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Quality of life, functional level and needs of care after vascular major lower limb amputation

Riis Madsen, Ulla LU (2017)
Abstract
This thesis was designed to investigate health-related quality of life, functional level and needs of care the first year after dysvascular major lower limb amputation and consists of four studies with three different designs.
A grounded theory was constructed in Study I. Data collection was guided by theoretical sampling and comprised of observations and interviews with eleven patients.The substantive theory of ‘Pendulating’ was constructed to explain patients' behavior shortly after having a leg amputated due to vascular disease. This theory shows that patients, independent of age and condition, go through a three-phased process as they realize they are experiencing a life-changing event. The results illustrates how cognitively and... (More)
This thesis was designed to investigate health-related quality of life, functional level and needs of care the first year after dysvascular major lower limb amputation and consists of four studies with three different designs.
A grounded theory was constructed in Study I. Data collection was guided by theoretical sampling and comprised of observations and interviews with eleven patients.The substantive theory of ‘Pendulating’ was constructed to explain patients' behavior shortly after having a leg amputated due to vascular disease. This theory shows that patients, independent of age and condition, go through a three-phased process as they realize they are experiencing a life-changing event. The results illustrates how cognitively and emotionally vulnerable patients are shortly after leg amputation.
In Study II, a systematic review was conducted in accordance with the Cochrane Handbook for systematic reviews to assess the effects of early mobilisation interventions in dysvascular lower limb amputated patients. With only five studies identified which covered the aim of the study—none of which were high quality—a research evidence gap was identified, and it cannot be concluded whether early mobilisation is beneficial to this vulnerable population. It was found that ambulation of newly amputated patients is complex but possible if the necessary interdisciplinary team is dedicated to the task.
A prospective longitudinal cohort study design was used in Studies III&IV. Short-term functional status was compared with status one month pre-amputation. Factors potentially influencing outcome were evaluated in Study III where characteristics of a consecutive sample of patients having amputation were also reported and participants were compared with non-participants. Effect of time and age on health related quality of life (HRQOL), general self-efficacy and functional level twelve months following dysvascular major lower limb amputation were investigated in Study IV. Data were collected via in-person interviews on functional level (Barthel index 100) at baseline and on Day 21(Study III) and HRQOL (SF36), functional level (Barthel index 100) and general self-efficacy (GSE) at baseline and after three, six and twelve months respectively (Study IV). Participants were consecutively recruited from patients having amputation at the tibia, knee or femoral level at two Danish hospitals. In all, 60 of 105 eligible patients participated at baseline. Fifty-one patients completed Study III and 38 completed Study IV.
Short-term functional outcome (Study III) was positively associated with lower age and physiotherapy initiated after discharge and indicates that outcome is modifiable by care provided. Non-participants were significantly older than participants and had a high prevalence of dementia, acute confusion and severely deterioriated health and were therefore expected to have worse outcomes than partipants.
Unique prospective longitudinal data on patients after dysvascular LLA who survived twelve months post-amputation were reported in Study IV. This study documents that significant improvement in more aspects of HRQOL can be achieved as soon as three months post-amputation. Independent of age, psychosocial problems persist and fluctuate throughout the first twelve months. Significant differences between age groups were identified in physical function over time with loss of physical function almost solely evident among the oldest patients after twelve months.
This thesis provides unique insight into the lives of dysvascularly-amputated patients during the first twelve months after an amputation and shows that, as a group, they are vulnerable in more aspects even though leg amputation can result in better HRQOL in all domains except physical function. Dysvascularly-amputated patients constitute a heterogeneous group with widely different functional levels and psychosocial needs and have a range of complex needs of care not always met by healthcare provided. Quality improvements are required in several areas to optimize quality of life. (Less)
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author
opponent
  • professor Geertzen, Jan HB, University Medical Center Groningen
organization
publishing date
type
Thesis
publication status
published
pages
106 pages
publisher
Lund University, Faculty of Medicine
defense location
SSHS-salen, Health Science Center, Baravägen 3, Lund
defense date
2017-11-16 13:00
ISBN
978-91-7619-537-6
language
English
LU publication?
yes
id
70217446-dfb8-4434-9b90-2833989d9c89
date added to LUP
2017-10-25 10:17:25
date last changed
2017-11-10 12:01:59
@phdthesis{70217446-dfb8-4434-9b90-2833989d9c89,
  abstract     = {This thesis was designed to investigate health-related quality of life, functional level and needs of care the first year after dysvascular major lower limb amputation and consists of four studies with three different designs.<br>
A grounded theory was constructed in Study I. Data collection was guided by theoretical sampling and comprised of observations and interviews with eleven patients.The substantive theory of ‘Pendulating’ was constructed to explain patients' behavior shortly after having a leg amputated due to vascular disease. This theory shows that patients, independent of age and condition, go through a three-phased process as they realize they are experiencing a life-changing event. The results illustrates how cognitively and emotionally vulnerable patients are shortly after leg amputation.<br>
In Study II, a systematic review was conducted in accordance with the Cochrane Handbook for systematic reviews to assess the effects of early mobilisation interventions in dysvascular lower limb amputated patients. With only five studies identified which covered the aim of the study—none of which were high quality—a research evidence gap was identified, and it cannot be concluded whether early mobilisation is beneficial to this vulnerable population. It was found that ambulation of newly amputated patients is complex but possible if the necessary interdisciplinary team is dedicated to the task.<br>
A prospective longitudinal cohort study design was used in Studies III&amp;IV. Short-term functional status was compared with status one month pre-amputation. Factors potentially influencing outcome were evaluated in Study III where characteristics of a consecutive sample of patients having amputation were also reported and participants were compared with non-participants. Effect of time and age on health related quality of life (HRQOL), general self-efficacy and functional level twelve months following dysvascular major lower limb amputation were investigated in Study IV. Data were collected via in-person interviews on functional level (Barthel index 100) at baseline and on Day 21(Study III) and HRQOL (SF36), functional level (Barthel index 100) and general self-efficacy (GSE) at baseline and after three, six and twelve months respectively (Study IV). Participants were consecutively recruited from patients having amputation at the tibia, knee or femoral level at two Danish hospitals. In all, 60 of 105 eligible patients participated at baseline. Fifty-one patients completed Study III and 38 completed Study IV.<br>
Short-term functional outcome (Study III) was positively associated with lower age and physiotherapy initiated after discharge and indicates that outcome is modifiable by care provided. Non-participants were significantly older than participants and had a high prevalence of dementia, acute confusion and severely deterioriated health and were therefore expected to have worse outcomes than partipants.<br>
Unique prospective longitudinal data on patients after dysvascular LLA who survived twelve months post-amputation were reported in Study IV. This study documents that significant improvement in more aspects of HRQOL can be achieved as soon as three months post-amputation. Independent of age, psychosocial problems persist and fluctuate throughout the first twelve months. Significant differences between age groups were identified in physical function over time with loss of physical function almost solely evident among the oldest patients after twelve months.<br>
This thesis provides unique insight into the lives of dysvascularly-amputated patients during the first twelve months after an amputation and shows that, as a group, they are vulnerable in more aspects even though leg amputation can result in better HRQOL in all domains except physical function. Dysvascularly-amputated patients constitute a heterogeneous group with widely different functional levels and psychosocial needs and have a range of complex needs of care not always met by healthcare provided. Quality improvements are required in several areas to optimize quality of life.},
  author       = {Riis Madsen, Ulla},
  isbn         = {978-91-7619-537-6},
  language     = {eng},
  pages        = {106},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Quality of life, functional level and needs of care after vascular major lower limb amputation},
  year         = {2017},
}