Quality of Life and Determinants of Ambulation after Major Lower Extremity Amputation at Addis Ababa Burn, Emergency, and Trauma Hospital, Ethiopia: a retrospective study

Quality of Life and Determinants of Ambulation after Major Lower Extremity Amputation at Addis Ababa Burn, Emergency, and Trauma Hospital, Ethiopia: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality of Life and Determinants of Ambulation after Major Lower Extremity Amputation at Addis Ababa Burn, Emergency, and Trauma Hospital, Ethiopia: a retrospective study Tariku Beriso, Kajela Abu, Samuel Kebede, Beza Giref, Tilahun Desta, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5965104/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Major lower extremity amputation (MLEA) is a life-altering surgical procedure commonly performed due to trauma, peripheral arterial disease (PAD), diabetic foot ulcers, or other pathologies. This procedure has profound physical, psychological, and socioeconomic consequences, significantly affecting patients' quality of life and functional independence. Access to prosthetic care and rehabilitation services, which is crucial for improved outcomes, is often limited, especially in resource-limited settings such as Ethiopia. This study aimed to assess the quality of life and determinants of ambulation status after MLEA at Addis Ababa Burn, Emergency, and Trauma Hospital (AaBET), Ethiopia. Methods A retrospective cross-sectional analysis was conducted on 89 patients who underwent MLEA at AaBET Hospital between January 2017 and June 2022. Data on sociodemographic characteristics, comorbidities, amputation level, preoperative ambulation, and postamputation functional status were collected. Quality of life (QoL) was measured via the EQ-5D-5L and EQ-VAS tools. Statistical analysis, including univariate and multivariate binary logistic regression, was performed to identify factors influencing ambulation status postamputation. Results Trauma was the leading cause of MLEA (57.3%), followed by peripheral arterial disease (22.7%) and infections (11.2%). Postamputation ambulation was achieved in 76.4% of patients, with 39.3% using prostheses, 28.1% using crutches, and 9% using both. The remaining 23.6% were nonambulatory. The mean EQ-5D-5L index score was 0.81 (SD 0.17), and the mean EQ-VAS score was 69.38 (SD 13.66). Factors significantly associated with ambulation included age, preoperative ambulation status, bilateral amputation, and the presence of comorbidities. Ambulatory patients had significantly better QoL scores than non-ambulatory patients did. Conclusion This study highlights the impact of trauma as the primary cause of MLEA in Ethiopia. Preoperative ambulation status, age, bilateral amputation, and comorbidities were identified as key determinants of functional outcomes. These findings suggest that addressing comorbidities and improving trauma care is critical for enhancing postamputation mobility and QoL in low-income settings. Orthopedic Surgery Orthopedics Physical Medicine & Rehab Vascular Medicine Sports Medicine and Kinesiology Major lower extremity amputations Quality of life Prosthesis Trans-tibial amputation Trans-femoral amputation EQ-5D-5L EQ-VAS Introduction Major lower extremity amputation (MLEA) is a life-altering surgical procedure that is often performed as a last resort to save lives, alleviate pain, or prevent the spread of disease. It is associated with significant physical, psychological, and socioeconomic consequences, profoundly impacting patients' quality of life (QoL) and functional independence. These procedures are often performed as a result of peripheral arterial disease (PAD), diabetic foot ulcers, trauma, infections, or other pathological conditions that compromise the functionality of the lower limbs [1–3]. Major lower extremity amputations (MLEAs) are particularly debilitating and present considerable challenges in rehabilitation. The functional outcomes following MLEA are influenced by a variety of factors, including the level of amputation, preoperative ambulation status, comorbidities, and access to appropriate rehabilitative care [4–6]. The experiences of individuals who undergo these procedures in resource-limited settings, such as Ethiopia, have not been extensively explored, and there is a need for localized data to guide healthcare planning and intervention strategies. In Ethiopia, the prevalence of limb loss is increasing due to factors such as trauma, infections, and chronic diseases such as diabetes and peripheral arterial disease [7–9]. Trauma, often due to road traffic accidents and work-related injuries, is the leading cause of amputation, followed by vascular diseases and diabetic complications [7]. Although MLEAs are life-saving procedures that prevent further complications such as systemic infections or gangrene, they present long-term challenges in terms of rehabilitation and reintegration into society. The rehabilitation process following major limb loss involves various stages, including wound healing, prosthetic fitting, physical therapy, and psychological adjustment. Successful rehabilitation depends heavily on early and effective intervention, including prosthetic rehabilitation, which has been shown to improve functional outcomes, mobility, and quality of life [1,10,11]. However, the availability of prosthetic devices and trained professionals remains limited in many low-resource settings, which can significantly hinder the rehabilitation process. Functional outcomes after MLEA, particularly the ability to ambulate and regain independence, are essential for patients' overall well-being and quality of life. Previous studies have demonstrated that a combination of factors, such as the level of amputation, preoperative ambulation status, comorbidities, smoking status, and social support, influence the likelihood of successful rehabilitation [3,4,6,12]. Age, bilateral amputations, and the presence of comorbidities such as diabetes, hypertension, and peripheral arterial disease are particularly associated with poorer functional outcomes [2,5,12]. Despite the growing body of literature on MLEA, there is a paucity of data from low and middle income countries (LMICs), particularly in sub-Saharan Africa, where the burden of trauma and limited healthcare resources pose unique challenges. Understanding the functional outcomes and factors associated with MLEA in these settings is essential for developing targeted interventions to improve patient outcomes and reduce the socioeconomic impact of limb loss. This study aims to address this gap by examining the functional outcomes and associated factors in patients undergoing MLEA at Addis Ababa Burn, Emergency, and Trauma Hospital (AaBET), Ethiopia. By analyzing patient characteristics, ambulation status, QoL, and factors influencing ambulation, this study provides valuable insights into the challenges and opportunities for improving postamputation care in resource-limited settings. The findings contribute to the global discourse on MLEA outcomes and inform the development of context-specific strategies to enhance functional independence and QoL for amputees in LMICs. Methods and materials Study Area The study was conducted at AaBET Hospital, a branch of Saint Paul’s Hospital Millennium Medical College, which is a major tertiary hospital located in Addis Ababa, Ethiopia. The hospital provides orthopedics, trauma, neurosurgery, burn, emergency, and critical care services and has a total of 145 beds, 4 OR tables, and 2 recovery rooms. Study Design This study is a retrospective cross-sectional analysis of on major lower extremity amputations conducted at AaBET Hospital from January 1st, 2017 to June 30th, 2022. Patients aged greater than or equal to eighteen years and those with a duration of 1 year or more after amputation were included in the study. The aims of this study are to assess quality of life, to dtermine ambulation rate and to assess factors affecting ambulation status after MLEAs. Deceased patients and patients unable to be reach with repeated calling were excluded from the study. Quality of life was assessed via the EQ-5D-5L and EQ-VAS. The EQ-5D-5L is a standardized measure of health status developed by the EuroQol Group to provide a simple, generic measure of health for clinical and economic appraisal. The EQ-5D-5L comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). However, each dimension has 5 levels of severity: no problems, slight problems, moderate problems, severe problems, and extreme problems. The EQ-VAS records the respondent’s self-rated health on vertical a visual analog scale that takes values between 100 (best imaginable health) and 0 (worst imaginable health), on which patients provide a global assessment of their health. Statistical analysis After the data were collected, the coded data were entered into SPSS Version 26 for analysis. Descriptive statistics are presented frequencies, percentages, tables, and text on rhw basis of the nature of the data. The Means, medians and standard deviations were used to describe continuous variables. The Mann-Whitiney U test was used to compare the medians of the EQ-5D-5L and EQ-VAS scores between ambulatory and nonambulatory patients. Univariate and multivariate analysis was performed via binary logistic regression and were used to determine the relationships between ambulation status and determining factors. A P-Value < 0.05 was considered to indicate statistical significance and the odds ratio was used at a 95% confidence interval to estimate the precision and strength of associations. Results Patient characteristics Between January 1st, 2017 and June 30th, 2022 there were 89 patients (97 MLEAs) who underwent MLEAs and were included in the study. The mean and median ages of the patients were 38.27 years and 31 years, respectively, with ages ranging from 19–70 years. Among these, 51.7% were below knee amputations and 39.3% were above knee amputations. Bilateral amputation was performed for 8 patients (9%). A total of 68.5% of patients had associated comorbidities and the most common indication for major lower extremity amputation was trauma acounting for 57.3% followed by peripheral arterial disease 22.7%. Table 1 details Table 1 Sociodemographic and clinical characteristics of patients Variables Categories Frequency(n) Percent (%) Sex Male Female 74 83.1 15 16.9 Marital Status Married 46 51.7 Single 39 43.8 Divorced 1 1.1 Widowed 3 3.4 Family Support Yes 82 92.1 No 7 7.9 Amputation level Unilateral BKA 46 51.7 Unilateral AKA 35 39.3 Bilateral 8 9.0 Preoperative ambulation status Yes 74 83.1 No 15 16.9 Comorbidity DM 7 7.9 HTN 6 6.7 CKD 3 3.4 Cardiac illness 1 1.1 ≥ 2 comorbidities 11 12.4 No 61 68.5 Alcohol use Yes 37 41.6 No 52 58.4 Smoking Yes 10 11.2 No 79 88.2 Causes of amputation Trauma 51 57.3 PAD 17 19.1 Diabetic foot ulcer 8 9 Infection 10 11.2 Tumor 3 3.4 AKA- Above Knee Amputation, BKA- Below Knee Amputation, PAD- Peripheral Arterial Disease Functional Outcome The postamputation ambulatory status rate was 76.4% with the most common mode of ambulation being prosthesis accounting for 39.3% (n = 35) followed by crutches, accounting for 28.1% (n = 25) and both prostheses and crutches accounting for 9% (n = 8). The remaining 23.6% of patients were nonambulatory. The minimum value of EQ 5D-5L index is 0.40, and the maximum value is 0.99, with a mean value of 0.81(SD 0.17), and a median score of 0.88. The EQ-VAS score ranged from 30 to 95, with a mean score of 69.38(SD 13.66) and a median score of 75. Ambulatory patients had significantly higher EQ 5D-5L and EQ-VAS scores than nonambulatory patients did. Those who ambulated only with a prosthesis had significantly better EQ 5D-5L and EQ-VAS scores than those who ambulated with crutches. See Table 2 . Table 2 Comparative study of EQ 5D-5L and EQ-VAS scores between ambulatory and nonambulatory patients. Non ambulatory N = 21 Ambulatory N = 68 P-value(Mann-Whitney U test) EQ 5D-5L Median 0.53 (iqr = 0.22) Median 0.91 (iqr = 0.11) < 0.001 With prosthesis With crutches Median 0.93 (iqr = 0.066) Median 0.84 (iqr = 0.17) 0.003 EQ-VAS Median 50 (iqr = 25) Median 75 (iqr = 12.25) < 0.001 With prosthesis With crutches Median 77.5 (iqr = 9.5) Median 70 (iqr = 10) 0.006 The factors affecting ambulatory status after amputation according to univariate binary logistic regression analysis were age, AKA, bilateral amputation, preoperative ambulatory status, comorbidities, family support and smoking. After adjusting for confounding factors via multivariate logistic regression only age, bilateral amputation, preoperative mobility and comorbidities were significantly associated with post-amputation ambulation. Details on Table 3 . Table 3 Univariate and multivariate binary logistic regression analysis of variable effect on ambulation Variable Ambulatory status Univariate multivariate Non-ambulatory(n = 21) Ambulatory (n = 68) Unadjusted OR (95% CI) P- value Adjusted OR (95% CI) P- value Age Mean 56.67 (SD 17) Mean 32.59 (SD 11.9) 1.11(1.06–1.16) < 0.001 1.16(1.04–1.29) 0.009 Family support Yes 17(80.95%) 65(95.59%) 5.09(1.04–24.98) 0.045 5.58(0.27–155.7) 0.266 No 4(19.05%) 3(4.41%) REF Amputation level BKA 6(28.57%) 40(58.82%) REF AKA 10(47.62%) 25(36.76%) 2.67 (0.86–8.25) 0.089 5.6(0.39–80.3) 0.202 Bilateral 5(23.81%) 3(4.4%) 11.11(2.09–58.96) 0.005 63.05(1.1-3643.9) 0.045 Preoperative ambulation Yes 10(47.62%) 64(94.12%) REF No 11(52.39%) 4(5.89%) 17.6(4.68–66.17) < 0.001 28.2(1.93–411.9) 0.015 Comorbidity Yes 18(85.71%) 10(14.71%) 34.8(8.6-140.3) < 0.001 14.49(1.34-157.34) 0.028 No 3(14.29%) 58(85.29%) REF Smoking Yes 5(23.81%) 5(7.35%) 3.94(1.02–15.27) 0.048 7.99(0.41–154) 0.169 No 16(76.19%) 63(92.65%) REF n- Number of patients, REF- reference, SD – Standard Deviation Discussion A study at AaBET Hospital reported that trauma (54.6%) was the leading cause of MLEA, followed by peripheral arterial disease (PAD) (22.7%) and infection (10.3%). This contrasts with studies from developed countries, where PAD and diabetes-related complications are the predominant causes of MLEA [2,3,5,13,14]. Similarly, Chopra et al. reported that PAD and diabetes were the leading causes of MLEA in the United States, with trauma accounting for a smaller proportion [2]. Prann et al reported 70% for sepsis, 24% for PAD and 4% for trauma [15]. The high prevalence of trauma-related amputations in Ethiopia may reflect the burden of road traffic accidents, occupational injuries in low-resource settings and extensive limb salvage surgeries after trauma which are not widely performed in developing nations. This aligns with findings from Benin [10], Nigeria [16], and a previous study in Ethiopia [7], where trauma was also a leading cause of MLEA. This study underscores the need for improved trauma care and preventive measures in low- and middle-income countries (LMICs). A recent study by Mengesha et al. in Hawassa, Ethiopia, further emphasized that preventable amputations are often linked to delayed access to healthcare and inadequate early interventions, highlighting the need for improved trauma care and preventive measures in LMICs [9]. The study reported a postamputation ambulation rate of 76.4%, with 38.2% of patients using prostheses, 29.2% using crutches, and 9% using both. The remaining 23.6% were nonambulatory. These findings are comparable to those of studies from other LMICs. Similarly, there was an increased rate of ambulation after the MLEA where trauma was the predominant cause. A systematic review by Tirrel et al, from an estimated 20 studies reporting ambulatory rates, revealed an average ambulatory rate of 90.97% [17]. Chigblo et al. reported that only 7% were non-ambulatory, with prosthetic use being the most common mode of ambulation [10]. Penn-Barwel et al reported that approximately 75% of individuals with traumatic transtibial amputation and 55% with transfemoral amputation could walk at least 500 m [18]. However, in PAD and diabetic foot dominant amputation studies, a lower ambulatory rate was recorded. Chopra et al. reported a 46.1% postamputation ambulatory rate [2] and Nehler et al. reported a 46% nonambulatory rate [19]. MacCallum et al. reported a 58.0% BKA and 25.2% AKA ambulatory rates at 6-month follow-up [3]. The use of the EQ-5D-5L value set for Ethiopians, developed by Welie et al., provided a culturally relevant and accurate measure of health-related QoL in this population, reinforcing the validity of the study's findings [27]. The mean EQ-5D-5L index value was 0.81 and the mean EQ-VAS score was 69.38 in the AaBET study which is higher than that reported in a study performed at a tertiary care institution in Trinidad and Tobago in which the cohort's average EQ-5D-5L index score was 0.598 and the mean EQ-VAS score was 64 [15]. This could be because the patients in this study were younger, with a mean age of 38.27 years, in contrast to a mean age of 63 years, and majority causes were trauma, however only 4% causes were trauma in their study. The study also revealed that ambulatory patients had significantly higher EQ-5D-5L and EQ-VAS scores than nonambulatory patients did, indicating better QoL. This finding is consistent with global findings. Pran et al. [15] and Sinha et al. [20] both highlighted that mobility is a critical determinant of QoL after MLEA. These findings underscore the importance of timely and effective prosthetic rehabilitation for enhancing functional recovery, as shown in a similar study by Fajardo-Martos et al. [11] Enweluzo et al. [25] and Patients who used prostheses had better QoL scores than those who used alternative devices did, emphasizing the importance of prosthetic rehabilitation which remains a key determinant of mobility and independence, as it facilitates a more natural gait pattern than crutches do. The study identified age, bilateral amputation, preoperative ambulatory status, and comorbidities as significant predictors of postamputation ambulation. These findings align with the global literature [3,5,6,12,24]. Similar findings were reported by Burger et al and found to be related to impairments and disabilities due to amputation [21]. MacCallum et al. [3] and Fajardo-Martis et al. [11] found that younger age and preoperative mobility were strong predictors of successful ambulation. Bilateral amputation was associated with poorer outcomes, as noted by Chopra et al. [2] and Pasquina et al. [13], who highlighted the increased physical and psychological challenges faced by bilateral amputees. The study also revealed that comorbidities significantly impacted ambulation, which is consistent with findings from Davie-Smith et al. [12], who reported that conditions such as diabetes and cardiovascular disease negatively affect rehabilitation outcomes. Mengesha et al. further highlighted that delayed access to healthcare and inadequate early interventions exacerbate the impact of comorbidities on postamputation outcomes [9]. Smoking, identified as a factor in univariate analysis, has also been linked to poorer outcomes in other studies, likely due to its impact on wound healing and vascular health [2,5,22]. Preoperative ambulation status was another critical factor; patients who were ambulatory prior to surgery had a significantly greater likelihood of regaining some form of mobility postamputation. This finding is consistent with the work of Chopra et al. [2], Damiani et al. [24] and Hijmans et al. [26], who reported that preoperative functional status is a strong predictor of postoperative mobility, as it reflects the patient’s baseline physical and psychological health. Additionally, having comorbidities, such as diabetes and hypertension, was strongly associated with poorer outcomes. Patients with comorbidities such as diabetes or vascular diseases often face complications such as poor wound healing, infections, and delayed prosthetic fitting, which hinder recovery and ambulation. This is supported by studies such as those of Rathnayake et al. [23] and Sinha et al. [20], who documented the negative impact of comorbidities on both quality of life and functional outcomes following amputation. The study also highlighted the role of family support in improving outcomes, with 92.1% of patients reporting family support. This aligns with findings from Davie-Smith et al. [12] and Chopra et al. [2], who emphasized the importance of social support in enhancing QoL and rehabilitation success in LMICs. The retrospective nature of the study, its small size, the inability to include some confounding factors such as biomass index, complications and specific comorbidities are some of the limitations of the study. Conclusion This study from AaBET Hospital provides critical insights into the functional outcomes and challenges faced by MLEA patients in Ethiopia. While the findings align with global trends in some areas, such as the importance of preoperative mobility and prosthetic use, they also highlight unique challenges in developing countries, including high trauma rates and limited access to rehabilitation services. Addressing these challenges requires a multifaceted approach, including improved trauma care, affordable prosthetics, and integrated rehabilitation programs. Postamputation ambulation rate was significantly influenced by preoperative ambulation status, age, comorbidities and bilateral amputation. These findings are consistent with those of similar studies from other regions, reinforcing the need for a comprehensive approach to amputation care that includes both medical and psychological support for optimal functional recovery. Future research should focus on longitudinal studies to assess long-term outcomes and the impact of targeted interventions in resource-limited settings. The use of culturally relevant tools such as the EQ-5D-5L value set for Ethiopians will further increase the accuracy and applicability of such studies. Abbreviations BKA Below Knee Amputation TKA Above Knee Amputation MLEAs Major Lower Extremity Amputations PAD Peripheral Arterial Disease LMICs Low and Middle Income Countries QoL Quality of Life Declarations Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Authors’ contributions TB and KA designed the study. TB, KA, and SK analyzed and interpreted the data. TB and KA drafted the manuscript. BG, TD and BL critically reviewed the manuscript. All authors read and approved the final manuscript. Acknowledgement We would like to thank St. Paul’s Hospital Millennium Medical College and the Department of Orthopedics and Trauma for preparing and cooperating on this study. We want to express our gratitude to everyone who helped with this research thesis along the way. Finally, we would like to thank those who participate and are willing to be involved in the study. Funding Funding for this study was obtained from St. Paul’s Hospital Millennium Medical College. The college had no role in the design of the study and collection, analysis, and interpretation of the data. Ethics declarations Ethic s approval and consent to participate An ethical clearance letter was obtained from the institutional ethical review board of Saint Paul’s Hospital Millennium Medical College Ref. No. pm23/612. A formal letter was issued to the Addis Ababa Burn, Emergency and Trauma (AaBET) Hospital requesting collaboration. The medical director at AaBET Hospital gave permission for the usage of patient records. Every case file was handled with confidentiality. 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Journal of the West African College of Surgeons 2023; 13(3): 71–76. https://doi.org/10.4103/jwas.jwas_28_23 Hijmans, J. M., Dekker, R., & Geertzen, J. H. B. Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes. Medical hypotheses 2020; 143: 110134. https://doi.org/10.1016/j.mehy.2020.110134 Welie, A. G., Gebretekle, G. B., Stolk, E., Mukuria, C., Krahn, M. D., Enquoselassie, F., & Fenta, T. G. Valuing Health State: An EQ-5D-5L Value Set for Ethiopians. Value in health regional issues 2020; 22: 7–14. https://doi.org/10.1016/j.vhri.2019.08.475 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5965104","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":411525180,"identity":"4d1f03d8-802c-41a1-a9d6-0c52fd0eb384","order_by":0,"name":"Tariku Beriso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYJACZiDmYeBvbP8hUQHiMjfgVc4D1yJxuEHC4gyIy0icFiBIb5CobAMxCGixZz/78HFBxT0Z+YaDDQY359VG87cDtfyo2IbbFp50Y+MZZ4p5DA43NiTO3HY8d8ZhxgbGnjO38TgsjU2aty2Bx4DhYMNhyW3HchuAWpgZ2/Bo4X/G/pv3XwKPfENiY/PfOcdy5xPUIpHGxszbkMDDcCCxmUGyoSZ3A0EtN54xS884BnTYjYNtDBLHDuRuBGo5iM8v7P1pjJ8LahLs5fvbnzFI1NTlzjt/+OCDHxW4taCDw2DyANHqgaCOFMWjYBSMglEwQgAAIkJZk6u/YxYAAAAASUVORK5CYII=","orcid":"","institution":"Jimma university","correspondingAuthor":true,"prefix":"","firstName":"Tariku","middleName":"","lastName":"Beriso","suffix":""},{"id":411525181,"identity":"c3f35054-3ff9-443a-8bfc-c6d21ea22d50","order_by":1,"name":"Kajela Abu","email":"","orcid":"","institution":"Jimma university","correspondingAuthor":false,"prefix":"","firstName":"Kajela","middleName":"","lastName":"Abu","suffix":""},{"id":411525182,"identity":"7ff25049-d265-4ffc-8382-31b452b5526b","order_by":2,"name":"Samuel Kebede","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Kebede","suffix":""},{"id":411525183,"identity":"a08aa8d7-acdd-4a61-a7f7-e17b2167d392","order_by":3,"name":"Beza Giref","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical college","correspondingAuthor":false,"prefix":"","firstName":"Beza","middleName":"","lastName":"Giref","suffix":""},{"id":411525184,"identity":"378cd636-b078-489b-804a-fba3301371a6","order_by":4,"name":"Tilahun Desta","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical college","correspondingAuthor":false,"prefix":"","firstName":"Tilahun","middleName":"","lastName":"Desta","suffix":""},{"id":411525185,"identity":"40ec87d9-d8a7-4f57-ad3d-72e1fe245b3d","order_by":5,"name":"Belay Leulseged","email":"","orcid":"","institution":"Saint Paul's Hospital Millennium Medical college","correspondingAuthor":false,"prefix":"","firstName":"Belay","middleName":"","lastName":"Leulseged","suffix":""}],"badges":[],"createdAt":"2025-02-05 11:07:10","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5965104/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5965104/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75583288,"identity":"a0352044-12ce-42f0-b55e-0d41926cc19f","added_by":"auto","created_at":"2025-02-06 06:06:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":762341,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5965104/v1/13278c1a-c624-442e-adc6-8ab6f6281f31.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eQuality of Life and Determinants of Ambulation after Major Lower Extremity Amputation at Addis Ababa Burn, Emergency, and Trauma Hospital, Ethiopia: a retrospective study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMajor lower extremity amputation (MLEA) is a life-altering surgical procedure that is often performed as a last resort to save lives, alleviate pain, or prevent the spread of disease. It is associated with significant physical, psychological, and socioeconomic consequences, profoundly impacting patients' quality of life (QoL) and functional independence. These procedures are often performed as a result of peripheral arterial disease (PAD), diabetic foot ulcers, trauma, infections, or other pathological conditions that compromise the functionality of the lower limbs [1\u0026ndash;3]. Major lower extremity amputations (MLEAs) are particularly debilitating and present considerable challenges in rehabilitation. The functional outcomes following MLEA are influenced by a variety of factors, including the level of amputation, preoperative ambulation status, comorbidities, and access to appropriate rehabilitative care [4\u0026ndash;6]. The experiences of individuals who undergo these procedures in resource-limited settings, such as Ethiopia, have not been extensively explored, and there is a need for localized data to guide healthcare planning and intervention strategies.\u003c/p\u003e \u003cp\u003eIn Ethiopia, the prevalence of limb loss is increasing due to factors such as trauma, infections, and chronic diseases such as diabetes and peripheral arterial disease [7\u0026ndash;9]. Trauma, often due to road traffic accidents and work-related injuries, is the leading cause of amputation, followed by vascular diseases and diabetic complications [7]. Although MLEAs are life-saving procedures that prevent further complications such as systemic infections or gangrene, they present long-term challenges in terms of rehabilitation and reintegration into society.\u003c/p\u003e \u003cp\u003eThe rehabilitation process following major limb loss involves various stages, including wound healing, prosthetic fitting, physical therapy, and psychological adjustment. Successful rehabilitation depends heavily on early and effective intervention, including prosthetic rehabilitation, which has been shown to improve functional outcomes, mobility, and quality of life [1,10,11]. However, the availability of prosthetic devices and trained professionals remains limited in many low-resource settings, which can significantly hinder the rehabilitation process.\u003c/p\u003e \u003cp\u003eFunctional outcomes after MLEA, particularly the ability to ambulate and regain independence, are essential for patients' overall well-being and quality of life. Previous studies have demonstrated that a combination of factors, such as the level of amputation, preoperative ambulation status, comorbidities, smoking status, and social support, influence the likelihood of successful rehabilitation [3,4,6,12]. Age, bilateral amputations, and the presence of comorbidities such as diabetes, hypertension, and peripheral arterial disease are particularly associated with poorer functional outcomes [2,5,12].\u003c/p\u003e \u003cp\u003eDespite the growing body of literature on MLEA, there is a paucity of data from low and middle income countries (LMICs), particularly in sub-Saharan Africa, where the burden of trauma and limited healthcare resources pose unique challenges. Understanding the functional outcomes and factors associated with MLEA in these settings is essential for developing targeted interventions to improve patient outcomes and reduce the socioeconomic impact of limb loss. This study aims to address this gap by examining the functional outcomes and associated factors in patients undergoing MLEA at Addis Ababa Burn, Emergency, and Trauma Hospital (AaBET), Ethiopia.\u003c/p\u003e \u003cp\u003eBy analyzing patient characteristics, ambulation status, QoL, and factors influencing ambulation, this study provides valuable insights into the challenges and opportunities for improving postamputation care in resource-limited settings. The findings contribute to the global discourse on MLEA outcomes and inform the development of context-specific strategies to enhance functional independence and QoL for amputees in LMICs.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eThe study was conducted at AaBET Hospital, a branch of Saint Paul\u0026rsquo;s Hospital Millennium Medical College, which is a major tertiary hospital located in Addis Ababa, Ethiopia. The hospital provides orthopedics, trauma, neurosurgery, burn, emergency, and critical care services and has a total of 145 beds, 4 OR tables, and 2 recovery rooms.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis study is a retrospective cross-sectional analysis of on major lower extremity amputations conducted at AaBET Hospital from January 1st, 2017 to June 30th, 2022. Patients aged greater than or equal to eighteen years and those with a duration of 1 year or more after amputation were included in the study. The aims of this study are to assess quality of life, to dtermine ambulation rate and to assess factors affecting ambulation status after MLEAs. Deceased patients and patients unable to be reach with repeated calling were excluded from the study. Quality of life was assessed via the EQ-5D-5L and EQ-VAS. The EQ-5D-5L is a standardized measure of health status developed by the EuroQol Group to provide a simple, generic measure of health for clinical and economic appraisal. The EQ-5D-5L comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). However, each dimension has 5 levels of severity: no problems, slight problems, moderate problems, severe problems, and extreme problems. The EQ-VAS records the respondent\u0026rsquo;s self-rated health on vertical a visual analog scale that takes values between 100 (best imaginable health) and 0 (worst imaginable health), on which patients provide a global assessment of their health.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eAfter the data were collected, the coded data were entered into SPSS Version 26 for analysis. Descriptive statistics are presented frequencies, percentages, tables, and text on rhw basis of the nature of the data. The Means, medians and standard deviations were used to describe continuous variables. The Mann-Whitiney U test was used to compare the medians of the EQ-5D-5L and EQ-VAS scores between ambulatory and nonambulatory patients. Univariate and multivariate analysis was performed via binary logistic regression and were used to determine the relationships between ambulation status and determining factors. A P-Value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance and the odds ratio was used at a 95% confidence interval to estimate the precision and strength of associations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eBetween January 1st, 2017 and June 30th, 2022 there were 89 patients (97 MLEAs) who underwent MLEAs and were included in the study. The mean and median ages of the patients were 38.27 years and 31 years, respectively, with ages ranging from 19\u0026ndash;70 years. Among these, 51.7% were below knee amputations and 39.3% were above knee amputations. Bilateral amputation was performed for 8 patients (9%). A total of 68.5% of patients had associated comorbidities and the most common indication for major lower extremity amputation was trauma acounting for 57.3% followed by peripheral arterial disease 22.7%. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e details\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and clinical characteristics of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAmputation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnilateral BKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnilateral AKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreoperative ambulation status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHTN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2 comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eCauses of amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetic foot ulcer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAKA- Above Knee Amputation, BKA- Below Knee Amputation, PAD- Peripheral Arterial Disease\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFunctional Outcome\u003c/h2\u003e \u003cp\u003eThe postamputation ambulatory status rate was 76.4% with the most common mode of ambulation being prosthesis accounting for 39.3% (n\u0026thinsp;=\u0026thinsp;35) followed by crutches, accounting for 28.1% (n\u0026thinsp;=\u0026thinsp;25) and both prostheses and crutches accounting for 9% (n\u0026thinsp;=\u0026thinsp;8). The remaining 23.6% of patients were nonambulatory.\u003c/p\u003e \u003cp\u003eThe minimum value of EQ 5D-5L index is 0.40, and the maximum value is 0.99, with a mean value of 0.81(SD 0.17), and a median score of 0.88. The EQ-VAS score ranged from 30 to 95, with a mean score of 69.38(SD 13.66) and a median score of 75.\u003c/p\u003e \u003cp\u003eAmbulatory patients had significantly higher EQ 5D-5L and EQ-VAS scores than nonambulatory patients did. Those who ambulated only with a prosthesis had significantly better EQ 5D-5L and EQ-VAS scores than those who ambulated with crutches. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative study of EQ 5D-5L and EQ-VAS scores between ambulatory and nonambulatory patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon ambulatory\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAmbulatory\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;68\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value(Mann-Whitney U test)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ 5D-5L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian 0.53 (iqr\u0026thinsp;=\u0026thinsp;0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMedian 0.91 (iqr\u0026thinsp;=\u0026thinsp;0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith prosthesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWith crutches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 0.93 (iqr\u0026thinsp;=\u0026thinsp;0.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian 0.84 (iqr\u0026thinsp;=\u0026thinsp;0.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEQ-VAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian 50 (iqr\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMedian 75 (iqr\u0026thinsp;=\u0026thinsp;12.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith prosthesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWith crutches\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedian 77.5 (iqr\u0026thinsp;=\u0026thinsp;9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian 70 (iqr\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe factors affecting ambulatory status after amputation according to univariate binary logistic regression analysis were age, AKA, bilateral amputation, preoperative ambulatory status, comorbidities, family support and smoking. After adjusting for confounding factors via multivariate logistic regression only age, bilateral amputation, preoperative mobility and comorbidities were significantly associated with post-amputation ambulation. Details on Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate binary logistic regression analysis of variable effect on ambulation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAmbulatory status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003emultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-ambulatory(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAmbulatory (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnadjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean 56.67 (SD 17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean 32.59 (SD 11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11(1.06\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.16(1.04\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFamily support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(80.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65(95.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.09(1.04\u0026ndash;24.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.58(0.27\u0026ndash;155.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(19.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(4.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAmputation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40(58.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25(36.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.67 (0.86\u0026ndash;8.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.6(0.39\u0026ndash;80.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.202\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilateral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(23.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.11(2.09\u0026ndash;58.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.05(1.1-3643.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePreoperative ambulation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(47.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64(94.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(52.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(5.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.6(4.68\u0026ndash;66.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.2(1.93\u0026ndash;411.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eComorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(85.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(14.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.8(8.6-140.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.49(1.34-157.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.028\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(14.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58(85.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(23.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(7.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.94(1.02\u0026ndash;15.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.99(0.41\u0026ndash;154)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(76.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(92.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eREF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003en- Number of patients, REF- reference, SD \u0026ndash; Standard Deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eA study at AaBET Hospital reported that trauma (54.6%) was the leading cause of MLEA, followed by peripheral arterial disease (PAD) (22.7%) and infection (10.3%). This contrasts with studies from developed countries, where PAD and diabetes-related complications are the predominant causes of MLEA [2,3,5,13,14]. Similarly, Chopra et al. reported that PAD and diabetes were the leading causes of MLEA in the United States, with trauma accounting for a smaller proportion [2]. Prann et al reported 70% for sepsis, 24% for PAD and 4% for trauma [15].\u003c/p\u003e \u003cp\u003eThe high prevalence of trauma-related amputations in Ethiopia may reflect the burden of road traffic accidents, occupational injuries in low-resource settings and extensive limb salvage surgeries after trauma which are not widely performed in developing nations. This aligns with findings from Benin [10], Nigeria [16], and a previous study in Ethiopia [7], where trauma was also a leading cause of MLEA. This study underscores the need for improved trauma care and preventive measures in low- and middle-income countries (LMICs). A recent study by Mengesha et al. in Hawassa, Ethiopia, further emphasized that preventable amputations are often linked to delayed access to healthcare and inadequate early interventions, highlighting the need for improved trauma care and preventive measures in LMICs [9].\u003c/p\u003e \u003cp\u003eThe study reported a postamputation ambulation rate of 76.4%, with 38.2% of patients using prostheses, 29.2% using crutches, and 9% using both. The remaining 23.6% were nonambulatory. These findings are comparable to those of studies from other LMICs. Similarly, there was an increased rate of ambulation after the MLEA where trauma was the predominant cause. A systematic review by Tirrel et al, from an estimated 20 studies reporting ambulatory rates, revealed an average ambulatory rate of 90.97% [17]. Chigblo et al. reported that only 7% were non-ambulatory, with prosthetic use being the most common mode of ambulation [10]. Penn-Barwel et al reported that approximately 75% of individuals with traumatic transtibial amputation and 55% with transfemoral amputation could walk at least 500 m [18]. However, in PAD and diabetic foot dominant amputation studies, a lower ambulatory rate was recorded. Chopra et al. reported a 46.1% postamputation ambulatory rate [2] and Nehler et al. reported a 46% nonambulatory rate [19]. MacCallum et al. reported a 58.0% BKA and 25.2% AKA ambulatory rates at 6-month follow-up [3].\u003c/p\u003e \u003cp\u003eThe use of the EQ-5D-5L value set for Ethiopians, developed by Welie et al., provided a culturally relevant and accurate measure of health-related QoL in this population, reinforcing the validity of the study's findings [27]. The mean EQ-5D-5L index value was 0.81 and the mean EQ-VAS score was 69.38 in the AaBET study which is higher than that reported in a study performed at a tertiary care institution in Trinidad and Tobago in which the cohort's average EQ-5D-5L index score was 0.598 and the mean EQ-VAS score was 64 [15]. This could be because the patients in this study were younger, with a mean age of 38.27 years, in contrast to a mean age of 63 years, and majority causes were trauma, however only 4% causes were trauma in their study.\u003c/p\u003e \u003cp\u003eThe study also revealed that ambulatory patients had significantly higher EQ-5D-5L and EQ-VAS scores than nonambulatory patients did, indicating better QoL. This finding is consistent with global findings. Pran et al. [15] and Sinha et al. [20] both highlighted that mobility is a critical determinant of QoL after MLEA. These findings underscore the importance of timely and effective prosthetic rehabilitation for enhancing functional recovery, as shown in a similar study by Fajardo-Martos et al. [11] Enweluzo et al. [25] and Patients who used prostheses had better QoL scores than those who used alternative devices did, emphasizing the importance of prosthetic rehabilitation which remains a key determinant of mobility and independence, as it facilitates a more natural gait pattern than crutches do.\u003c/p\u003e \u003cp\u003eThe study identified age, bilateral amputation, preoperative ambulatory status, and comorbidities as significant predictors of postamputation ambulation. These findings align with the global literature [3,5,6,12,24]. Similar findings were reported by Burger et al and found to be related to impairments and disabilities due to amputation [21]. MacCallum et al. [3] and Fajardo-Martis et al. [11] found that younger age and preoperative mobility were strong predictors of successful ambulation. Bilateral amputation was associated with poorer outcomes, as noted by Chopra et al. [2] and Pasquina et al. [13], who highlighted the increased physical and psychological challenges faced by bilateral amputees.\u003c/p\u003e \u003cp\u003eThe study also revealed that comorbidities significantly impacted ambulation, which is consistent with findings from Davie-Smith et al. [12], who reported that conditions such as diabetes and cardiovascular disease negatively affect rehabilitation outcomes. Mengesha et al. further highlighted that delayed access to healthcare and inadequate early interventions exacerbate the impact of comorbidities on postamputation outcomes [9]. Smoking, identified as a factor in univariate analysis, has also been linked to poorer outcomes in other studies, likely due to its impact on wound healing and vascular health [2,5,22].\u003c/p\u003e \u003cp\u003ePreoperative ambulation status was another critical factor; patients who were ambulatory prior to surgery had a significantly greater likelihood of regaining some form of mobility postamputation. This finding is consistent with the work of Chopra et al. [2], Damiani et al. [24] and Hijmans et al. [26], who reported that preoperative functional status is a strong predictor of postoperative mobility, as it reflects the patient\u0026rsquo;s baseline physical and psychological health.\u003c/p\u003e \u003cp\u003eAdditionally, having comorbidities, such as diabetes and hypertension, was strongly associated with poorer outcomes. Patients with comorbidities such as diabetes or vascular diseases often face complications such as poor wound healing, infections, and delayed prosthetic fitting, which hinder recovery and ambulation. This is supported by studies such as those of Rathnayake et al. [23] and Sinha et al. [20], who documented the negative impact of comorbidities on both quality of life and functional outcomes following amputation.\u003c/p\u003e \u003cp\u003eThe study also highlighted the role of family support in improving outcomes, with 92.1% of patients reporting family support. This aligns with findings from Davie-Smith et al. [12] and Chopra et al. [2], who emphasized the importance of social support in enhancing QoL and rehabilitation success in LMICs.\u003c/p\u003e \u003cp\u003eThe retrospective nature of the study, its small size, the inability to include some confounding factors such as biomass index, complications and specific comorbidities are some of the limitations of the study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study from AaBET Hospital provides critical insights into the functional outcomes and challenges faced by MLEA patients in Ethiopia. While the findings align with global trends in some areas, such as the importance of preoperative mobility and prosthetic use, they also highlight unique challenges in developing countries, including high trauma rates and limited access to rehabilitation services. Addressing these challenges requires a multifaceted approach, including improved trauma care, affordable prosthetics, and integrated rehabilitation programs. Postamputation ambulation rate was significantly influenced by preoperative ambulation status, age, comorbidities and bilateral amputation. These findings are consistent with those of similar studies from other regions, reinforcing the need for a comprehensive approach to amputation care that includes both medical and psychological support for optimal functional recovery. Future research should focus on longitudinal studies to assess long-term outcomes and the impact of targeted interventions in resource-limited settings. The use of culturally relevant tools such as the EQ-5D-5L value set for Ethiopians will further increase the accuracy and applicability of such studies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBKA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBelow Knee Amputation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTKA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAbove Knee Amputation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMLEAs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMajor Lower Extremity Amputations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePeripheral Arterial Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow and Middle Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTB and KA designed the study. TB, KA, and SK analyzed and interpreted the data. TB and KA drafted the manuscript. BG, TD and BL critically reviewed the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank St. Paul\u0026rsquo;s Hospital Millennium Medical College and the Department of Orthopedics and Trauma for preparing and cooperating on this study. We want to express our gratitude to everyone who helped with this research thesis along the way. Finally, we would like to thank those who participate and are willing to be involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this study was obtained from St. Paul\u0026rsquo;s Hospital Millennium Medical College. The college had no role in the design of the study and collection, analysis, and interpretation of the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthic\u003c/strong\u003e\u003cstrong\u003es approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ethical clearance letter was obtained from the institutional ethical review board of Saint Paul\u0026rsquo;s Hospital Millennium Medical College Ref. No. pm23/612.\u0026nbsp;A formal letter was issued to the Addis Ababa Burn, Emergency and Trauma (AaBET) Hospital requesting collaboration. The medical director at AaBET Hospital gave permission for the usage of patient records. Every case file was handled with confidentiality. No one outside the study team is given access to the patient\u0026apos;s name or chart, which are kept private and used exclusively for research. The Helsinki Declaration served as a broad guideline for our investigation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAljarrah, Q., Allouh, M. Z., Bakkar, S., Aleshawi, A., Obeidat, H., Hijazi, E., et al. Major lower extremity amputation: a contemporary analysis from an academic tertiary referral centre in a developing community. BMC surgery 2019; 19(1): 170. https://doi.org/10.1186/s12893-019-0637-y\u003c/li\u003e\n\u003cli\u003eChopra, A., Azarbal, A. F., Jung, E., Abraham, C. Z., Liem, T. K., Landry,et al. Ambulation and functional outcome after major lower extremity amputation. Journal of vascular surgery 2018; 67(5): 1521\u0026ndash;1529. https://doi.org/10.1016/j.jvs.2017.10.051\u003c/li\u003e\n\u003cli\u003eMacCallum, K. P., Yau, P., Phair, J., Lipsitz, E. C., Scher, L. A., \u0026amp; Garg, K. Ambulatory Status following Major Lower Extremity Amputation. Annals of vascular surgery 2021; 71: 331\u0026ndash;337. https://doi.org/10.1016/j.avsg.2020.07.038\u003c/li\u003e\n\u003cli\u003eDarter, B. J., Hawley, C. E., Armstrong, A. J., Avellone, L., \u0026amp; Wehman, P. Factors Influencing Functional Outcomes and Return-to-Work After Amputation: A Review of the Literature. Journal of occupational rehabilitation 2018; 28(4): 656\u0026ndash;665. https://doi.org/10.1007/s10926-018-9757-y\u003c/li\u003e\n\u003cli\u003eKahle, J. T., Highsmith, M. J., Schaepper, H., Johannesson, A., Orendurff, M. S., \u0026amp; Kaufman, K. Predicting walking ability following lower limb amputation: an updated systematic literature review. Technology and innovation 2016; 18(2-3): 125\u0026ndash;137. https://doi.org/10.21300/18.2-3.2016.125\u003c/li\u003e\n\u003cli\u003eHando, D. J., Byomuganyizi, M. J., Ngendahayo, J. B., Khamisi, R. H., Kivuyo, N. E., Kunambi, P. P., et al. Factors Influencing the Health-Related Quality of Life Among Lower Limb Amputees: A Two-Center Cross-Sectional Study. The East African health research journal 2013; 7(1): 121\u0026ndash;126. https://doi.org/10.24248/eahrj.v7i1.718\u003c/li\u003e\n\u003cli\u003eGebreslassie, B., Gebreselassie, K., \u0026amp; Esayas, R. Patterns and Causes of Amputation in Ayder Referral Hospital, Mekelle, Ethiopia: A Three-Year Experience. Ethiopian journal of health sciences 2018; 28(1): 31\u0026ndash;36. https://doi.org/10.4314/ejhs.v28i1.5\u003c/li\u003e\n\u003cli\u003eSume, B. W., \u0026amp; Geneti, S. A. Determinant Causes of Limb Amputation in Ethiopia: A Systematic Review and Meta-Analysis. Ethiopian journal of health sciences 2023; 33(5): 891\u0026ndash;902. https://doi.org/10.4314/ejhs.v33i5.19\u003c/li\u003e\n\u003cli\u003eMengesha, M., Garikapati, V., Adem, E., Getachew, E., Kassaye, H., \u0026amp; Harrison, W. Assessing the Burden of Preventable Amputations in Hawassa: The Role of Health Care Access and Appropriate Early Interventions. Ethiopian Medical Journal 2024; 62(4): 261\u0026ndash;268. https://dx.doi.org/10.4314/emj.v62i4.4\u003c/li\u003e\n\u003cli\u003eChigblo, P., Tidjani, I. F., Alagnid\u0026eacute;, E., Lawson, E., Madougou, S., Agbessi, O., et al. Outcomes of lower limb amputees at Cotonou. Journal of clinical orthopaedics and trauma 2019; 10(1): 191\u0026ndash;194. https://doi.org/10.1016/j.jcot.2017.12.002\u003c/li\u003e\n\u003cli\u003eFajardo-Martos, I., Roda, O., Zambudio-Periago, R., Bueno-Cavanillas, A., Hita-Contreras, F., \u0026amp; S\u0026aacute;nchez-Montesinos, I. Predicting successful prosthetic rehabilitation in major lower-limb amputation patients: a 15-year retrospective cohort study. Brazilian journal of physical therapy 2018; 22(3): 205\u0026ndash;214. https://doi.org/10.1016/j.bjpt.2017.08.002\u003c/li\u003e\n\u003cli\u003eDavie-Smith, F., Coulter, E., Kennon, B., Wyke, S., \u0026amp; Paul, L. Factors influencing quality of life following lower limb amputation for peripheral arterial occlusive disease: A systematic review of the literature. Prosthetics and orthotics international 2017; 41(6): 537\u0026ndash;547. https://doi.org/10.1177/0309364617690394\u003c/li\u003e\n\u003cli\u003ePasquina, P. F., Miller, M., Carvalho, A. J., Corcoran, M., Vandersea, J., Johnson, E., \u0026amp; Chen, Y. T. Special Considerations for Multiple Limb Amputation. Current physical medicine and rehabilitation reports 2014; 2(4): 273\u0026ndash;289. https://doi.org/10.1007/s40141-014-0067-9\u003c/li\u003e\n\u003cli\u003eZiegler-Graham, K., MacKenzie, E. J., Ephraim, P. L., Travison, T. G., \u0026amp; Brookmeyer, R. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Archives of physical medicine and rehabilitation2008; 89(3): 422\u0026ndash;429. https://doi.org/10.1016/j.apmr.2007.11.005\u003c/li\u003e\n\u003cli\u003ePran, L., Baijoo, S., Harnanan, D., Slim, H., Maharaj, R., \u0026amp; Naraynsingh, V. Quality of Life Experienced by Major Lower Extremity Amputees. Cureus 2021; 13(8): e17440. https://doi.org/10.7759/cureus.17440\u003c/li\u003e\n\u003cli\u003eEdomwonyi, Edwin \u0026amp; Onuminya, John. An Update on Major Lower Limb Amputation in Nigeria. International organizationl for science and research 2014; 13: 90-96. \u003cu\u003ehttps:// doi.org/10.9790/0853-131029096\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eTirrell, A. R., Kim, K. G., Rashid, W., Attinger, C. E., Fan, K. L., \u0026amp; Evans, K. K. Patient-reported Outcome Measures following Traumatic Lower Extremity Amputation: A Systematic Review and Meta-analysis. Plastic and reconstructive surgery. Global open 2021; 9(11): e3920. https://doi.org/10.1097/GOX.0000000000003920\u003c/li\u003e\n\u003cli\u003ePenn-Barwell J. G. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury2011; 42(12): 1474\u0026ndash;1479. https://doi.org/10.1016/j.injury.2011.07.005\u003c/li\u003e\n\u003cli\u003eNehler, M. R., Coll, J. R., Hiatt, W. R., Regensteiner, J. G., Schnickel, G. T., Klenke, W. and et al. Functional outcome in a contemporary series of major lower extremity amputations. Journal of vascular surgery2003; 38(1): 7\u0026ndash;14. https://doi.org/10.1016/s0741-5214(03)00092-2\u003c/li\u003e\n\u003cli\u003eSinha, R., van den Heuvel, W. J., \u0026amp; Arokiasamy, P. Factors affecting quality of life in lower limb amputees. Prosthetics and orthotics international 2011; 35(1): 90\u0026ndash;96. https://doi.org/10.1177/0309364610397087\u003c/li\u003e\n\u003cli\u003eBurger, H., \u0026amp; Marinček, Č. Return to work after lower limb amputation. Disability and Rehabilitation 2007, 29(17): 1323\u0026ndash;1329. https://doi.org/10.1080/09638280701320797\u003c/li\u003e\n\u003cli\u003eNorvell, D. C., \u0026amp; Czerniecki, J. M. Risks and Risk Factors for Ipsilateral Re-Amputation in the First Year Following First Major Unilateral Dysvascular Amputation. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 2020; 60(4): 614\u0026ndash;621. https://doi.org/10.1016/j.ejvs.2020.06.026\u003c/li\u003e\n\u003cli\u003eRathnayake, A., Saboo, A., Malabu, U. H., \u0026amp; Falhammar, H. Lower extremity amputations and long-term outcomes in diabetic foot ulcers: A systematic review. World journal of diabetes 2020; 11(9): 391\u0026ndash;399. https://doi.org/10.4239/wjd.v11.i9.391\u003c/li\u003e\n\u003cli\u003eDamiani, C., Pournajaf, S., Goffredo, M., Proietti, S., Denza, G., Rosa, Band et al. Community ambulation in people with lower limb amputation: An observational cohort study. Medicine 2021; 100(3): e24364. https://doi.org/10.1097/MD.0000000000024364\u003c/li\u003e\n\u003cli\u003eEnweluzo, G. O., Asoegwu, C. N., Ohadugha, A. G. U., \u0026amp; Udechukwu, O. I. Quality of Life and Life after Amputation among Amputees in Lagos, Nigeria. Journal of the West African College of Surgeons 2023; 13(3): 71\u0026ndash;76. https://doi.org/10.4103/jwas.jwas_28_23\u003c/li\u003e\n\u003cli\u003eHijmans, J. M., Dekker, R., \u0026amp; Geertzen, J. H. B. Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes. Medical hypotheses 2020; 143: 110134. https://doi.org/10.1016/j.mehy.2020.110134\u003c/li\u003e\n\u003cli\u003eWelie, A. G., Gebretekle, G. B., Stolk, E., Mukuria, C., Krahn, M. D., Enquoselassie, F., \u0026amp; Fenta, T. G. Valuing Health State: An EQ-5D-5L Value Set for Ethiopians. Value in health regional issues 2020; 22: 7\u0026ndash;14. https://doi.org/10.1016/j.vhri.2019.08.475\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Saint Paul's Hospital Millennium Medical college ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Major lower extremity amputations, Quality of life, Prosthesis, Trans-tibial amputation, Trans-femoral amputation, EQ-5D-5L, EQ-VAS","lastPublishedDoi":"10.21203/rs.3.rs-5965104/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5965104/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMajor lower extremity amputation (MLEA) is a life-altering surgical procedure commonly performed due to trauma, peripheral arterial disease (PAD), diabetic foot ulcers, or other pathologies. This procedure has profound physical, psychological, and socioeconomic consequences, significantly affecting patients' quality of life and functional independence. Access to prosthetic care and rehabilitation services, which is crucial for improved outcomes, is often limited, especially in resource-limited settings such as Ethiopia. This study aimed to assess the quality of life and determinants of ambulation status after MLEA at Addis Ababa Burn, Emergency, and Trauma Hospital (AaBET), Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional analysis was conducted on 89 patients who underwent MLEA at AaBET Hospital between January 2017 and June 2022. Data on sociodemographic characteristics, comorbidities, amputation level, preoperative ambulation, and postamputation functional status were collected. Quality of life (QoL) was measured via the EQ-5D-5L and EQ-VAS tools. Statistical analysis, including univariate and multivariate binary logistic regression, was performed to identify factors influencing ambulation status postamputation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTrauma was the leading cause of MLEA (57.3%), followed by peripheral arterial disease (22.7%) and infections (11.2%). Postamputation ambulation was achieved in 76.4% of patients, with 39.3% using prostheses, 28.1% using crutches, and 9% using both. The remaining 23.6% were nonambulatory. The mean EQ-5D-5L index score was 0.81 (SD 0.17), and the mean EQ-VAS score was 69.38 (SD 13.66). Factors significantly associated with ambulation included age, preoperative ambulation status, bilateral amputation, and the presence of comorbidities. Ambulatory patients had significantly better QoL scores than non-ambulatory patients did.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the impact of trauma as the primary cause of MLEA in Ethiopia. Preoperative ambulation status, age, bilateral amputation, and comorbidities were identified as key determinants of functional outcomes. These findings suggest that addressing comorbidities and improving trauma care is critical for enhancing postamputation mobility and QoL in low-income settings.\u003c/p\u003e","manuscriptTitle":"Quality of Life and Determinants of Ambulation after Major Lower Extremity Amputation at Addis Ababa Burn, Emergency, and Trauma Hospital, Ethiopia: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 05:42:10","doi":"10.21203/rs.3.rs-5965104/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"55442b1b-2be7-449b-ac12-183e8ba34513","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":43879200,"name":"Orthopedic Surgery"},{"id":43879201,"name":"Orthopedics"},{"id":43879202,"name":"Physical Medicine \u0026 Rehab"},{"id":43879203,"name":"Vascular Medicine"},{"id":43879204,"name":"Sports Medicine and Kinesiology"}],"tags":[],"updatedAt":"2025-02-06T05:42:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-06 05:42:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5965104","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5965104","identity":"rs-5965104","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}