1-3.9, p=.02) were identified as independent predictors of adverse cardiovascular events during the follow-up. AF is common in patients with LLA and associated with higher risk of adverse cardiovascular events during long-term follow-up.

Identifying Factors Predicting Hospital Length-of stay and Receiving Prosthesis of Lower Limb Amputee Patients after Amputation Surgery- A Singapore Perspective

Abstract Aims To identify predictors affecting total hospital length of stay(TLOS) and receiving lower limb prosthesis of amputees after surgery in a Singapore tertiary hospital. Materials and Methods A retrospective study of 96 patients was undertaken with various levels of lower limb amputation admitted to Singapore General Hospital (SGH) from January 2009 to December 2014. Patients were divided into two groups: 40-59 and 60 to 80 years old. We correlate clinical variables with TLOS and receiving prosthesis at 6 months from surgery. Results For the cohort of age 40-59, presence of IHD (B=22.4), wound infection (B=17.8) and those needing inpatient rehabilitation(B=36.8) correlate to increased TLOS. Premorbid independence (B=28.6) and presence of care-giver (B=23.3) led to a reduction of TLOS. For successful receiving of prosthesis at 6months from surgery, diabetes (B=0.69) and CRF (B=0.31)were negative predictors. In the older cohort, presence of care-giver (B=18.6) predicted shorter TLOS whereas those needing inpatient rehabilitation contributed to longer TLOS(B=25.61). Those who needed for inpatient rehabilitation had statistically signifi cant higher chance of receiving prosthesis later(B=0.53). Conclusion IHD, wound infection and need for inpatient rehabilitation, premorbid independence and care-giver availability are important predictors of TLOS. For receiving of prosthesis at 6months, predictors include needing inpatient rehabilitation, diabetes and CRF.

Estudio de la influencia de la ruralidad sobre los factores de riesgo vascular en el paciente amputado de miembro inferior

Estudio de la influencia de la ruralidad sobre los factores de riesgo vascular en el paciente amputado de miembro inferior

A clinical evaluation of skin disorders of lower limb amputation sites.

Amputee patients commonly experience skin problems that may result in social, mental, and economic difficulties. The purpose of this study was to evaluate the incidence of dermatological disorders and identify potential causes and symptomatic patterns among a population of lower limb amputees. Seventy lower limb amputees were enrolled. Complete examinations were performed by a dermatologist, who diagnosed and documented any skin disorders observed and recorded demographic characteristics of each patient. Mycological and bacteriological swabs were collected from the skin at the amputation site for culture analysis. In patients with suspected disease, patch tests were performed. Of the 70 patients, 58 (82.9%) were male and 12 (17.1%) female. Vascular insufficiency due to diabetes (n = 38, 54.3%) and trauma (n = 16, 22.9%) were the most common reasons for amputation. Skin problems were observed in 49 (70%) cases, and positive allergen reactions occurred in 16 (45.7%) of the 35 contact dermatitis cases. Fungal infection occurred in two patients and bacterial infection in seven. Seventy percent of the lower limb amputee patients in this cohort exhibited skin problems. This high percentage indicates that skin problems may reduce patients' quality of life. A multidisciplinary approach to the treatment of patients who have undergone amputation and early recognition and treatment of symptoms are therefore of critical importance.

Psychiatric symptoms in male traumatic lower limb amputees: associations with neuropathic pain, locomotor capabilities, and perception of body image

Aims: The aim of this study was to compare psychiatric symptoms in male lower limb amputation (LLA) patients with neuropathic pain and LLA patients without neuropathic pain and to evaluate the relationship between these outcomes and functional status and body image disturbances. Methods: Fifty male traumatic LLAs were included. Twenty-seven were diagnosed with neuropathic pain (Group 1), while 23 had no neuropathic pain (Group 2). Demographic data including age, height, weight, and duration of amputation, amputee body image scale score (ABIS), and locomotor capabilities index score (LCI) were recorded. Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, State–Trait Anxiety Inventory, and Short Form 36. Results: Intergroup comparison revealed significant differences in somatization, interpersonal sensitivity, depression, anxiety, anger-hostility, sleep quality, sleep duration, sleep disturbance, daytime sleepiness, trait anxiety and QOL. The differences were statistically significantly higher in Group 1 compared with Group 2. There were significant correlations among ABIS, LCI and psychiatric symptoms. Conclusion: Other psychiatric symptoms may be present in addition to depression and anxiety in amputees with neuropathic pain. Increasing physical activity and adjustment of body image can contribute to improved psychiatric symptoms.

Pain related to amputation and functionality of individuals with lower limb amputations

The presence of persistent pain, whether from the stump, phantom pain, or in the contralateral limb may negatively interfere with obtaining a gait with a prosthesis in an amputee patient. Objective: To investigate the presence of pain related to amputation in lower limb amputees during their rehabilitation treatment, to evaluate their functional status with and without a prosthesis, and to verify whether there is any association between the presence of pain and gait. Method: A transversal study with 60 unilateral lower limb amputees in treatment at a rehabilitation center in São Paulo to investigate: age, gender, time since amputation, level and etiology of amputation, number of comorbidities, presence of pain in the stump or phantom pain or in contralateral limb, and if so, the kind of pain, intensity, frequency, improvement or worsening factors, use of medication, prosthetization, type of gait with prosthesis (community, therapeutic or household), use of gait assistance and application of Functional Independence Measure (FIM). Data was analysed with absolute and relative values and parametric tests (ANOVA) and non-parametric tests (equality of two proportions), chi-square, and confidence interval of 95% and P-value &lt; 0.05. Results: The group, which contained 73.4% men, one year since amputation at the transtibial level, vascular etiology, with two comorbidities composed the sample in a statistically significant way (p &lt; 0.001). There was no difference between patients fitted and not fitted with prostheses for stump pain and phantom pain, but there was a difference for the contralateral limb, statistically significant in those patients not fitted with prostheses. Although there was a mean difference between patients with and without prostheses for the 3 FIM scores, it was not statistically significant. Conclusion: Most unilateral lower limb amputation patients in rehabilitation at the AACD - Lar Escola at the time of the study had a low incidence of pain related to amputation and it didn’t interfere with their acquiring a gait with their prostheses.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease.

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease.Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used.Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted.Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients.

Quality of life and functionality after lower limb amputations

It is difficult for the lower limb amputee patients to adapt to their new lifestyles. To compare the life quality and functionality of patients with bilateral vs. unilateral lower extremity amputations. Cross-sectional study. Fifteen bilateral and 15 unilateral lower extremity amputee patients were enrolled. Demographics, cause and level of amputations, frequency and duration of prosthesis use were evaluated. SF-36, Satisfaction with Prosthesis Questionnaire (SAT-PRO), Amputee Body Image Scale. (ABIS), Houghton Scale (HS), six-minute walk test (6MWT), and 10-metre walk test (10 MWT) were performed. Physical function, physical and emotional role scores of SF-36 were significantly lower in the bilateral amputee group in comparison with the unilateral group. SAT-PRO and ABIS total scores were similar between the groups. There was a positive correlation between the frequency of prosthetic use and SF-36 subgroups (except pain). The unilateral amputee group had significantly better scores than the bilateral amputee group in terms of HS, 6MWT and 10 MWT. Physical capacity of bilateral lower extremity amputee patients is lower than the unilateral amputee patients; satisfaction with prosthesis and body image are not related with the amputation level; and the life quality and satisfaction with prostheses are increased in parallel with the use of the prostheses. Clinical relevance Although differences exist between the groups, in terms of quality of life and functionality, patients can reach an acceptable life standard with good rehabilitation and a suitable prosthesis.

Turkish Version of The Amputee Body Image Scale and Relationship with Quality of Life

Objective: To adapt the Amputee Body Image Scale (ABIS) into Turkish and to assess the reliability of the original and revised Amputee Body Image Scale (ABIS-R) in lower limb amputees. Method: Turkish version of the ABIS (20 items; ratings of 1?5) was administered to 91 lower-limb amputee patients wearing prosthesis. One month later, retest was applied to 37 patients. SF?36 was also administered to 37 patients for validity. The scores have been reevaluated for the reliability of the ABIS-R (14 items; ratings of 0?2). Results: Turkish version of the ABIS and ABIS-R fitted the unidimensional construct that the scale was intended to measure and demonstrated good reliability. Cronbach?s alpha was 0.88 for the ABIS and 0.86 for the ABIS-R. Items-total correlation ranged from 0.25 (item 3) to 0.75 (items 8 and 14) for the ABIS. Items-total correlation ranged from 0.33 (item 3) to 0.76 (items 6 and 8) for the ABIS-R. Test-retest correlation coefficient was 0.78 for the ABIS and 0.74 for the ABIS-R. Negative correlations with SF-36 subscales ranged from 0.33 (mental health) to 0.60 (physical functioning) for the ABIS and ranged from 0.31 (mental health) to 0.60 (physical functioning) for the ABIS-R. Conclusions: We conclude that the Turkish versions of ABIS and ABIS-R demonstrate good reliability for measuring body image disturbances in individuals with lower-limb amputations. Moreover, the two scales displayed significant correlations with SF?36.

Health Related Quality of Life and Sense of Coherence in Sudanese Diabetic Subjects with Lower Limb Amputation

Quality of life is an important outcome measure in diabetic patients with lower limb amputation (LLA). The aim of this study was to investigate the influence of lower limb amputation on health-related quality of life (HRQOL) in Sudanese diabetic subjects. Additionally the Sense of Coherence scale (SOC-13) and a symptom check list was used in subjects with LLA. A total of 60 (M/F; 40/20) diabetic subjects with LLA and 60 (M/F; 23/37) diabetic reference subjects without LLA, were studied. For both groups HRQOL was measured using The Medical Outcomes Study questionnaire (MOS). Subjects with LLA had significantly poorer HRQOL compared to the reference group in most HRQOL domains (p < 0.0001). Duration of diabetes had the greatest negative impact on HRQOL in both groups, those with LLA (p < 0.0001), and in those without LLA (p < 0.0001), although subjects who were amputated earlier had poorer HRQOL than recently amputated (p < 0.0001). Higher SOC scores were recorded in LLA patients who have greater ratings of positive feelings, family satisfaction and sleep in the HRQOL examination (p < 0.0001). In conclusion, Sudanese diabetic subjects with LLA have a poor quality of life. The triad of diabetes duration, symptoms and amputations, has turned to be important risk factor for poorer HRQOL. Functional and mobility status were suggested to be an important determinant of HRQOL among this population. As the Sudanese population has coherent social relationships, this poor performance of the diabetic subjects will certainly increase the burden on the whole family, in both integrity and economical status. Nevertheless, these deep-rooted social interrelations together with increasing diabetes awareness have substantially improved the family satisfaction among our patients.

Retorno ao trabalho em amputados dos membros inferiores

O retorno ao trabalho deve ser incentivado, pois proporciona bem estar, melhora da auto-estima e do convívio social, além de dar mais um sentido a vida. Objetivo: Verificar a situação atual de trabalho e o uso de próteses de membros inferiores em amputados atendidos no Lar Escola São Francisco - Centro de Reabilitação – UNIFESP, São Paulo. Métodos: Estudo retrospectivo dos pacientes atendidos de 1999 a 2005, com amputação de membros inferiores, com idade acima de 18 anos, que estivessem trabalhando ou estudando na época da amputação. A amostra foi composta por 78 amputados, 61 homens e 17 mulheres, com média de idade de 46,3 anos. Cinqüenta por cento eram transfemurais e 34,6% transtibiais. A vasculopatia foi a mais prevalente das causas de amputação (62,8%). Cinquenta e um pacientes (65,4%) tinham grau de instrução fundamental. Realizada entrevista, por telefone, no período de dezembro de 2006 e janeiro de 2007. Resultados: Sessenta e quatro por cento dos pacientes estavam em uso de prótese de membro inferior no momento da entrevista. A taxa de retorno ao trabalho foi de 10,2%, sendo todos para a mesma ocupação pré-amputação. Conclusão: Baixa taxa de retorno ao trabalho de amputados de membros inferiores reabilitados com próteses. Alguns fatores, tais como, idade avançada na época da amputação e baixo nível de instrução podem ser responsáveis por estes resultados. Outros estudos precisam ser realizados para melhor análise desta situação.

Care of elderly lower limb amputees, as described in medical and nursing records

The aim of this study was to characterize elderly lower limb amputees and explore problems/requirements inherent in their care. A retrospective study of medical and nursing records of patients who had undergone lower limb amputation (LLA) at Uddevalla General Hospital in 1997 was conducted. Demographic data were compared with those from a comparable regional health care district. Hospitalization, rehabilitation and nursing-related data related to subjects alive after 6 months were compared with data concerning those deceased during hospital stay and within 6 months after amputation. During the defined period, the study population consisted of 45 patients aged 60 and above. Fifty-six percent were men, with a mean age of 81.6. Eight patients died in the hospital post-amputation and five died within 6 months of surgery. The aetiology of the diagnosis leading to the LLA was cardiovascular disease in the majority of cases. The most common amputation level was below the knee. LLA patients were reported to have major problems maintaining physical and mental functions, markedly deteriorated general health status and severe pain problems. LLA patients require well functioning and qualified care and rehabilitation. The patients surviving after 6 months had permanent problems in the area of nutrition, elimination, skin ulceration, sleep, pain and pain alleviation. The patients who died during the hospital stay had problems in all these areas. With increasing shorter stays in hospital and decreasing resources in primary and municipal care, there is a risk that these patients' needs and requirements for professional care might be underestimated and thus remain unfulfilled.

Gait patterns of transtibial amputee patients walking indoors barefoot.

To evaluate the gait patterns of lower limb amputee patients walking with and without shoes and to identify differences in barefoot gait patterns when using different prosthetic feet. Optoelectronic three-dimensional motion analysis of gait was performed on six transtibial amputees using a solid ankle cushion heel foot and a single-axis foot, both with and without shoes. Gait abnormalities were observed during barefoot walking when the solid ankle cushion heel foot was used. These included knee joint hyperextension of 9.9 +/- 2.0 degrees and the loss of ankle plantar flexion in the early stance phase. When the single-axis foot was used, knee flexion thrust declined from 9.9 +/- 3.7 degrees to 7.2 +/- 3.8 degrees and ankle plantar flexion decreased from 9.9 +/- 2.8 degrees to 7.0 +/- 2.1 degrees during the early stance phase. In transtibial amputees, significant gait abnormalities were observed during barefoot walking using the solid ankle cushion heel foot. These gait patterns improved, however, with use of a single-axis prosthetic foot, which permits a further plantar flexion after the initial contact.

Evaluating a written emotional disclosure homework intervention for lower-limb amputees

Gallagher P, MacLachlan M. Evaluating a written emotional disclosure homework intervention for lower-limb amputees. Arch Phys Med Rehabil 2002;83:1464-6. Objective: To evaluate the Pennebaker Emotional Disclosure paradigm with lower-limb amputee patients in terms of compliance and efficacy. Design: Repeated measures. Setting: Home based. Participants: Low compliance, both with the initial mailed request (28%) and the subsequent writing task (48%), resulted in 23 lower-limb amputees who had been fitted with a prosthesis participating. Interventions: Patients completed a 15-minute writing task, 6 times, over 2 weeks, with initial baseline and 2-month follow-up assessments. Main Outcome Measures: Cognitive processing, well-being, adjustment to an artificial limb, pain, and prosthetic use. Results: Stronger emotional disclosure was associated with significant reductions in psychologic and physical aspects of amputees' satisfaction with their prosthesis, some of which were mediated by positive changes in affect immediately after the writing tasks. Conclusions: Our results failed to support previous findings with nonclinical samples; in fact, our results contradicted previous findings. We therefore caution that written emotional disclosure may be contraindicated with lower-limb amputee patients. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Clinical rehabilitation of the amputee: a retrospective study.

The aim of this study was to determine the rehabilitation outcome of lower limb amputee patients after clinical rehabilitation. Altogether 183 amputee patients admitted for clinical rehabilitation in the years 1987-1991 were reviewed by retrospective analysis of medical record data. Three groups of amputee patients were identified by reason for amputation. The vascular group: (N = 132), mean age 67 years, mean admission time 119 days, 85% prosthetic fitting. The oncology group (N = 15), mean age 55 years, mean admission time 77 days, 60% prosthetic fitting. The traumatic amputee group: (N = 14), mean age 41 years, mean stay 134 days and 100% prosthetic fitting. Some 22 patients were bilateral amputees and were assessed separately. The most important reasons for not fitting a prosthesis were oncological metastases, stump and wound healing problems. After rehabilitation 86% of all patients could be discharged home. These results are more favourable than those seen in previous studies.

Predicting prosthetic rehabilitation outcome in lower limb amputee patients with the functional independence measure

Objective: To determine the value of the Functional Independence Measure (FIM) score as a prognostic indicator for prosthetic use in the lower limb amputee patient. Design: Cohort study of 41 patients with lower limb amputations. Setting: University hospital rehabilitation unit. Main Outcome Measures: FIM motor subscore and Houghton Scale for prosthetic use. Results: FIM score on admission did not correlate with prosthetic use as measured by the Houghton Scale; however, FIM motor subscore at discharge did. Conclusion: The admission FIM score is not useful in predicting successful prosthetic rehabilitation in lower extremity amputee patients. Only the motor subscore at discharge correlates with the use of prosthesis.