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Patient-reported Outcome Measures following Traumatic Lower Extremity Amputation: A Systematic Review and
Abigail R Tirrell1, Kevin G Kim2, Waleed Rashid3
1Georgetown University School of Medicine, Washington, D.C.
Background:
Outcomes after traumatic major lower extremity amputation (MLEA) have focused on surgical complications, despite the life-altering impact on patients. With advances in the surgical management of MLEA, a heightened need for consistent reporting of patient-centered outcomes (PCO) remains. This meta-analysis assesses articles for the prevalence and methods of PCO reporting among traumatic MLEA studies.
Methods:
An electronic database search was completed using Ovid MEDLINE for studies published between 2000 and 2020. Studies were included that reported any outcome of traumatic MLEA. Weighted means of outcomes were calculated when data were available. The prevalence of PCO was assessed in the categories of physical function, quality of life (QOL), psychosocial, and pain. Trends in PCO reporting were analyzed using Pearson's chi-squared test and analysis of variance when appropriate.
Results:
In total, 7001 studies were screened, yielding 156 articles for inclusion. PCO were evaluated in 94 (60.3%) studies; 83 (53.2%) reported physical function and mobility outcomes, 33 (21.2%) reported QOL and satisfaction measures, 38 (24.4%) reported psychosocial data, and 43 (27.6%) reported pain outcomes. There was no change in prevalence of PCO reporting when comparing 5-year intervals between 2000 and 2020 (P = 0.557).
Conclusions:
Optimization of function and QOL following traumatic MLEA has become a cornerstone of surgical success; however, only 60% of studies report PCO, with no trend over the last two decades suggesting improvement. As healthcare progresses toward patient-centered care, this inconsistent means of reporting PCO calls for improved inclusion and standardization of instruments to assess function, QOL, and other patient-focused measures.
Insights
Patient-centered outcomes (PCO) are crucial after traumatic major lower extremity amputation (MLEA). However, reporting of PCO remains inconsistent, with no improvement observed over two decades.
Area of Science:
- Trauma Surgery
- Rehabilitation Medicine
- Health Outcomes Research
Background:
- Focus on surgical complications in traumatic major lower extremity amputation (MLEA) overlooks patient impact.
- Advances in MLEA surgery necessitate consistent reporting of patient-centered outcomes (PCO).
- This study evaluates PCO reporting prevalence and methods in traumatic MLEA literature.
Purpose of the Study:
- To assess the prevalence of patient-centered outcome reporting in traumatic major lower extremity amputation studies.
- To analyze the methods used for reporting PCO in this patient population.
- To identify trends in PCO reporting over time.
Main Methods:
- Systematic literature search of Ovid MEDLINE (2000-2020).
- Inclusion criteria: studies reporting any outcome of traumatic MLEA.
- Assessment of PCO prevalence across physical function, quality of life (QOL), psychosocial, and pain domains.
Main Results:
- 156 studies included from 7001 screened.
- PCO reported in 60.3% of studies.
- Physical function (53.2%) and pain (27.6%) were most frequently reported PCO; QOL (21.2%) and psychosocial (24.4%) were less common.
Conclusions:
- Despite the importance of function and QOL, only 60% of studies report PCO.
- No significant trend in PCO reporting was observed between 2000 and 2020.
- Standardized PCO assessment is needed to align with patient-centered care goals.
