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The Glasgow Amputee
Population: pre, peri
and post- amputation
Fiona Davie-Smith
PhD Student & Physiotherapist
Sir George Alberti Fellowship, Diabetes UK
Plan For Today
PhD project overview
Greater Glasgow & Clyde
Recruitment
Medical note review
Pre-amputation data
Peri-amputation data
Post -amputation data
SIMD
Qualitative Interviews
PhD Study
Design
Mixed methods, prospective longitudinal study
• Work Programmes
1. Describe the population prospectively
2. Review them at 6, 12 & 18 months post-op
3. Outcome measures at 6 month intervals
4. 15 Face to face interviews: maximum variation
sample of QOL scores from EQ-5D
5. Survey of physiotherapists in UK and indication of
how they decide upon prosthetic referrals
Prospective Cohort
Prospectively collected data of all non-traumatic
major amputations in NHS Greater Glasgow &
Clyde between March 1st 2014 and 28th February
2015
Established and primary amputees
All have a repeat medical case note review at 6,
12 & 18 months
Those who consent will have additional data:
outcome measures at 6, 12 & 18 months
Face to Face Interviews with 15 of this cohort
Recruitment
Included Major Amputations
Diabetes
PAD
Excluded <18 years old
Hip disarticulation
Trans-pelvectomy
Orthopaedic Complications
Tumour
Trauma
Congenital Abnormality
0
5
10
15
20
25
30
Original
Cohort
6 month
Follow Up
Pre-amputationVariable Number Percentage
Male 128 75%
Female 43 25%
Age 65.9 years
Diabetes 91 53%
Living Alone 65 38%
Retired 118 69%
Working 11 6.5%
LTS, Unemployed 42 24.5%
Social Housing 83 49%
Smoking (current) 83 49%
Limb Salvaging Surgery
Variable Number Percentage
Imaging 145 85%
Surgery < 12 months pre-amputation 57%
Angioplasty 27 27%
Bypass 29 30%
Minor Amputation 16 16%
Embolectomy/
Endarterectomy
13 13%
Bypass & Minor
amp
4 4%
Peri-amputationVariable Number Percentage
Primary amputee 143 84%
Established amputee 28 17%
Trans-tibial 106 62%
Through knee 4 2%
Trans-femoral 62 37%
Bilateral 36 21%
Reason for amputation
Ischaemia 89 52%
Infection 24 14%
Both 58 34%
Points To Note
Ideally more TT than TF
The National ratio in Scotland is 1.2:1
TT: TF
This cohort is 1.5:1 TT:TF
It is 0.8:1 in those without diabetes
3.8: 1 in those with diabetes
Post-amputation
Variable Number Percentage
30 day mortality 9 6%
Revision to same level 6 3.5%
Trans-Femoral Level 19 18%
Falls as I/P 12 7%
Length of stay 39.2days
Intention to limb fit 101 66.5%
Discharge Location
Housebound 38 24%
Single room living 82 51%
Face to Face Interviews:
To explore the factors which influence quality of life since
amputation and examine the motivations and barriers to
rehabilitation
Maximum Variation Sample by Quality of Life
Interview Schedule
Life comparison from before to after
amputation
Mobility/Function
Self-Image
Social Support
Co-morbidities
Life comparison
Q. How does your life compare now to before the
amputation?
I’m not the same person that I was. I know that.
I’ve changed. I wouldn’t walk into a crowd
anymore. I wouldn’t walk into a pub without
support. There are a lot of things I wouldn’t do. I
wouldn’t go dancing anymore or clubbing, as
they say now. I think you’re very much aware of
yourself…you can’t see my disability but I need
to make you aware that I’m not one of you
anymore…Male, TTA, Limb fitted, SIMD=5
Mobility/Function
Q. What made you want to walk again?
…I just had to walk, I had to do it. I have got six grandchildren and they are really very, very important to me. In a way I had to be able to do a lot of the things with them. I was very active with them before. That was one big thing I would say motivated me to interact with them, not in the same way quite as I did before in terms of running around and everything……
Self Perception
Q. How do you feel now since the amputation ?
...I mean I’m 54 and I don’t want to be a burden on anybody…..you’re not the same as everybody else who has a pair of legs, you just can’t jump out to the pub or the shops, you have to wheel yourself down and you’re just different , just very different….you just don’t want people staring at you, you really don’t want that at all…you’re just different..
Male, TTA & TFA, Limb fitted, SIMD=1
Social Support
Q. Was there any support when you came home?
Just herself…..I didn’t want people in my house, it’s so annoying even when you’re out and folk come up to you and I am like leave us alone, I hate it, even with the Mrs I am like I know what I want, I know how to do it, I’m not a cripple…
Male, TFA, Limb fitted, SIMD=2
Co-Morbidities
Q. How do you feel about your health just now?
It’s a concern but I don’t think about my health that much because after my heart operation we basically came to the conclusion that I was a dead man walking because of my diabetes so I’ve tried to put myself out there as much as I possibly can because I know that my days are …..
Male, TTA, Limb Fitted, SIMD=4
Emerging Themes
Pain
Isolation
Weight Gain
Disability Complex
Prosthesis Issues
Change in Attitudes
Emotional Journey
Acceptance
Conclusion
Majority of patients in GG&C are white males ~65 years old
Social deprivation is high & most were not independently mobile pre-amputation
Unable to assume what their QOL will be like
QOL is a complex construct
… I’m still the same clown I always was, I still go to parties and do the dancing just so long as they don’t do the hokey cokey (laughs)…..
Friday 10th June 2016
‘NOT THE LAST LEG’ Optimizing re-integration and care after amputation
Glasgow, Scotland
2nd conference presented by
Scottish Physiotherapy Amputee Rehab Group
knowledge.scot.nhs.uk/sparg
please check website for registration details and updated info
Topics include:
Co-morbidities
Quality of Life
Dementia Strategies
Type 2 Diabetes
Sleep Disorders
Body Image
Community Sport
Wheatley House 25 Cochrane Street
Glasgow G1 1HL
Early Bird Rate £65
before 30/04/16 Standard Rate £85 Inc. lunch & refreshments
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