How ‘preventable’ are lower extremity amputations? A qualitative study of patient perceptions of precipitating factors

Abstract

Purpose: Clinicians commonly believe that lower extremity amputations are potentially preventable with coordinated care and motivated patient self-management. We used in-depth interviews with recent amputees to assess how patients viewed their initial amputation risk and causes. Method: We interviewed 22 patients at a rehabilitation hospital 2–6 weeks after an incident amputation. We focused on patients’ representations of amputation cause and methods of coping with prior foot and leg symptoms. Results: Patients reported unexpected onset and rapid progression of ulceration, infection, progressive vascular disease, foot trauma and complications of comorbid illness as precipitating events. Fateful delays of care were common. Many had long histories of painful prior treatments. A fatalistic approach to self-management, difficulties with access and communication with providers and poor understanding of medical conditions were common themes. Few patients seemed aware of the role of smoking as an amputation risk factor. Conclusions: Most patients felt out of control and had a poor understanding of the events leading to their initial amputations. Prevention of subsequent amputations will require rehabilitation programs to address low health literacy and psychosocial obstacles to self-management.

Implications for Rehabilitation

• Among amputees, pre-amputation perceptions of decisional and informational control are known to affect rehabilitation and disability adjustment prospects.

• Our findings on patient perceptions of their experiences with an initial lower extremity amputation are salient to rehabilitation specialists working with amputees to avoid a proximal or contralateral amputation.

Keywords::

• Diabetes
• peripheral vascular disease
• self-management

Acknowledgements

We thank Northwestern medical students Eitan Barbalat, Katherine Carlin and Guanning Lu for their research assistance and transcription services.

Declaration of Interest: This work was supported by the Northwestern Memorial Foundation Collaborative Development Initiative, Center for Limb Preservation, Bluhm Cardiovascular Institute, Chicago, Illinois, USA.