“Factors affecting Quality of Life post lower limbs amputation – A multicenter cross-sectional study in Rwanda”

Abstract

Background: Most of lower limb amputations performed are due to peripheral vascular diseases and trauma, mostly in middle and lower income countries. Quality of life post lower limb amputations as outcome is important and the cognition of what affects it is vital for its promotion. Objectives: The objectives of this research are to determine the quality of life post LLA and its modifiable associated factors. Methodology: Lower limbs amputees aged from 15 years and above, attending CHUK and CHUB surgical outpatient clinic and physiotherapy, were assessed, by using the health questionnaire (EQ-5D) for the measurement of quality of life, and factors associated with it were on a structured questionnaire Study design: Cross-sectional study Results: Among 126 participants, male were 72.2% (n=91) and female were 27.8% (n=35) with the mean age of 45years. Low level of education and socio-economical status were predominant. Trauma 39.7% (50), was the leading indication of LLA followed by peripheral vascular diseases 27% (34), tumors with 11.9%(15) and diabetic foot with 8.7% (11). Major amputations, 93.7 % (118), were mostly done , and they were amongst factors influencing the QoL, particularly the mobility aspect (p-value: 0.03). Amongst all aspects of QoL, mobility aspect was the most affected. 92.9% were having problems of walking in different degree of severity, with 54.7 % (n=69) who had severe problem in walking). In usual self care, 50% (n=63) reported not to have any problem in usual self care, whereas the other half reported with problems in usual self-care in different degree of severity. The 27% reported no problem in performing usual activities whereas 73 % presented problems of doing usual activities in different levels of severity. The pain or discomfort were present in 70.6%(n=89) and 29.4% (n=37) reported not to have any pain or discomfort. 46.8% (n=59) reported to be either anxious or depressed after LLA whereas 53.2% (n=67) didn’t have any anxiety or depression. Different factors like education, level of amputations, stump related problems, presence of co-morbidities, poor perception of body image, access to walking device (prosthesis, crutches and wheel chair), occupation and the economical status had significant impact at different rates in the domain of the QoL. Conclusion and recommendation: The burden of LLA affect different domain of QoL and different factors play role in poor QoL after LLA. Appropriate prevention of RTA, management and control of PVD, DM and perioperative psychological support and provision of walking device would result in the diminution of amputation rate and postoperative management of LLA sequelae.