Multidimensional Factors Affecting Functional Outcomes After Amputation

For persons with amputations and for their healthcare providers, it is of critical importance to have a strong understanding of the multitude of factors that associate with positive functional outcomes. An understanding of these factors is necessary for optimal determination of prognosis, custom tailoring of interventions and resources provided, and overall improvement of quality of life. Additionally, an understanding of these factors aids both the developers and prescribers of prosthetic devices. Using the Oxford Level of Evidence Based Medicine, a systematic review was done in order to identify these factors. The study was limited to single, lower‐limb amputations between the levels of transpelvis and ankle mortis that resulted from combat‐associated trauma from either the Vietnam War or Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF). From this literature, the emerging factors were identified and organized according to frequency of mention in the literature, degree, and relation to functional status. The most prominent factors discovered were psychological disorder, amputation level, cardiovascular comorbidities, soft tissue and/or systemic infection, residual limb pain, metabolic comorbidities, age, health of the intact leg, and phantom limb pain. Other factors discovered included Special Forces designation, low back pain, time of amputation, increased debridement at the time of amputation, sex, marriage status, skin condition on the residual limb, respiratory comorbidities, physical fitness, timing of amputation, and amputation secondary to salvage attempt. It is our hope that a better understanding of these factors will promote improved functional outcomes for persons with amputations.