Health related quality of life and associated factors following major lower limb amputations in patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Major lower limb amputations cause physical and psychological disability to both the individual and society. Among the common indications for amputation are peripheral vascular diseases, trauma and tumors. Health related quality of life (HRQOL) following major lower limb amputations in our setting is largely unknown despite it being a principal end point of healthcare. Objective: To determine the health-related quality of life and associated factors following major lower limb amputations at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional study of major lower limb amputees at MTRH conducted between 1st January 2017 and 30th June 2018. A census study was done since the average number of major lower limb amputations done annually in 2014 and 2015 was 45. A total of 44 participants were recruited. After informed consent, an interviewer administered questionnaire was used to collect data on socio-demographics, indications for amputation, levels of amputation, prosthesis use, laterality, time interval from amputation, complications and co-morbidities. The World Health Organization Quality of Life instrument (WHOQOL-Bref) was used to assess quality of life. The tool had questions on self-perceived overall quality of life and health and the rest of the 24 questions were domain specific. Continuous variables were summarized using mean ± SD or Median and corresponding IQR in years as appropriate while categorical variables were summarized as frequencies and corresponding percentages. The t - test was used to compare means between two groups while analysis of variance (ANOVA) was used when comparing means among more than two groups. Multivariate linear regression analysis was used to test for association. All data analysis was performed at 95% level of significance. Results: The median age of the participants was 48(34, 60). The male to female ratio was 2.6:1. Following amputation, 25 (56.8%) of the participants had no occupation as compared to only 2 (4.5%) prior to amputation. The common causes of amputation were trauma and diabetes accounting for 21 (47.7%) and 16 (36.36%) respectively. Twentynine (65.9%) were not using prosthesis. Among these, 18 (66.7%) attributed it to high cost of prosthesis while 7 (25.9%) were due to poorly fitting prosthesis. The self perceived overall HRQOL was poor to fair among 36 (81.8%) participants. A higher overall HRQOL was associated with male gender and having an occupation. The mean physical, psychological and environmental domain specific HRQOL scores were 60.93 ± 15.96, 56.23 ± 13.6 and 60.11 ± 8.73 respectively. The median social domain HRQOL score was 56(50, 69). Higher physical domain HRQOL scores were associated with lower age, male gender and prosthesis use (p < 0.05). Higher psychological domain HRQOL scores were associated with having an occupation and prosthesis use (p < 0.05). Higher environmental domain HRQOL scores were associated with having an occupation and not having comorbidity (p < 0.05). Conclusion: Majority of major lower limb amputees at MTRH had poor to fair selfperceived HRQOL. The common causes of amputation were trauma and diabetes. A higher HRQOL was associated with male gender, having an occupation, younger age, absence of a comorbidity and using a prosthesis Recommendation: Adoption of strategies to make well-fitting prostheses available and affordable. Prevention of trauma and adequate treatment of Diabetes to reduce the number of amputations. Emphasis on occupational therapy for amputees in order to reoccupy themselves.