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Abstract
Purpose: To determine the impact of pain in the vertebral column on the activities of daily living (ADL) level of war victims with bilateral lower limb amputation. Method: All the war-related bilateral lower limb amputees were invited. More than half of them (n = 335) participated and underwent a thorough assessment after giving informed consent. Results: The majority of the participants were male (97.6%). Their mean age was 42 years and 97.6% of them were married. The most common causes of injury leading to amputation were shells of artillery and mortar (56.7%). The most common level of amputation was bilateral transtibial (37.6%) and 64% were wearing the prosthesis of both sides. The most ADL dependency were transfer activities (27.8%) and bathing (23.3%) and the most independent functioning was eating (97.6%). Upper cervical vertebral pain was associated with dependency in the bowel and bladder management and dressing (p < 0.03 and p < 0.04, respectively). Pain in the lower cervical vertebrae was associated with dependency in toileting and dressing (p < 0.01 and p < 0.01, respectively). There were significant relationships between pain in the thoracic vertebrae and dependency in bathing, transfer activities and toileting (p < 0.02, p < 0.003 and p < 0.03, respectively). Pain in the lumbosacral region had a relationship with the level of amputation, transfer activities and toileting (p < 0.006, p < 0.03 and p < 0.05, respectively). Conclusions: Vertebral pain in bilateral lower limb amputees, especially lumbosacral pain, was accompanied with higher dependency in ADL. Therefore, a multidisciplinary approach to the management of pain is required to minimize disability and maximize functioning.
Implications for Rehabilitation
As common as back pain in the general population, some studies have found that people with lower limb amputation are at even greater risk of back pain and interference with their lifestyle.
The results of this study suggest that after bilateral lower extremity amputations, some patients experience various kinds of pain in the spinal column, which may affect their activities of daily living.
A multidisciplinary approach to the management of pain is necessary to minimize disability and maximize functioning in these patients.
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Acknowledgements
We thank Dr. N. Shokrpour for the help in preparation of the manuscript, and the patients and staff for taking part in the study.
Declaration of interest: This study was part of a research that was funded by the Janbazan Medical and Engineering Research Center (JMERC).