Health-Related Quality of Life and Psychological Impact on Patients Post-Amputation Due to Diabetic Foot Ulcer

Diabetic foot ulcers (DFUs) are a serious complication of diabetes mellitus and the leading cause of non-traumatic lower limb amputation (LLA). Such amputations can profoundly impact patients' health-related quality of life (HRQoL) and psychological well-being. Understanding the factors that affect HRQoL and psychological well-being is crucial for developing targeted interventions to improve patient outcomes. Despite the significant burden of DFUs and their complications, which may lead to LLA, research on the HRQoL and psychological well-being of patients following LLA remains limited in the Kingdom of Saudi Arabia. This study aimed to address this gap by assessing HRQoL and psychological distress among patients who had undergone LLA due to DFU complications.

This retrospective, cross-sectional study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients who had undergone LLA due to DFU complications between 2012 and 2023, with a minimum post-amputation period of one year, were enrolled. Data collection involved a structured telephone interview, during which informed consent was obtained from all patients, and demographic and clinical information was recorded. We administered the "Short Form-36" (SF-36) and the "Hospital Anxiety and Depression Scale" (HADS) to assess the patients' HRQoL and psychological distress status.

This study included 51 patients who had undergone DFU-related LLA (median age 63.0 years; 74.5% men). The highest SF-36 scores were observed in the "social functioning," "role limitations due to emotional problems," and "pain" domains, while the lowest scores were in the "role limitations due to physical health," "physical functioning," and "energy/fatigue" domains. Depression and anxiety were common, affecting 25.5% and 23.5% of patients, respectively. Regression analyses showed that a higher income, being married, and independent mobility were associated with better HRQoL, whereas major amputation, cardiovascular disease, neuropathy, depression, and anxiety were associated with poorer outcomes.

Patients who had undergone LLA due to DFUs showed relatively preserved HRQoL in the "social functioning," "role limitations due to emotional problems," and "pain" domains, while the "role limitations due to physical health," "physical functioning," and "energy/fatigue" domains were more impaired. Depression and anxiety were common and were associated with poorer outcomes, whereas higher income, being married, and independent mobility were associated with better HRQoL. These findings may indicate a possible role for mental health screening and supportive interventions in addressing physical and psychosocial limitations in this population. Further research is needed to develop amputation-specific instruments that better capture patient-reported outcomes and to evaluate rehabilitation and psychosocial support strategies; larger, prospective studies are needed to further evaluate these relationships and confirm these findings.