Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review

Abstract

Purpose

To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA).

Methods

A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis.

Results

One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations.

Conclusion

Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.

Implications for rehabilitation

• Sex and gender are important constructs that influence outcomes following lower limb amputation.

• Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.

Keywords:

• Quality of life
• sex
• gender identity
• amputation
• review

Acknowledgements

The authors would like to acknowledge Erica Nekolaichuk, faculty liaison and librarian with the University of Toronto for her assistance with developing the search strategy used in this review. We would also like to acknowledge the Canadian Institutes for Health Research for providing funding for this project. Dr. Guilcher is supported by a Canadian Institutes of Health Research Embedded Clinician Scientist Salary Award on Transitions in Care working with Ontario Health (Quality; formerly Health Quality Ontario).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project is part of Ms. Stephanie Cimino's requirements for the completion of her PhD, which is being funded by the Canadian Institutes of Health Research (Grant #: 162125).