الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
Lower limb amputation is usually performed as a life-saving procedure to remove all infected, pathologic, or ischemic tissue. Irrespective of the cause of LLA, it is one of the most common acquired disabilities and has a significant impact on patients’ quality of life and a major economic burden on national health care systems. Patients with lower limb amputation require special and holistic care because they are subjected to multiple physiological, psychological, social stressors, and lifestyle changes. The nurse as a member of the rehabilitation team has a fundamental roles in the rehabilitation process after LLA such as prevention of postoperative complications, stump care, pain management, edema control, shape the residual limb to fit a prosthesis, providing psychological support and health education. Rehabilitation program helps to achieve the maximum possible physical, emotional, social, vocational and financial independency of patients with LLA and maximum efficiency in all aspects of life.
Aim of the study:
The aim of the study was to determine the effect of a rehabilitation program on the quality of life for patients with lower limb amputation.
Research Design:
A quasi experimental design was used to conduct this study.
Setting:
This study was carried out in two settings in Alexandria. The first setting was the Surgical Units and Vascular Unit, Department of Surgery, Alexandria Main University Hospital. The second setting was Alexandria Vascular Center (AVC) at Smouha district.
Subjects:
This study was carried out in two settings in Alexandria. The first setting was the Surgical Units and Vascular Unit, Department of Surgery, Alexandria Main University Hospital. The second setting was Alexandria Vascular Center (AVC) at Smouha district.
Subjects:
A convenience sample of 50 adult patients undergoing lower limb amputation and admitted to the previously mentioned settings were selected. They were randomly recruited into 2 groups, group one (control group) and group two (study group), 25 patients for each group. The control group received the routine hospital care while the study group received the rehabilitation program.
Tools of the study:
Three tools were used for data collection:
Tool I: Preoperative and Postoperative Lower Limb Amputation Assessment Tool.
This tool was adapted by the researcher and consisted of two main parts:
- Part I: Preoperative patient assessment:
This part included socio-demographic data, medical data, diagnostic studies and assessment of patient’s physical status.
- Part II: Postoperative patient assessment:
This part included postoperative pain assessment and wound healing observation checklist assessment.
Tool II: Amputee Mobility Predictor (AMP) Assessment:
It was adopted by the researcher and used to assess mobility of patients who had lower limb amputation with the use of a prosthesis which called (AMPPRO) and without the use of a prosthesis which called (AMPnoPRO) and measure function post-rehabilitation.
Tool III: Short Form 36 (SF-36) Health Survey Questionnaire:
It was used to assess quality of life (QOL) for patients with lower limb amputation and adopted by the researcher. It was already translated into Arabic and was consisted of 36 questions (items) measuring physical and mental health status.
The main results of the study:
1. No statistical significant differences were found between the control and study groups in relation to socio-demographic and medical data except length of hospital stay.
2. No statistical significant differences were found between the control and study groups regarding laboratory investigations, diagnostic studies; and preoperative assessment of vital signs, mobility and anthropometric assessment.
3. No statistical significant differences were found between the control and study groups related to preoperative neurological assessment at intact and affected lower limbs.
4. No statistical significant differences were found between the control and study groups regarding preoperative vascular assessment at intact and affected lower limbs.
5. Statistical significant differences were found between the control and study groups in relation to intensity of pain during postoperative follow up weeks.
6. Statistical significant differences were found between the control and study groups regarding postoperative wound healing during the second, third and fourth weeks postoperatively with P values equal (0.037, 0.024 and 0.017) respectively.
7. A statistical significant difference was found between the control and study
Patients in the study group had higher mean scores than those of the control group after one month and three months of lower limb amputation regarding the eight quality of life domains.
9. There was a statistical significant difference between the control and study groups after one month of LLA regarding quality of life domains except role limitations due to physical health domain, role limitations due to emotional problems domain and social functioning domain.
10. There was a statistical significant difference between the control and study groups after three months of LLA regarding all quality of life domains.
11. Quality of life for patients with LLA was improved significantly at three months compared to one month after amputation surgery.
The main recommendations of the study:
1. Continuous educational and training programs should be provided to patients with lower limb amputation on regular basis to improve their physical and psychological health; and quality of life.
2. The rehabilitation program should be considered as an integral part in the hospital routine care of patients with LLA.
3. Nurses should provide a holistic care for patients with LLA that includes physical, psychological, social, spiritual and teaching aspects.
4. Establish educational and training programs, in service education and workshops periodically and regularly for nurses to upgrade their knowledge and skills.
5. The developed handout booklet should be present in vascular units and outpatient clinics in order to be provided to patients with LLA.
6. Ongoing assessment of patient satisfaction with nursing care and rehabilitation services is very important as it is a desired outcome of care and indicator of the quality of provided care.
7. Further research for assessment of quality of life for patient with LLA after 6 months and one year is suggested.
8. Assessment of patients’ satisfaction with lower limb prosthesis following LLA.