Exercise as it relates to Disease/Physical activity involvement in lower limb amputee populations

What is the background to this research?
There are many forms of disabilities, a key contributor to permanent disability are those who live with amputations (1). Individuals living with amputations often further into having struggles with anxiety, isolation and depression (1). Many know the benefits of physical activity (PA) such as increasing longevity of life and promotes psychological wellbeing; equivalent to those with amputations can benefit similarly to those without an amputation (1).

In Scotland, 82.9% of those who live an amputee is due to peripheral vascular disease, 38.6% undergo an amputation due to diabetes (1). Average age of amputation in Scotland with an Average of 80% over the age of 60 and 20% over the age of 80 (1). Those who attended Sub-regional English Limb Center, 50.5% were trans-tibial amputation, 49.5% of amputations where due to vascular diabetic cases (1). The demographics presented represent a perspective how PA may be projected. Pell et al. stated that physical mobility inability was the significant factor that affected quality of life measured by the Nottingham Health Profile, compared to non-amputee individuals (1). According to the demographics presented, creating personalised activity programs could reduce metabolic diseases such as diabetes, diminishing the cause of diabetes (1).

The aim of the study is to determine a relationship between quality of life and the restriction of PA activity in lower-limb amputation individuals (1).

Where is the Research from?
Sarah A. Deans, Angus K. McFadyen, & Philip J. Rowe from the University of Strathclyde, Glasgow, UK, and Glasgow Caledonian University, Glasgow, UK. This article was first published online on January 1, 2008, than later published on June 1, 2008.

The corresponding author for the article was Sarah A. Deans, who is based in: The National Centre for Prosthetics & Orthotics, University of Strathclyde.

Participants for the study were gathered from West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital Trust, Glasgow, UK, for prosthetic care (1).

What Kind of Research was This?
The research is a [crosshttps://en.wikipedia.org/wiki/Cross-sectional_data|cross-sectional], mixed-methodology study of a group of lower-limb amputees (1). A cross-sectional design was selected to compare prevalence and scores between amputee and non-amputee individuals (1). A mixed-methodology design was chosen to compare both qualitative and quantitative data (prevalence and scores) (1).

What Did the Research Involve?
75 participants were selected who were both adult men and women who trans-tibial or trans-femoral lower-limb amputation and who were fitted and ambulatory with a prosthesis (1). There was no upper age limit however there was a lower age limit of 18 years. Participants for the study were gathered from West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital Trust, Glasgow, UK, for prosthetic care (1). The selected sample consisted of individuals who lost their limb due to peripheral vascular disease (with/without accompanying diabetes), in order to create a similar physical-stamina levels (1).

In order to measure PA a section from the Trinity Amputation and Prosthesis Experience Scales (TAPES); Activity Restriction section, where the limitation of PA became prominent (1). This allowed for the range of activities to be covered whilst excluding those that weren’t relevant (1).

Three subcategories that were selected from the Activity Restriction were i. Athletic, ii. Functional and iii. Social (1).

i.	Activities that involve more dynamic physical effort; ie. sport and recreation.

ii. Simple functional activities such as climbing up stairs.

iii. Social activities such as visiting friends and/or working on hobbies.

In order to measure Quality of Life (QOL), the World Health Organization (WHO) Quality-of-Life Scale (WHOQOL-Bref) self-administration questionnaire was used (1). The goal of the questionnaire, is to identify the individual’s perception on their QOL (1). Four categories were analysed in the WHOQOL-Bref; physical health, psychological health, social relationships and environment (1).

Results from both the Activity Restriction TAPES and the WHOQOL-Bref were collected and analysed using descriptive statistics (1). Summary statics were also gathered (mean, standard deviation), subscales and domains were analysed using Spearman’s Rank correlation.

What Were the Basic Results?
A return rate of 33% occurred with the questionnaires (25 of the 75 participants), Table 1 outlies the samples profiles (1).

Table 2 presents the summary statistics, for the TAPES subscales, the highest mean score was achieved on the Athletic subscale (7.24, SD = 0.88) and the lowest on the Social subscale (3.44, SD = 2.50). For the WHOQOL-Bref, the lowest mean score was achieved in the Physical domain of (56.32, SD = 18.70), and highest in the Environmental domain (72.20, SD = 15.19) (1).

Table 3 represents the relationship between both the TAPES subscales and WHOQOL-Bref domains. The negative sign on all correlations reflects that a higher score on a TAPES subscale indicates more restriction, hence less PA, whilst a higher score in a WHOQOL-Bref domain indicates a better perception on quality of life (1). A large negative correlation between PA and perceived QOL, therefore it demonstrates a strong positive relationship (1).



What Conclusions Can We Take from This Research?
Core data suggests that older individuals who are less active seek to comfort, gain confidence and priorities social situations such as relationships rather than level of physical functioning (1). Findings highlight a weaker-than-expected relationship between PA and QOL, potentially due to rehabilitation post-operative (1). Post-operative physiotherapy, individuals may only receive one-on-one gait training or prosthetic therapy (1). Without positive one-on-one reinforcement, important PA information is missed. However, group/social rehabilitation may counteract, as amputee individuals, seeking guidance through others experiences (1). The study confidently states that amputee individuals rely on social support, PA increases so long as social relationships do not compromise (1).

Practical Advice
Through the physiotherapy component, during rehabilitation, implementation of PA programs, promotes patient adherence, especially in early stages (1). Promotion in early stages allows the amputee individual to identify an activity which they enjoy, at an intensity which is appropriate to induce psychological effects (1). Creating positive situations for amputee individuals, such as positive reinforcing teams can escalate amputee individual’s comfort and confidence (1). Constructing such scenarios for these individuals can be valuable to recovery, and adjustment to social life, profound social situation, allows for better PA execution. Further Information/Resources

Further information/resources
https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

https://apps.who.int/iris/handle/10665/40268