title: Comparison of upper limb amputees and lower limb amputees: a psychosocial perspective.
abstract: BACKGROUND
  Amputation of limb is essential in certain conditions; however, it may have significant impact on the patient's psychological condition. The present study investigates psychological responses of upper limb (UL) amputees versus lower limb (LL) amputees regarding prosthetic adjustment, social discomfort, depression, and body image anxiety.
  
  
  METHODS
  Traumatic major amputations of 20 upper and 38 lower extremities of 58 patients who were currently using prosthesis were included. 12 of UL amputations were of dominantly used limb. Seven of the UL amputations, and nine of the LL amputations were female. The Trinity Amputation and Prosthesis Experience Scales was used for adjustment, restriction, and satisfaction. Anxiety and depression levels were assessed using Hospital Anxiety and Depression Scale (HADS). Body image disturbance and social discomfort were assessed with Amputation Body Image Scale-Revised (ABIS-R) and Social Discomfort Score, respectively.
  
  
  RESULTS
  58 individuals with 20 UL and 38 LL amputations were included. Mean age of UL amputees was 44.76 ± 12.26 and 49.1 ± 14.3 years for LL amputees. Mean time of daily prosthesis use was 11.35 ± 4.8 and 11.52 ± 4.7 h, respectively. Mean time since amputation was 35.4 ± 14.3 and 36.05 ± 13.6 months; length of prosthesis use time was 24.8 ± 13.4 and 23.9 ± 15.12 months, respectively. Social adjustment and adjustment to limitation subscales had significantly higher scores in LL amputees (p < 0.001). There was statistically significant difference between mean HADS depression and anxiety scores (p < 0.001). Mean total ABIS-R score indicated significantly greater body image disturbance for UL amputees (p < 0.001).
  
  
  CONCLUSIONS
  Well-adjusted LL prosthesis probably has better cosmetic appearance compared to that of UL prosthesis and perception of cosmetic appearance may be the key factor that leads to increased levels of body image anxiety and social discomfort.
  
  
  METHODS
  Epidemiologic and prognostic study, level III.
authors.affiliation: Üsküdar State Hospital, Istanbul, Turkey.
authors.forename: E E
authors.initials: EE
authors.lastname: Desteli
authors.affiliation: Üsküdar State Hospital, Istanbul, Turkey. yunusimren@yahoo.com.
authors.forename: Y
authors.initials: Y
authors.lastname: İmren
authors.affiliation: Ondokuzmayis University Hospital, Samsun, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Erdoğan
authors.affiliation: Ondokuzmayis University Hospital, Samsun, Turkey.
authors.forename: G
authors.initials: G
authors.lastname: Sarısoy
authors.affiliation: Ondokuzmayis University Hospital, Samsun, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Coşgun
keywords: Amputee; Lower limb; Prosthesis; Psychosocial adjustment; Upper limb
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