A systematic literature review of quality of life in lower limb amputees

Purpose. To systematically review studies on quality of life (QoL) in lower limb amputees. Method. Computerised literature search of MEDLINE, CINAHL, PUBMED and PsycINFO databases was performed using the keywords, amputee, leg, knee, foot, amputation, QoL, prosthesis, orthopaedic equipment, ADL, phantom, mobility, rehabilitation, psychosocial, psychology and social. Eligible studies published from database inception through March 2009 were selected. The study was included if (1) the study population comprised of adolescent and adult lower-limb amputees as a group or a sub-group, and had ten or more subjects; (2) the study involved subjective assessment of QoL or self-appraisal of life or satisfaction with life; (3) the study was an empirical research study and (4) at least one of the study outcomes was QoL or self-appreciation of life, and QoL results were presented. The selected articles were assessed for study quality based on a standardised set of 19 criteria. The criteria list was pilot-tested for applicability and operationalisation by the authors. Objectives, study population description, QoL instruments used and study outcomes were summarised for the included studies. Results. Twenty-six articles met the inclusion criteria. Fifteen studies were cross-sectional, four prospective, six retrospective and one mixed study-design. The studies were found to be heterogeneous with respect to the study objectives and instruments used to assess QoL. The summary quality score was 50% or more for ten studies, with the maximum being 81%. Conclusions. Lacunas were found in the methodological and study population characteristics of most of the studies. Prospective longitudinal studies are envisaged to systematically study the events following amputation, and the change in QoL over time. To enable this, amputee specific standardised and validated QoL instruments are needed to capture the multitude of facets influencing QoL in amputees, and thereby, facilitating direct comparison across studies.