Alexander T. Hawkins1, Anthony J. Pallangyo2, Ayesiga M. Herman2, Antonia J. Henry1, Maria J. Schaumeier1, Ann D. Smith1, Nathanael D. Hevelone1, Rachel Rifkin1, Elifuraha G. Maya2, David M. Crandell3, Louis L. Nguyen1
1Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA; 2Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania; 3Spaulding Rehabilitation Hospital, Boston, MA.
OBJECTIVES: Major lower extremity (MLE) amputation is a profound change in a patient's life. We seek to determine the role of social integration in outcomes after amputation. The impact of social context is tested by including patients from the United States (US) and Tanzania (TNZ).
METHODS: MLE amputees were recruited from US and TNZ sites in a prospective study. Data collected included demographic, social integration (CHART), walking function (6-minute walk test) and QoL (EQ5D). Chi-squared and ANOVA tests were used to assess association between social integration and outcomes. Multivariable logistic regression analysis was performed to assess the role of social context.
RESULTS: Of the 90 enrolled patients, 50 (56%) were from the US, 58 (64%) were male, with a mean age of 64.4 years. Patients with high social integration had a trend toward improved function defined by a score of 171 meters or better (36% vs. 66% vs. 74%; p=0.055) and significantly higher mean EQ5D scores (0.65 vs. 0.70 vs. 0.79; p=0.021). Findings were more dramatic in the US sub-group for both function (17% vs. 38% vs. 74%; p=0.008) and QoL (0.52 vs. 0.58 vs. 0.79; p=0.001). In a multivariate analysis, the TNZ site was not associated with less favorable function (p=0.783) or QoL (p=0.364).
CONCLUSIONS: In the US population, increased social integration is associated with both improved function and quality-of-life outcomes among amputees. This effect is attenuated in TNZ, likely due to differences in social context. Steps should be taken to identify and aid amputees with poor social integration in the US and factors associated with low function elsewhere.
AUTHOR DISCLOSURES: D. M. Crandell: Nothing to disclose; A. T. Hawkins: Nothing to disclose; A. J. Henry: Nothing to disclose; A. M. Herman: Nothing to disclose; N. D. Hevelone: Nothing to disclose; E. G. Maya: Nothing to disclose; L. L. Nguyen: Nothing to disclose; A. J. Pallangyo: Nothing to disclose; R. Rifkin: Nothing to disclose; M. J. Schaumeier: Nothing to disclose; A. D. Smith: Nothing to disclose.
Posted April 2013