Jesse A Columbo1,2,3,4, Louise Davies2,3, Ravinder Kang2,3,4, J Aaron Barnes1, Kathleen A Leinweber4, Bjoern D Suckow1,4, Philip P Goodney1,3,4, David H Stone1,4. 1. 1 Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 2. 2 VA Quality Scholars Program, Veterans Health Association, White River Junction, VT, USA. 3. 3 VA Outcomes Group, Veterans Health Association, White River Junction, VT, USA. 4. 4 Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Abstract
OBJECTIVES: To date, studies of vascular amputees primarily examine quantitative outcomes following limb loss. Less is known about the patient's perspective after major lower limb amputation. Here, we define and describe the postamputation recovery period. METHODS: Qualitative study using purposive, maximum variation sampling on the variables of amputation level and times since surgery. We first conducted structured interviews with 20 participants (median age: 65 years, range: 45-88 years; 85% male; below knee amputation n = 14; above knee amputation n = 6; median time from amputation to interview = 16 months, range: 4-51 months). Findings were validated via a focus group with 5 amputees. Data were coded, analyzed, and interpreted by 2 reviewers. RESULTS: All participants expressed the desire to have an active role in the decision to undergo amputation, even while acknowledging that limb salvage options were exhausted. Following amputation, participants described a 6-month recovery period when they learned to modify daily activities to accommodate their new functional and psychological needs. Participants defined recovery as when they had regained functional independence, which was described as a level of mobility that allowed them to perform daily activities with minimal assistance. Concerns that participants felt were poorly addressed included uncontrolled pain, feeling unprepared to live with an amputation, and questions about prosthetics. Two of the 5 focus group participants stated a preference for amputation earlier in the treatment course. CONCLUSIONS: Postamputation recovery has an early (up to 6 months) and late phase (after 6 months) and concludes when amputees regain what they perceive as independence. Patients desire to participate in amputation decision-making; in this study, some would have preferred amputation earlier in their clinical course. Attention to the domains that impact quality of life, and fostering a shared decision-making process, are opportunities to enhance postamputation recovery.
OBJECTIVES: To date, studies of vascular amputees primarily examine quantitative outcomes following limb loss. Less is known about the patient's perspective after major lower limb amputation. Here, we define and describe the postamputation recovery period. METHODS: Qualitative study using purposive, maximum variation sampling on the variables of amputation level and times since surgery. We first conducted structured interviews with 20 participants (median age: 65 years, range: 45-88 years; 85% male; below knee amputation n = 14; above knee amputation n = 6; median time from amputation to interview = 16 months, range: 4-51 months). Findings were validated via a focus group with 5 amputees. Data were coded, analyzed, and interpreted by 2 reviewers. RESULTS: All participants expressed the desire to have an active role in the decision to undergo amputation, even while acknowledging that limb salvage options were exhausted. Following amputation, participants described a 6-month recovery period when they learned to modify daily activities to accommodate their new functional and psychological needs. Participants defined recovery as when they had regained functional independence, which was described as a level of mobility that allowed them to perform daily activities with minimal assistance. Concerns that participants felt were poorly addressed included uncontrolled pain, feeling unprepared to live with an amputation, and questions about prosthetics. Two of the 5 focus group participants stated a preference for amputation earlier in the treatment course. CONCLUSIONS: Postamputation recovery has an early (up to 6 months) and late phase (after 6 months) and concludes when amputees regain what they perceive as independence. Patients desire to participate in amputation decision-making; in this study, some would have preferred amputation earlier in their clinical course. Attention to the domains that impact quality of life, and fostering a shared decision-making process, are opportunities to enhance postamputation recovery.
Authors: D C Norvell; M L Thompson; E J Boyko; G Landry; A J Littman; W G Henderson; A P Turner; C Maynard; K P Moore; J M Czerniecki Journal: Br J Surg Date: 2019-03-13 Impact factor: 6.939
Authors: Chelsea Leonard; George Sayre; Sienna Williams; Alison Henderson; Daniel Norvell; Aaron P Turner; Joseph Czerniecki Journal: PLoS One Date: 2022-03-18 Impact factor: 3.752
Authors: Sarah Milosevic; Lucy Brookes-Howell; Brenig Llwyd Gwilym; Cherry-Ann Waldron; Emma Thomas-Jones; Ryan Preece; Philip Pallmann; Debbie Harris; Ian Massey; Philippa Stewart; Katie Samuel; Sian Jones; David Cox; Christopher P Twine; Adrian Edwards; David C Bosanquet Journal: BMJ Open Date: 2022-01-17 Impact factor: 3.006
Authors: Brenig L Gwilym; Cherry-Ann Waldron; Emma Thomas-Jones; Ryan Preece; Sarah Milosevic; Lucy Brookes-Howell; Philip Pallmann; Debbie Harris; Ian Massey; Jo Burton; Philippa Stewart; Katie Samuel; Sian Jones; David Cox; Adrian Edwards; Chris Twine; David C Bosanquet Journal: BJS Open Date: 2021-11-09
Authors: Philip Goodney; Samir Shah; Yiyuan David Hu; Bjoern Suckow; Scott Kinlay; David G Armstrong; Patrick Geraghty; Megan Patterson; Matthew Menard; Manesh R Patel; Michael S Conte Journal: J Vasc Surg Date: 2022-01-24 Impact factor: 4.860