Quality of life after lower extremity amputation due to diabetic foot ulcer: the role of prosthesis-related factors, body image, self-esteem, and coping styles

ABSTRACT Objective: The purpose of this study was to identify clinical and psychosocial factors that predict an individual’s subjective quality of life after having undergone a lower limb amputation secondary to diabetic foot ulcer. Method: The study sample comprised 65 patients who underwent amputation because of an infected diabetic foot ulcer. Short Form 36, The Trinity Amputation and Prosthesis Experience Scale, Coping Attitudes Evaluation Scale, Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, and Amputee Body Image Scale were administered as questionnaires. Stepwise linear regression analysis was conducted to assess the factors predicting quality of life. Results: Quality of life was negatively correlated with depression, anxiety, body image, activity limitation, and dysfunctional coping strategies and positively correlated with perceived social support, satisfaction with prosthesis, self-esteem, and problem-focused coping style. Regression analysis showed satisfaction with prosthesis and body perception, problem-focused coping strategies, dysfunctional coping strategies, and self-esteem to be the factors with the highest predictive power for the physical component of quality of life, while body perception, problem-focused, and dysfunctional coping strategies were the strongest predictors for the mental component of quality of life. Conclusion: Impaired body image and self-esteem, less usage of problem-focused and high usage of dysfunctional coping strategies, in addition to low satisfaction with the prosthesis were the strongest predictors for poor quality of life. Factors associated with better quality of life after the amputation were investigated in this study, which may support future development of post-amputation rehabilitation strategies for lower limb amputees.

___

1. Ragnarson Tennvall G, Apelqvist J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications 2000; 14:235-241.

2. Carrington AL, Mawdsley SK, Morley M, Kincey J, Boulton AJ. Psychological status of diabetic people with or without lower limb disability. Diabetes Res Clin Pract 1996; 32:19-25.

3. Willrich A, Pinzur M, McNeil M, Juknelis D, Lavery L. Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study. Foot Ankle Int 2005; 26:128-134.

4. Boutoille D, Féraille A, Maulaz D, Krempf M. Quality of life with diabetes-associated foot complications: comparison between lower-limb amputation and chronic foot ulceration. Foot Ankle Int 2008; 29:1074-1078.

5. Asano M, Rushton P, Miller WC, Deathe BA. Predictors of quality of life among individuals who have a lower limb amputation. Prosthet Orthot Int 2008; 32:231-243.

6. Horgan O, MacLachlan M. Psychosocial adjustment to lowerlimb amputation: a review. Disabil Rehabil 2004; 26:837-850.

7. Grossman EF. The Gestalt approach to people with amputations. J Appl Rehabil Couns 1990; 21:16-19.

8. Rybarczyk B, Nyenhuis D, Nicholas JJ, Cash SM, Kaiser J. Body image, perceived social stigma, and the prediction of psychosocial adjustment to leg amputation. Rehabil Psychol 1995; 40:95-110.

9. Holzer LA, Sevelda F, Fraberger G, Bluder O, Kickinger W, Holzer G. Body image and self-esteem in lower-limb amputees. PLoS One 2014; 9:e92943.

10. Dunn DS. Well-being following amputation: Salutary effects of positive meaning, optimism, and control. Rehabil Psychol 1996; 41:285-302.

11. Livneh H, Antonak RF, Gerhardt J. Psychosocial adaptation to amputation: the role of sociodemographic variables, disabilityrelated factors and coping strategies. Int J Rehabil Res 1999; 22:21-31.

12. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth 2011; 55:111-115.

13. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473-483.

14. Ware JE, Jr, Kosinski MA, Keller SD. SF-36 physical and mental health summary scales: a User’s Manual. Fifth ed., Boston: MA Health Assessment Lab, New England Medical Center, 1994.

15. Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976) 2000; 25:3130-3139.

16. Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis AK. Reliability and validity of the Short Form 36, Turkish version (KF-36). Ilac ve Tedavi Dergisi 1999; 12:102-106. (Turkish)

17. Gallagher P, MacLachlan M. Development and psychometric evaluation of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Rehabil Psychol 2000; 45:130-154.

18. Topuz S, Ulger O, Yakut Y, Gul Sener F. Reliability and construct validity of the Turkish version of the Trinity Amputation and Prosthetic Experience Scales (TAPES) in lower limb amputees. Prosthet Orthot Int 2011;35:201-206.

19. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989; 56:267- 283.

20. Agargun MY, Besiroglu L, Kiran UK, Ozer OA, Kara H. The psychometric properties of the COPE inventory in Turkish sample: a preliminary research. Anadolu Psikiyatri Derg 2005; 6:221.

21. Carver CS, Scheier MF. Situational coping and coping dispositions in a stressful transaction. J Pers Soc Psychol 1994; 66:184-195.

22. Cooper C, Katona C, Orrell M, Livingston G. Coping strategies and anxiety in caregivers of people with Alzheimer’s disease: the LASER-AD study. J Affect Disord 2006; 90:15-20.

23. Coolidge FL, Segal DL, Hook JN, Stewart S. Personality disorders and coping among anxious older adults. J Anxiety Disord 2000; 14:157-172.

24. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 1988;52:30-41.

25. Eker D, Arkar H, Yaldiz H. Factorial Structure, Validity, and Reliability of Revised Form of the Multidimensional Scale of Perceived Social Support. Turk Psikiyatri Derg 2001; 12:17-25. (Turkish)

26. Rosenberg M. Society and the Adolescent Self-Image. First ed., Princeton, NJ.:Princeton University Press, 1965.

27. Cuhadaroglu F. Self-esteem in Adolescents. Specialization Thesis, Hacettepe University Medical Faculty Department of Psychiatry, Ankara. 1986. (Turkish)

28. Breakey JW. Body image: the lower-limb amputee. JPO J Prosthetics Orthot 1997; 9:58-66.

29. Safaz I, Yilmaz B, Goktepe AS, Yazicioglu K. Turkish version of the amputee body image scale and relationship with quality of life. Bulletin Clin Psychopharmacol 2010; 20:79-83.

30. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606-613.

31. Yazici Gulec M, Gulec H, Simsek G, Turhan M, Aydin Sunbul E. Psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms. Compr Psychiatry 2012; 53:623-629.

32. Demiral Y, Ergor G, Unal B, Semin S, Akvardar Y, Kivircik B, et al. Normative data and discriminative properties of short form 36 (SF-36) in Turkish urban population. BMC Public Health 2006; 6:247.

33. Hagberg K, Brånemark R. Consequences of non-vascular transfemoral amputation: a survey of quality of life, prosthetic use and problems. Prosthet Orthot Int 2001; 25:186-194.

34. Sinha R, van den Heuvel WJ, Arokiasamy P. Factors affecting quality of life in lower limb amputees. Prosthet Orthot Int 2011; 35:90-96.

35. Arena JG, Sherman RA, Bruno GM, Smith JD. The relationship between situational stress and phantom limb pain: cross-lagged correlational data from six month pain logs. J Psychosom Res 1990; 34:71-77.

36. van der Schans CP, Geertzen JH, Schoppen T, Dijkstra PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage 2002; 24:429-436.

37. Kaur A, Guan Y. Phantom limb pain: A literature review. Chin J Traumatol 2018; 21:366-368.

38. Knežević A, Salamon T, Milankov M, Ninković S, Jeremić Knežević M, Tomašević Todorović S. Assessment of quality of life in patients after lower limb amputation. Med Pregl 2015; 68:103-108.

39. Burger H, Marincek C, Isakov E. Mobility of persons after traumatic lower limb amputation. Disabil Rehabil. 1997; 19:272- 277.

40. Raya MA, Gailey RS, Fiebert IM, Roach KE. Impairment variables predicting activity limitation in individuals with lower limb amputation. Prosthet Orthot Int 2010; 34:73-84.

41. Schürmann T, Beckerle P, Preller J, Vogt J, Christ O. Theoretical implementation of prior knowledge in the design of a multi-scale prosthesis satisfaction questionnaire. Biomed Eng Online 2016; 15:143.

42. Millstein S, Bain D, Hunter GA. A review of employment patterns of industrial amputees--factors influencing rehabilitation. Prosthet Orthot Int 1985; 9:69-78.

43. Sansam K, Neumann V, O’Connor R, Bhakta B. Predicting walking ability following lower limb amputation: a systematic review of the literature. J Rehabil Med 2009; 41:593-603.

44. Fernández A, Isusi I, Gómez M. Factors conditioning the return to work of upper limb amputees in Asturias, Spain. Prosthet Orthot Int 2000; 24:143-147.

45. Matsen SL, Malchow D, Matsen FA 3rd. Correlations with patients’ perspectives of the result of lower-extremity amputation. J Bone Joint Surg Am 2000; 82:1089-1095.

46. Akarsu S, Tekin L, Safaz I, Göktepe AS, Yazicioğlu K. Quality of life and functionality after lower limb amputations: comparison between uni- vs. bilateral amputee patients. Prosthet Orthot Int 2013; 37:9-13.

47. Deans SA, McFadyen AK, Rowe PJ. Physical activity and quality of life: A study of a lower-limb amputee population. Prosthet Orthot Int 2008; 32:186-200.

48. Copuroglu C, Ozcan M, Yilmaz B, Gorgulu Y, Abay E, Yalniz E. Acute stress disorder and post-traumatic stress disorder following traumatic amputation. Acta Orthop Belg 2010; 76:90-93.

49. Pereira MG, Ramos C, Lobarinhas A, Machado JC, Pedras S. Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance. Scand J Psychol 2018; 59:414-421.

50. Desmond DM, MacLachlan M. Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations. Soc Sci Med 2006; 62:208-216.

51. Andersson M, Deighan F. Coping strategies in conjunction with amputation: A literature study. Thesis, Division for Health and Caring Sciences, Karlstads University, Sweden, 2006.

52. Couture M, Desrosiers J, Caron CD. Coping with a lower limb amputation due to vascular disease in the hospital, rehabilitation, and home setting. ISRN Rehabil 2012; 179878.

53. Oaksford K, Frude N, Cuddihy R. Positive coping and stressrelated psychological growth following lower limb amputation. Rehabil Psychol 2005; 50:266-277.

54. Parkes CM. Components of the reaction to loss of a lamb, spouse or home. J Psychosom Res 1972; 16:343-349.

55. Adamson PA, Doud Galli SK. Modern concepts of beauty. Curr Opin Otolaryngol Head Neck Surg 2003; 11:295-300.

56. Deusen J Van. Body image of non-clinical and clinical populations of men: a literature review. Occup Ther Ment Heal 1996; 13:37- 57.

57. Ching S, Thoma A, McCabe RE, Antony MM. Measuring outcomes in aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 2003; 111:469-480.

58. Goldenberg JL, McCoy SK, Pyszczynski T, Greenberg J, Solomon S. The body as a source of self-esteem: the effect of mortality salience on identification with one’s body, interest in sex, and appearance monitoring. J Pers Soc Psychol 2000; 79:118-130.

59. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Support Care Cancer 2004; 12:871-876.

60. Alavi M, Molavi H, Molavi R. The impact of cognitive behavioral therapy on self-esteem and quality of life of hospitalized amputee elderly patients. Nurs Midwifery Stud 2017; 6:162-167.

61. Didarloo A, Alizadeh M. Health-Related Quality of Life and its Determinants Among Women With Diabetes Mellitus: A CrossSectional Analysis. Nurs Midwifery Stud. 2016; 5:e28937.

62. Kiani J, Pakizeh A, Ostovar A, Namazi S. Effectiveness of cognitive behavioral group therapy (CBGT) in increasing the self esteem & decreasing the hopelessness of β-thalassemic adolescents. Iran South Med J 2010; 13:241-252. (Persian)
Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık
Sayıdaki Diğer Makaleler

Monocyte-to-lymphocyte ratio and platelet-tolymphocyte ratio in opioid use disorder and marijuana use disorder

Mehmet Hamdi ORUM, Mahmut Zabit KARA

Aggravating influence of atomoxetine on the severity of stuttering and its successful treatment with methylphenidate: a case report

Ayla Uzun CİCEK

Replication analysis of the Coronavirus Anxiety Scale

Sherman A. LEE

Evaluation of domestic physical violence in a male sample in a psychiatric outpatient clinic: a controlled study

Vahap KARABULUT, Başak ÖZÇELİK, Oğuz KARAMUSTAFALIOĞLU

Rapid efficacy of mirtazapine in the treatment of hyperemesis gravidarum with esophagus perforation and ketonuria in a normoglycemic patient: a case report

Aysegul TASDELEN KUL, Ibrahim GUNDOGMUS, Mikail Burak AYDİN

Quality of life after lower extremity amputation due to diabetic foot ulcer: the role of prosthesis-related factors, body image, self-esteem, and coping styles

Ozlem Kazan KİZİLKURT, Taha KİZİLKURT, Medine Yazici GULEC, Ferzan Ergun GİYNAS, Gökhan POLAT, Onder Ismet KİLİCOGLU, Hüseyin GÜLEÇ

Valproicacid- induced hyperammonemic encephalopathy

Naciye HOCAOGLU, Saliha ÖZSOY, Kadir BULUT, Sevda İSMAİLOĞULLARI, Mustafa ERDOĞAN

Acute stress disorder with panic episodes induced by exposure to COVID-19 outbreak news in a child

Duygu KABA, Burcu AKİN SARİ

Substance use patterns, psychosocial traumas, psychiatric comorbidities, and gender differences among adolescent inpatients at an addiction treatment center

Deniz YILDIZ, Arzu ÇİFTÇİ, Özhan YALÇIN

The relationship between perceived stress, dissociative experiences, depressive symptoms, and anxiety sensitivity in borderline personality disorder

Mehmet Emin DEMİRKOL, Lut TAMAM, Soner ÇAKMAK, Kerim UĞUR, Caner YESİLOĞLU