Change in health-related quality of life in the first 18 months after lower limb amputation: A prospective, longitudinal study
- Fortington, Lauren, Dijkstra, Pieter, Bosmans, Joline, Post, Wendy, Geertzen, Jan
- Authors: Fortington, Lauren , Dijkstra, Pieter , Bosmans, Joline , Post, Wendy , Geertzen, Jan
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Rehabilitation Medicine Vol. 45, no. 6 (2013), p. 587-594
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- Description: Objective: To describe changes in health-related quality of life in people with lower limb amputation, from time of amputation to 18 months, taking into consideration the influence of age and walking distance. In addition, quality of life for people with amputation is compared with the Dutch population norm values. Design: Multicentre, longitudinal study. Subjects: All people undergoing first amputation: 106 were referred, of whom 82 were included, mean age 67.8 years (standard deviation; SD 13.0), 67% men. A total of 35 remained in the study at 18 months. Methods: Dutch language RAND-36 questionnaire (Research and Development Corporation measure of Quality of Life) was completed at time of amputation, 6 and 18 months after amputation. Results: Over time, a significant improvement was seen in physical function, social function, pain, vitality, and perceived change in health (all p < 0.001). Subjects over 65 years of age had a poorer outcome compared with people < 65 years for physical function only (p < 0.001). Walking distance was associated with improved scores in social function (p = 0.047). Conclusion: Quality of life improved significantly in 5 of 7 domains investigated; most change occurred in the first 6 months. Physical function remained well below population norm values. Different domains may be affected in different ways for older and younger age groups, but this requires further research. © 2013 Foundation of Rehabilitation Information.
- Description: C1
- Authors: Fortington, Lauren , Dijkstra, Pieter , Bosmans, Joline , Post, Wendy , Geertzen, Jan
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Rehabilitation Medicine Vol. 45, no. 6 (2013), p. 587-594
- Full Text:
- Reviewed:
- Description: Objective: To describe changes in health-related quality of life in people with lower limb amputation, from time of amputation to 18 months, taking into consideration the influence of age and walking distance. In addition, quality of life for people with amputation is compared with the Dutch population norm values. Design: Multicentre, longitudinal study. Subjects: All people undergoing first amputation: 106 were referred, of whom 82 were included, mean age 67.8 years (standard deviation; SD 13.0), 67% men. A total of 35 remained in the study at 18 months. Methods: Dutch language RAND-36 questionnaire (Research and Development Corporation measure of Quality of Life) was completed at time of amputation, 6 and 18 months after amputation. Results: Over time, a significant improvement was seen in physical function, social function, pain, vitality, and perceived change in health (all p < 0.001). Subjects over 65 years of age had a poorer outcome compared with people < 65 years for physical function only (p < 0.001). Walking distance was associated with improved scores in social function (p = 0.047). Conclusion: Quality of life improved significantly in 5 of 7 domains investigated; most change occurred in the first 6 months. Physical function remained well below population norm values. Different domains may be affected in different ways for older and younger age groups, but this requires further research. © 2013 Foundation of Rehabilitation Information.
- Description: C1
Rehabilitation in skilled nursing centres for elderly people with lower limb amputations: A mixed-methods, descriptive study
- Fortington, Lauren, Rommers, Gerardus, Wind-Kral, Anne, Dijkstra, Pieter, Geertzen, Jan
- Authors: Fortington, Lauren , Rommers, Gerardus , Wind-Kral, Anne , Dijkstra, Pieter , Geertzen, Jan
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Rehabilitation Medicine Vol. 45, no. 10 (2013), p. 1065-1070
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- Description: Objectives: To describe the current set-up, barriers and potential for providing rehabilitation to people with lower limb amputation in skilled nursing centres. Design: Survey and interviews. Subjects/participants: Elderly care physicians, physiotherapists. Methods: In 2011, clinicians from 34 skilled nursing centres participated in a semi-structured interview covering rehabilitation and daily care, personal skills and training, team work and communication, and discharge processes. Results: Each centre sees only a small proportion of people with amputation (a maximum of 3.6% of all admissions). This limited number of patients appears to be the main barrier in providing care, as it is difficult for clinicians to maintain knowledge, and resources are spread widely. Two main areas of improvement were suggested by participants: (i) use of guidelines in care; and (ii) collaboration with specialized team members. Conclusion: The spread of patients across many centres makes it difficult for professionals working in skilled nursing centres to obtain the necessary skills and knowledge for care of people with amputation. A designated skilled nursing centre for amputation rehabilitation is presented as a solution, but smaller clinical changes are also suggested, including improvements in communication and training.
- Description: C1
- Authors: Fortington, Lauren , Rommers, Gerardus , Wind-Kral, Anne , Dijkstra, Pieter , Geertzen, Jan
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Rehabilitation Medicine Vol. 45, no. 10 (2013), p. 1065-1070
- Full Text:
- Reviewed:
- Description: Objectives: To describe the current set-up, barriers and potential for providing rehabilitation to people with lower limb amputation in skilled nursing centres. Design: Survey and interviews. Subjects/participants: Elderly care physicians, physiotherapists. Methods: In 2011, clinicians from 34 skilled nursing centres participated in a semi-structured interview covering rehabilitation and daily care, personal skills and training, team work and communication, and discharge processes. Results: Each centre sees only a small proportion of people with amputation (a maximum of 3.6% of all admissions). This limited number of patients appears to be the main barrier in providing care, as it is difficult for clinicians to maintain knowledge, and resources are spread widely. Two main areas of improvement were suggested by participants: (i) use of guidelines in care; and (ii) collaboration with specialized team members. Conclusion: The spread of patients across many centres makes it difficult for professionals working in skilled nursing centres to obtain the necessary skills and knowledge for care of people with amputation. A designated skilled nursing centre for amputation rehabilitation is presented as a solution, but smaller clinical changes are also suggested, including improvements in communication and training.
- Description: C1
Bias in amputation research; impact of subjects missed from a prospective study
- Fortington, Lauren, Geertzen, Jan, Bosmans, Joline, Dijkstra, Pieter
- Authors: Fortington, Lauren , Geertzen, Jan , Bosmans, Joline , Dijkstra, Pieter
- Date: 2012
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 7, no. 8 (August 2012), p. e43629
- Full Text:
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- Description: For research findings to be generalized, a sample must be representative of the actual population of interest. Lower limb amputation is most frequently performed in older patients with vascular disease, a population that is often under-represented in research. The aim of this study was to explore the impact of selection bias by comparing characteristics from a sample included in a prospective study of phantom pain with the actual population who underwent amputation. Only 27% of all potential patients were referred during the first year of the prospective study. The referred patients were 8 years younger (p<0.001) and less likely to have had amputation because of a vascular condition, diabetes or infection (p = 0.003) than those not referred. There was also a significant difference in one year survival between the groups; 67% of referred patients survived compared with just 40% of non-referred patients (p = 0.004). The biased population in the phantom pain study may have resulted in an underestimation of phantom pain in the original study and subsequent protective factors should be considered within the context of the younger population reported. Selection bias is common in amputation research, and research methods to minimize its impact must be given greater attention.
- Description: C1
- Authors: Fortington, Lauren , Geertzen, Jan , Bosmans, Joline , Dijkstra, Pieter
- Date: 2012
- Type: Text , Journal article
- Relation: PLoS ONE Vol. 7, no. 8 (August 2012), p. e43629
- Full Text:
- Reviewed:
- Description: For research findings to be generalized, a sample must be representative of the actual population of interest. Lower limb amputation is most frequently performed in older patients with vascular disease, a population that is often under-represented in research. The aim of this study was to explore the impact of selection bias by comparing characteristics from a sample included in a prospective study of phantom pain with the actual population who underwent amputation. Only 27% of all potential patients were referred during the first year of the prospective study. The referred patients were 8 years younger (p<0.001) and less likely to have had amputation because of a vascular condition, diabetes or infection (p = 0.003) than those not referred. There was also a significant difference in one year survival between the groups; 67% of referred patients survived compared with just 40% of non-referred patients (p = 0.004). The biased population in the phantom pain study may have resulted in an underestimation of phantom pain in the original study and subsequent protective factors should be considered within the context of the younger population reported. Selection bias is common in amputation research, and research methods to minimize its impact must be given greater attention.
- Description: C1
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