COSMIN database

A systematic review of functional and quality of life assessment after major lower extremity amputation

Hawkins, A. T., Henry, A. J., Crandell, D. M., and Nguyen, L. L.
BACKGROUND: When judging the success or failure of major lower extremity (MLE) amputation, the assessment of appropriate functional and quality of life (QOL) outcomes is paramount. The heterogeneity of the scales and tests in the current literature is confusing and makes it difficult to compare results. We provide a primer for outcome assessment after amputation and assess the need for the additional development of novel instruments.

METHODS: MEDLINE, EMBASE, and Google Scholar were searched for all studies using functional and QOL instruments after MLE amputation. Assessment instruments were divided into functional and QOL categories. Within each category, they were subdivided into global and amputation-specific instruments. An overall assessment of instrument quality was obtained.

RESULTS: The initial search revealed 746 potential studies. After a review of abstracts, 102 were selected for full review, and 40 studies were then included in this review. From the studies, 21 different assessment instruments were used 63 times. There were 14 (67%) functional measures and 7 (33%) QOL measures identified. Five (36%) of the functional instruments and 3 (43%) of the QOL measures were specific for MLE amputees. Sixteen instruments were used >1 time, but only 5 instruments were used >3 times. An additional 5 instruments were included that were deemed important by expert opinion. The 26 assessment instruments were rated. Fourteen of the best-rated instruments were then described.

CONCLUSIONS: The heterogeneity of instruments used to measure both functional and QOL outcomes make it difficult to compare MLE amputation outcome studies. Future researchers should seek to use high-quality instruments. Clinical and research societies should endorse the best validated instruments for future use in order to strengthen overall research in the field.
Ann Vasc Surg
1615-5947 (Electronic)
Publication year:
Functional status:
Physical functioning
General health perceptions / HRQoL:
Health-related quality of life
Overall quality of life:
Overall quality of life
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Injury, poisoning and certain other consequences of external causes
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
4 - Performance-based tests
6 - Clinical rating scales
7 - Observations
10MWT - 10 Meter Walk Test   
2MWT - 2-Minute Walk Test   
6MWT - 6-Minute Walk Test    | 
EQ-5D - EuroQoL-5 Dimensions   
FAI - Frenchay Activities Index   
Houghton Scale
LCI-5 - Locomotor Capabilities Index-5-point ordinal scale
NHP - Nottingham Health Profile   
PEQ - Prosthesis Evaluation Questionnaire
RMI - Rivermead Mobility Index   
SF-12 - 12-item Short Form Health Survey [alias: RAND-12]
SF-36 - 36-item Short Form Health Survey [alias: RAND-36][alias: Medical Outcomes Study (MOS) SF-36]]    |  | also see:
SIGAM - Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire
TUG - Timed Up and Go test   
WHOQOL-100 - World Health Organization Quality Of Life Assessment Instrument 100 items
WHOQOL-BREF - World Health Organization Quality of Life questionnaire–Abbreviated Questionnaire [alias: WHO-QOL BREF]