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

IRH

RAHSGH

WIG

GGH

GRI

Vic

Medical Note Review

Clinical Portal

Paper Medical Notes

Local Databases

ReTis

SPARG

Patient

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%

Scottish Index of Multiple

Deprivation

0

10

20

30

40

50

60

1 2 3 4 5

No

. o

f LE

A

SIMD

<70

>70

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