Prosthetic Categories

Study Finds Factors that Affect Quality of Life in Lower-Limb Amputees

    A person’s quality of life embodies overall well-being and happiness, including access to healthcare and work opportunities, as well as excellent physical and emotional health. It measures how well an individual lives. For patients who have undergone a major lower limb amputation, quality of life is a significant concern.

     Researchers studied the quality of life of major lower limb amputees in Trinidad and Tobago.

    A recently published study looked into the quality of life experienced by major lower extremity amputees in Trinidad and Tobago, where there have been previous reports of diabetic foot-related complications and lower extremity amputations. The study aimed to determine the health-related quality of life in patients after a major lower limb amputation.

    The study  

    A total of 134 individuals participated in the study. The researchers collected data from major lower limb amputations at a tertiary care hospital in Trinidad and Tobago from January 2012 to December 2016. The researchers then assessed the patients’ quality of life using the EuroQol 5D-5L tool, consisting of the EQ-5D descriptive system and the EQ visual analog scale.

    The EQ-5D descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety or depression. Meanwhile, the EQ visual analog scale records the patient’s self-rated health on a vertical visual analog scale, where the endpoints are labeled “The worst health you can imagine” and “The best health you can imagine.”


    The study participants’ average EQ-5D-5L index value was 0.598—significantly lower than the population norms for Trinidad and Tobago.

    The researchers also found that quality of life was better in prosthetic users (0.787) than those who used another walking device (0.656) and those who could not walk (0.195).

    In terms of amputation level, the researchers didn’t find a significant difference in the quality of life between above- and below-knee amputees. Despite this minor difference, the researchers cited medical literature that proposed having a below-knee amputation is more favorable for mobility. Part of the reason for this assessment is that individuals with below-knee limb loss expend less energy when moving with a prosthetic limb than those with above-knee limb loss.

    How age influences the quality of life  

    In terms of age, the study showed that amputees aged 50 and below experienced a better quality of life than those older.

    This could be because most older patients are more likely to have comorbidity, contributing to delayed rehabilitation and poor mobility, thus resulting in a poor quality of life.

    Based on the results, the study's authors suggest that rehabilitation of older patients requires a tailored and aggressive approach. They further indicated that goals for rehabilitation need to be set before amputation surgery and that all aspects of care, including surgical intervention, should be tailored to this.

    The bottom line  

    The study has identified several factors contributing to a better quality of life in those with lower-limb loss:

    • ability to walk,

    • access and use of prosthetic limbs, and

    • younger age.

    It's important to note that the researchers compared this with the average overall index values in first-world countries with superior health care systems. And the quality of life of the study participants had a higher overall index value than those from Scotland, Sweden, and China.