Comparison of pain and quality of life between the victims with transfemoral and transtibial amputation 10 years after the Wenchuan earthquake_West China Medical Journal

Authors：

WANG Qian ^1,2 , CHEN Caiyun ³ , ZHANG Sheng ³ , TANG Yiming ³ , WANG Hongxia ³ , ZOU Xue ³ ,  WONG Mansang ⁴

1. Center of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Rehabilitation Key Laboratory of Sichuan Province, Chengdu, Sichuan 610041, P. R. China;
3. Center of Comprehensive Service of Disabled, Deyang, Sichuan 618000, P. R. China;
4. Department of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong 999077, P. R. China;

Corresponding author：

WONG Mansang, Email: m.s.wong@polyu.edu.hk

Keywords：

Transfemoral amputation; Transtibial amputation; Earthquake; Rehabilitation; Pain; Quality of life

DOI：

10.7507/1002-0179.202006261

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Objective To investigate the amputation-related pain and quality of life (QoL) between the amputees with transfemoral amputation (TFA) and transtibial amputation (TTA) 10 years after the Wenchuan earthquake, and compare the effects of two different amputation level on the long-term functional rehabilitation of amputees. Methods A total of 305 amputees from Center of Comprehensive Service of Disabled of Deyang for the disabled 10 years after the Wenchuan earthquake were selected for cross-sectional study from February to June 2018. Through face-to-face interview, the basic information of amputees was collected and the evaluation of Prosthetic Evaluation Questionnaire (PEQ) was completed. The amputees were divided into TFA group and TTA group according to the amputation level. Results A total of 53 amputees were included, including 27 in the TFA group and 26 in the TTA group. The PEQ scores showed that the prevalences of phantom limb sensation (96.3% vs. 65.4%; χ²=6.372, P=0.012) and phantom limb pain (92.6% vs. 69.2%; P=0.039) in the TFA group were significantly higher than those in the TTA group. There was no significant difference with regard to the intensity of amputation-related pain between the victims with TFA and TTA (P>0.05). However, the TFA group were more bothered by phantom limb sensation than the TTA group (52.9±24.1 vs. 35.9±26.7; t=2.108, P=0.042), there was no significant difference in other indexes (P>0.05). There was no significant difference in QoL between the TFA and TTA groups (P>0.05). Conclusions The phantom limb sensation, phantom limb pain, residual limb pain, non-amputated limb pain and back pain are still prevalent among the victims with TFA and TTA 10 years after the Wenchuan earthquake. The higher amputation level is associated with increased prevalence of phantom limb sensation and phantom limb pain, as well as more bothersomeness of phantom limb sensation. The amputation level appeares to have no impact on the long-term QoL.

Citation： WANG Qian, CHEN Caiyun, ZHANG Sheng, TANG Yiming, WANG Hongxia, ZOU Xue, WONG Mansang. Comparison of pain and quality of life between the victims with transfemoral and transtibial amputation 10 years after the Wenchuan earthquake. West China Medical Journal, 2021, 36(12): 1686-1691. doi: 10.7507/1002-0179.202006261 Copy

1.	Zhang X, Hu XR, Reinhardt JD, et al. Functional outcomes and health-related quality of life in fracture victims 27 months after the Sichuan earthquake. J Rehabil Med, 2012, 44(3): 206-209.
2.	Ni J, Reinhardt JD, Zhang X, et al. Dysfunction and post-traumatic stress disorder in fracture victims 50 months after the Sichuan earthquake. PLoS One, 2013, 8(10): e77535.
3.	Zhang X, Reinhardt JD, Gosney JE, et al. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment. PLoS One, 2013, 8(1): e53995.
4.	Li Y, Pan F, Li Y. Analysis of rehabilitation needs, measures taken, and their effectiveness for the wounded following the Wenchuan Earthquake. J Evid Based Med, 2009, 2(4): 258-264.
5.	Bowker HK, Michael JW. Atlas of limb prosthetics: surgical, prosthetic, and rehabilitation principles. Rosemont IL: American Academy of Orthopaedic, 2002: 255-264.
6.	Furtado S, Grimer RJ, Cool P, et al. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey. Bone Joint J, 2015, 97-B(9): 1284-1290.
7.	Chu CK, Wong MS. Comparison of prosthetic outcomes between adolescent transtibial and transfemoral amputees after sichuan earthquake using step activity monitor and prosthesis evaluation questionnaire. Prosthet Orthot Int, 2016, 40(1): 58-64.
8.	Li WS, Chan SY, Chau WW, et al. Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake. Prosthet Orthot Int, 2019, 43(1): 104-111.
9.	Yilmaz M, Gulabi D, Kaya I, et al. The effect of amputation level and age on outcome: an analysis of 135 amputees. Eur J Orthop Surg Traumatol, 2016, 26(1): 107-112.
10.	Highsmith MJ, Goff LM, Lewandowski AL, et al. Low back pain in persons with lower extremity amputation: a systematic review of the literature. Spine J, 2019, 19(3): 552-563.
11.	Perkins ZB, De’Ath HD, Sharp G, et al. Factors affecting outcome after traumatic limb amputation. Br J Surg, 2012, 99 (Suppl 1): 75-86.
12.	Devan H, Hendrick P, Hale L, et al. Exploring factors influencing low back pain in people with nondysvascular lower limb amputation: a national survey. PM R, 2017, 9(10): 949-959.
13.	Miller MJ, Magnusson DM, Lev G, et al. Relationships among perceived functional capacity, self-efficacy, and disability after dysvascular amputation. PM R, 2018, 10(10): 1056-1061.
14.	Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of amputees (MAAT Ⅰ): quality of life and satisfaction are strongly related to mobility for patients with a lower limb prosthesis. Prosthet Orthot Int, 2018, 42(5): 498-503.
15.	Sinha R, Van Den Heuvel WJ. A systematic literature review of quality of life in lower limb amputees. Disabil Rehabil, 2011, 33(11): 883-899.
16.	Li L, Reinhardt JD, Zhang X, et al. Physical function, pain, quality of life and life satisfaction of amputees from the 2008 Sichuan earthquake: a prospective cohort study. J Rehabil Med, 2015, 47(5): 466-471.
17.	Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol, 2002, 1(3): 182-189.
18.	Collins KL, Russell HG, Schumacher PJ, et al. A review of current theories and treatments for phantom limb pain. J Clin Invest, 2018, 128(6): 2168-2176.
19.	Ephraim PL, Wegener ST, MacKenzie EJ, et al. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch phys med rehabil, 2005, 86(10): 1910-1919.
20.	Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev, 2015, 8(8): CD007264.
21.	Gallagher P, Maclachlan M. The trinity amputation and prosthesis experience scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil, 2004, 85(5): 730-736.
22.	Ebrahimzadeh MH, Moradi A, Khorasani MR, et al. Long-term clinical outcomes of war-related bilateral lower extremities amputations. Injury, 2015, 46(2): 275-281.
23.	Hisam A, Ashraf F, Rana MN, et al. Health related quality of life in patients with single lower limb amputation. J Coll Physicians Surg Pak, 2016, 26(10): 851-854.
24.	McQuerry J, Gammon L, Carpiaux A, et al. Effect of amputation level on quality of life and subjective function in children. J Pediatr Orthop, 2019, 39(7): e524-e530.
25.	Christensen J, Ipsen T, Doherty P, et al. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disabil rehabil, 2016, 38(24): 2345-2353.

1. Zhang X, Hu XR, Reinhardt JD, et al. Functional outcomes and health-related quality of life in fracture victims 27 months after the Sichuan earthquake. J Rehabil Med, 2012, 44(3): 206-209.
2. Ni J, Reinhardt JD, Zhang X, et al. Dysfunction and post-traumatic stress disorder in fracture victims 50 months after the Sichuan earthquake. PLoS One, 2013, 8(10): e77535.
3. Zhang X, Reinhardt JD, Gosney JE, et al. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment. PLoS One, 2013, 8(1): e53995.
4. Li Y, Pan F, Li Y. Analysis of rehabilitation needs, measures taken, and their effectiveness for the wounded following the Wenchuan Earthquake. J Evid Based Med, 2009, 2(4): 258-264.
5. Bowker HK, Michael JW. Atlas of limb prosthetics: surgical, prosthetic, and rehabilitation principles. Rosemont IL: American Academy of Orthopaedic, 2002: 255-264.
6. Furtado S, Grimer RJ, Cool P, et al. Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey. Bone Joint J, 2015, 97-B(9): 1284-1290.
7. Chu CK, Wong MS. Comparison of prosthetic outcomes between adolescent transtibial and transfemoral amputees after sichuan earthquake using step activity monitor and prosthesis evaluation questionnaire. Prosthet Orthot Int, 2016, 40(1): 58-64.
8. Li WS, Chan SY, Chau WW, et al. Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake. Prosthet Orthot Int, 2019, 43(1): 104-111.
9. Yilmaz M, Gulabi D, Kaya I, et al. The effect of amputation level and age on outcome: an analysis of 135 amputees. Eur J Orthop Surg Traumatol, 2016, 26(1): 107-112.
10. Highsmith MJ, Goff LM, Lewandowski AL, et al. Low back pain in persons with lower extremity amputation: a systematic review of the literature. Spine J, 2019, 19(3): 552-563.
11. Perkins ZB, De’Ath HD, Sharp G, et al. Factors affecting outcome after traumatic limb amputation. Br J Surg, 2012, 99 (Suppl 1): 75-86.
12. Devan H, Hendrick P, Hale L, et al. Exploring factors influencing low back pain in people with nondysvascular lower limb amputation: a national survey. PM R, 2017, 9(10): 949-959.
13. Miller MJ, Magnusson DM, Lev G, et al. Relationships among perceived functional capacity, self-efficacy, and disability after dysvascular amputation. PM R, 2018, 10(10): 1056-1061.
14. Wurdeman SR, Stevens PM, Campbell JH. Mobility analysis of amputees (MAAT Ⅰ): quality of life and satisfaction are strongly related to mobility for patients with a lower limb prosthesis. Prosthet Orthot Int, 2018, 42(5): 498-503.
15. Sinha R, Van Den Heuvel WJ. A systematic literature review of quality of life in lower limb amputees. Disabil Rehabil, 2011, 33(11): 883-899.
16. Li L, Reinhardt JD, Zhang X, et al. Physical function, pain, quality of life and life satisfaction of amputees from the 2008 Sichuan earthquake: a prospective cohort study. J Rehabil Med, 2015, 47(5): 466-471.
17. Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol, 2002, 1(3): 182-189.
18. Collins KL, Russell HG, Schumacher PJ, et al. A review of current theories and treatments for phantom limb pain. J Clin Invest, 2018, 128(6): 2168-2176.
19. Ephraim PL, Wegener ST, MacKenzie EJ, et al. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch phys med rehabil, 2005, 86(10): 1910-1919.
20. Johnson MI, Mulvey MR, Bagnall AM. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database Syst Rev, 2015, 8(8): CD007264.
21. Gallagher P, Maclachlan M. The trinity amputation and prosthesis experience scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil, 2004, 85(5): 730-736.
22. Ebrahimzadeh MH, Moradi A, Khorasani MR, et al. Long-term clinical outcomes of war-related bilateral lower extremities amputations. Injury, 2015, 46(2): 275-281.
23. Hisam A, Ashraf F, Rana MN, et al. Health related quality of life in patients with single lower limb amputation. J Coll Physicians Surg Pak, 2016, 26(10): 851-854.
24. McQuerry J, Gammon L, Carpiaux A, et al. Effect of amputation level on quality of life and subjective function in children. J Pediatr Orthop, 2019, 39(7): e524-e530.
25. Christensen J, Ipsen T, Doherty P, et al. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disabil rehabil, 2016, 38(24): 2345-2353.

West China Medical Journal

Comparison of pain and quality of life between the victims with transfemoral and transtibial amputation 10 years after the Wenchuan earthquake

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