Impact of pain in vertebral column on activities of daily living in the Iranian amputees with bilateral lower limb amputation.
OBJECTIVE
To determine the impact of pain in the vertebral column on the activities of daily living (ADL) level of war victims with bilateral lower limb amputation.


METHODS
All the war-related bilateral lower limb amputees were invited. More than half of them (n = 335) participated and underwent a thorough assessment after giving informed consent.


RESULTS
The majority of the participants were male (97.6%). Their mean age was 42 years and 97.6% of them were married. The most common causes of injury leading to amputation were shells of artillery and mortar (56.7%). The most common level of amputation was bilateral transtibial (37.6%) and 64% were wearing the prosthesis of both sides. The most ADL dependency were transfer activities (27.8%) and bathing (23.3%) and the most independent functioning was eating (97.6%). Upper cervical vertebral pain was associated with dependency in the bowel and bladder management and dressing (p < 0.03 and p < 0.04, respectively). Pain in the lower cervical vertebrae was associated with dependency in toileting and dressing (p < 0.01 and p < 0.01, respectively). There were significant relationships between pain in the thoracic vertebrae and dependency in bathing, transfer activities and toileting (p < 0.02, p < 0.003 and p < 0.03, respectively). Pain in the lumbosacral region had a relationship with the level of amputation, transfer activities and toileting (p < 0.006, p < 0.03 and p < 0.05, respectively).


CONCLUSIONS
Vertebral pain in bilateral lower limb amputees, especially lumbosacral pain, was accompanied with higher dependency in ADL. Therefore, a multidisciplinary approach to the management of pain is required to minimize disability and maximize functioning.
Department of Physical Medicine and Rehabilitation, Burn research center, Shiraz University of Medical Sciences, Iran.
Alireza
A
Ashraf
Hadi
H
Shojaee
Batool
B
Mousavi
Mehdi
M
Masoumi
Noushin
N
Rezaei
Hasan
H
Azema
Mohammadreza
M
Soroush
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000523:psychology; D000674:Amputees / Q000534:rehabilitation*; D001416:Back Pain / Q000209:etiology* / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007492:Iran; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D018434:Sickness Impact Profile; D013131:Spine / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014728:Veterans; D014857:Warfare; D055815:Young Adult