title: How 'preventable' are lower extremity amputations? A qualitative study of patient perceptions of precipitating factors.
abstract: OBJECTIVE
  Clinicians commonly believe that lower extremity amputations are potentially preventable with coordinated care and motivated patient self-management. We used in-depth interviews with recent amputees to assess how patients viewed their initial amputation risk and causes.
  
  
  METHODS
  We interviewed 22 patients at a rehabilitation hospital 2-6 weeks after an incident amputation. We focused on patients' representations of amputation cause and methods of coping with prior foot and leg symptoms.
  
  
  RESULTS
  Patients reported unexpected onset and rapid progression of ulceration, infection, progressive vascular disease, foot trauma and complications of comorbid illness as precipitating events. Fateful delays of care were common. Many had long histories of painful prior treatments. A fatalistic approach to self-management, difficulties with access and communication with providers and poor understanding of medical conditions were common themes. Few patients seemed aware of the role of smoking as an amputation risk factor.
  
  
  CONCLUSIONS
  Most patients felt out of control and had a poor understanding of the events leading to their initial amputations. Prevention of subsequent amputations will require rehabilitation programs to address low health literacy and psychosocial obstacles to self-management.
authors.affiliation: Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. j-feinglass@northwestern.edu
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Vera P
authors.initials: VP
authors.lastname: Shively
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Martin
authors.forename: Mark E
authors.initials: ME
authors.lastname: Huang
authors.forename: Rachna H
authors.initials: RH
authors.lastname: Soriano
authors.forename: Heron E
authors.initials: HE
authors.lastname: Rodriguez
authors.forename: William H
authors.initials: WH
authors.lastname: Pearce
authors.forename: Elisa J
authors.initials: EJ
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000674:Amputees / Q000523:psychology*; D017719:Diabetic Foot / Q000150:complications / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D016523:Foot Ulcer / Q000150:complications / Q000517:prevention & control* / Q000601:surgery; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010465:Perception; D015985:Precipitating Factors; D036301:Qualitative Research; D012047:Rehabilitation Centers; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012648:Self Care