JOURNAL OF MEDICAL & CLINICAL CASE REPORTS

Abstract

Background: Amputation is a devastating and life-threatening incident that leads to physical, socio-economical, and psychological confrontation.

Objectives: The study sought to determine the functional outcome after completing rehabilitation among unilateral lower limb amputation (LLA) patients.

Methods: The cross-sectional study was carried out from May to July of 2023. The convenience sampling technique was used to collect data from 149 patients with unilateral LLA who were receiving treatment at a tertiary hospital in Bangladesh. The Locomotor Capabilities Index (LCI), scale was used to measure the physical functioning of the survivors. The study was conducted using version 25.0 of the Statistical Package for Social Sciences (SPSS). The Spearman‘s test was done to analyze the correlation where the p-value was < 0.05, which seems as significant.

Results: The mean age ± SD of the participants was 33.09 ± 11.13. Out of 149 respondents, the majority (34.9%) were in the age range of 21 to 30 years. The majority of the respondents (81.2%) were males, 65.1% were unmarried, and 67.8% were from rural areas. Road traffic accidents (66.4%) are the major causes of injury where most of the amputation (45.6%) was done below the knee. There was a significant correlation between gender (p = 0.014) and current occupation (p = 0.001) with the score of LCI respectively. Further, a significant positive correlation was found between the use of prosthesis (p = 0.014) and the LCI total score of the respondents.

Conclusion: The results of the study revealed that patients with LLA reported considerable independence of physical functioning of the respondents with supportive aids.

Keywords: Amputation, Lower limb amputation, Functional outcome, Physical function.

Introduction

Amputation is simply the surgical removal of a full or partial limb to safeguard the remaining skin-covered components [1]. Lower limb amputation (LLA) is a permanent surgical method that can affect a person's everyday activities as well as their function [2]. LLA is a procedure having substantial anatomical, functional, psychological, and social implications that may affect patients' quality of life (QOL). A life-changing scenario arises as a result of lower limb surgery or removal [3]. People who have had below-level amputations have greater levels of physical functioning [4]. Diabetes is the leading cause of surgical amputations [5]. Peripheral vascular disease is the most frequent reason for amputation in developing nations. Research conducted in India found that trauma was responsible for 70.3% of amputations [6].

Physical therapy is an essential part of being able to do functional tasks. Amputees must get instruction in order to perform some everyday tasks, such as self-care, mobility, transfer, balance, and exercises that they can perform independently [7]. The fundamental objective of rehabilitation is to improve quality of life and physical function independently [8]. Exercise is essential for the patient's post-amputation healing, as well as wheelchair and crutch mobility. Muscle development in both lower extremities is also necessary for patients to be able to do their daily tasks by themselves [7]. LLA has an impact on a person's mobility and ability to participate in a number of daily activities. As a result, fewer individuals can walk and do everyday duties with prostheses in their homes and communities [1].

According to most research, those who have had unilateral or distal amputations recover more and are better able to walk and do ADLs than those who have had bilateral or proximal amputations [9]. Rehabilitation, which focuses on recovering the patient's functioning and involvement in activities, as well as general health and psychological well-being, pain management, skin and stump care, and prosthesis fitting, is the most crucial responsibility after amputation [10].

Mousavi et al. [11] estimated that one out of every 190 persons in the United States has lost a limb. The figure is predicted to more than quadruple by 2050 if present trends persist. Approximately 1.7 million individuals today live with amputations. According to a recent survey done in Kolkata, lower limb amputees constituted 94.8% of the population with amputations [1]. Amputation-related impairment has grown internationally in recent years. Many people who experience depression and anxiety following amputation refuse to seek therapy because they believe they are a burden to their families and society. In Bangladesh, there is no proof of amputation survivors' psychological well-being. However, the investigator believes that there are certain restrictions. There has been no meaningful study on this topic in Bangladesh yet. As a result, it is critical to investigate their psychological status and urge them to seek physical therapy treatment. The study sought to determine the socio-demographic profile and functional outcome among unilateral LLA patients.

Methodology

Study Design

Examining the physical and mental well-being of LLA patients in Bangladesh was the aim of this cross-sectional study. The convenience sample approach was utilized to gather information from 149 individuals. Patients with unilateral LLA were the study population who were receiving rehabilitation support from the prosthetics and orthotics department at the tertiary level hospital of the Centre for the Rehabilitation of the Paralyzed (CRP) in Dhaka, Bangladesh.

Study Population

The study was carried out in 2023 between May and July. In this study, the researcher additionally evaluated eligibility criteria, which assisted the researcher in selecting acceptable and relevant individuals for the study. Patients with unilateral LLA of both genders ranging in age from 15 to 70 years actively participated in this study and satisfied the eligibility requirements. Participants with mental and cognitive problems were excluded from the study, as did those who refused to participate.

Outcome Measurements

Data was gathered using a semi-structured questionnaire. The survey was created with consideration for the present investigation's features and aims. The questionnaire contained two fundamental elements. The first section included demographic and amputation-related data, such as age, gender, marital status, dwelling region, sources of injury, duration of amputation, side of amputation, level of amputation, and participant satisfaction. The researcher gathered information through an individual interviewing approach in a quiet setting.
In the second section, the Locomotor Capabilities Index (LCI) was utilized to assess the participants' physical functional level [8,12]. LCI was utilized to assess individuals' mobility levels and their ability to ambulate freely. It consists of 14 questions that measure persons' basic and advanced skills across five levels to determine their level of independence. Level 5 implies that an individual can conduct daily activities independently, even without the use of assistive technology, whereas level 1 shows that an individual is unable to complete daily duties even with the assistance of another person [13].

Data Analysis

Microsoft Office Excel 2013 and the Statistical Package for Social Sciences (SPSS) version 25.0 were used to data input and analyze the gathered data. The chi-square test was utilized to ascertain the degree of significance between two or more variables. Continuous data were displayed as mean and standard deviation (SD), while categorical variables were displayed as percentages and frequencies. At the p < 0.05 analytical level, the null hypothesis was excluded.

Ethical Approval

The World Health Organization (WHO), Bangladesh Medical Research Council (BMRC), and Centre for the Rehabilitation of the Paralyzed (CRP) have had their ethical standards met. Patients were fully described about the study's goals and methodology before participation, and they completed an informed consent form. The project was approved by administrative bodies from the Bangladesh Health Professions Institute's (BHPI) CRP ethical committee and the Institutional Review Board. The registration number is: CRP/BHPI/IRB/03/2023/704.

Results

In this observational study, one hundred forty-nine participants completed the survey. Nearly all of the material required for the study is included in the study. Table 1 represents the distribution of the participant’s socio-demographic and amputation-related information. The mean age ± SD of the participants was 33.09 ± 11.13. The vast majority of participants (34.9%) were between the ages of 21 and 30. Out of 149 respondents, the majority of respondents (81.2%) were males, and 18.8% were females. The maximum respondents (65.1%) were unmarried, 67.8% were from rural areas, and 32.1% of the respondent’s educational level was primary. Most of the respondents (66.4%) who caused amputation were road traffic accidents, where maximum amputation (45.6%) was done below knee amputation. The majority of the respondent’s injury duration was more than 5 years and 55.7% of the respondents had a high level of satisfaction.

Table 01: Socio-Demographic and Amputation-Related Information of The Respondents (N=149)

The Locomotors capability index (LCI) shows how independent the individual was when performing basic and advanced daily activities. Level 5 means total independence or can walk without any aids, level 4 means slightly independent or can walk with aids, level 3 means if someone is near the person, level 2 means if someone helps the person, and level 1 means no or total dependence. The majority 56.4% of the participants had physical functioning at level 4 which indicates the individuals are slightly independent or can walk with aids (Table 2).

Table 02: Functional Mobility Level of The Respondents (N=149)

Table 3 represents the association between the socio-demographic variable and the physical functioning of the participants. The Spearman‘s test was done to analyze the correlation where the p-value was < 0.05 seems as significant. The results showed that there was a significant correlation between gender (p = 0.014) and current occupation (p = 0.001) with the total score of LCI respectively. In addition to that, there was no significant positive correlation among address, Educational status, side of amputation, or satisfaction level with LCI. Further, a significant positive correlation was found use of prosthesis (p = 0.014) with the total score LCI of the respondents.

Table 3: Correlation Between Socio-Demographic and Physical Functioning

Discussion