A systematic review of functional and quality of life assessment after major lower extremity amputation.
BACKGROUND
When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount. The heterogeneity of the scales and tests in the current literature is confusing and makes it difficult to compare results. We provide a primer for outcome assessment after amputation and assess the need for the additional development of novel instruments.


METHODS
MEDLINE, EMBASE, and Google Scholar were searched for all studies using functional and QOL instruments after MLE amputation. Assessment instruments were divided into functional and QOL categories. Within each category, they were subdivided into global and amputation-specific instruments. An overall assessment of instrument quality was obtained.


RESULTS
The initial search revealed 746 potential studies. After a review of abstracts, 102 were selected for full review, and 40 studies were then included in this review. From the studies, 21 different assessment instruments were used 63 times. There were 14 (67%) functional measures and 7 (33%) QOL measures identified. Five (36%) of the functional instruments and 3 (43%) of the QOL measures were specific for MLE amputees. Sixteen instruments were used >1 time, but only 5 instruments were used >3 times. An additional 5 instruments were included that were deemed important by expert opinion. The 26 assessment instruments were rated. Fourteen of the best-rated instruments were then described.


CONCLUSIONS
The heterogeneity of instruments used to measure both functional and QOL outcomes make it difficult to compare MLE amputation outcome studies. Future researchers should seek to use high-quality instruments. Clinical and research societies should endorse the best validated instruments for future use in order to strengthen overall research in the field.
Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts.
Alexander T
AT
Hawkins
Brigham & Women's Hospital, Boston, Massachusetts.
Antonia J
AJ
Henry
Spaulding Rehabilitation Hospital, Charlestown, Massachusetts; Harvard Medical School, Boston, Massachusetts.
David M
DM
Crandell
Center for Surgery and Public Health, Boston, Massachusetts; Brigham & Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: llnguyen@partners.org.
Louis L
LL
Nguyen
D000203:Activities of Daily Living; D000671:Amputation, Surgical / Q000009:adverse effects / Q000523:psychology; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D005080:Exercise Test; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D011237:Predictive Value of Tests; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome