title: The effect of social integration on outcomes after major lower extremity amputation.
abstract: OBJECTIVE
  Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes.
  
  
  METHODS
  From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D.
  
  
  RESULTS
  We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis.
  
  
  CONCLUSIONS
  In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration.
authors.affiliation: Center for Surgery and Public Health, Boston, Mass; Department of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, Mass; Department of Surgery, Massachusetts General Hospital, Boston, Mass.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hawkins
authors.affiliation: Department of Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Pallangyo
authors.affiliation: Department of Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
authors.forename: Ayesiga M
authors.initials: AM
authors.lastname: Herman
authors.affiliation: Center for Surgery and Public Health, Boston, Mass.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Schaumeier
authors.affiliation: Center for Surgery and Public Health, Boston, Mass; Department of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Ann D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: Center for Surgery and Public Health, Boston, Mass; Department of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, Mass.
authors.forename: Nathanael D
authors.initials: ND
authors.lastname: Hevelone
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Mass; Spaulding Rehabilitation Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: David M
authors.initials: DM
authors.lastname: Crandell
authors.affiliation: Center for Surgery and Public Health, Boston, Mass; Department of Vascular and Endovascular Surgery, Brigham & Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: llnguyen@partners.org.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000523:psychology*; D000674:Amputees / Q000523:psychology*; D001900:Boston; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005080:Exercise Test; D005260:Female; D006801:Humans; D016014:Linear Models; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D015999:Multivariate Analysis; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D012919:Social Behavior; D012944:Social Support; D011795:Surveys and Questionnaires; D013636:Tanzania; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult