Quality of life and not health status improves after major amputation in the elderly critical limb ischaemia patient

Chloe M. L. Peters*, Jolanda de Vries, Paul Lodder, Stijn L. Steunenberg, Eelco J. Veen, Hans G. W. de Groot, Gwan H. Ho, Lijckle van der Laan

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objectives: 

A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation.

Methods: 

Patients suffering fromCLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not. The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL. The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up.

Results: 

Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45), p = 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46), p = 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57; -0.63), p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78; -2.23), p = 0.003).

Conclusions: 

There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when assessing the HS or QoL outcome of patients undergoing hospital care. With respect to shared decision making, distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, provide a very important outcome measurement and should be used in future research.

Original languageEnglish
Pages (from-to)547-553
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume57
Issue number4
DOIs
Publication statusPublished - 2019

Keywords

  • Quality of life
  • Health status
  • Amputation
  • Peripheral arterial disease
  • Frail elderly
  • FUNCTIONAL STATUS
  • DISEASE
  • OUTCOMES
  • SURGERY
  • RELIABILITY
  • MORTALITY

Cite this

@article{55d1c981fd73415d92dffbf284daf4ab,
title = "Quality of life and not health status improves after major amputation in the elderly critical limb ischaemia patient",
abstract = "Objectives: A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation.Methods: Patients suffering fromCLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not. The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL. The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up.Results: Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95{\%} CI -7.84;-1.45), p = 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95{\%} CI -9.58;-1.46), p = 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95{\%} CI -1.57; -0.63), p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95{\%} CI -5.78; -2.23), p = 0.003).Conclusions: There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when assessing the HS or QoL outcome of patients undergoing hospital care. With respect to shared decision making, distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, provide a very important outcome measurement and should be used in future research.",
keywords = "Quality of life, Health status, Amputation, Peripheral arterial disease, Frail elderly, FUNCTIONAL STATUS, DISEASE, OUTCOMES, SURGERY, RELIABILITY, MORTALITY",
author = "Peters, {Chloe M. L.} and {de Vries}, Jolanda and Paul Lodder and Steunenberg, {Stijn L.} and Veen, {Eelco J.} and {de Groot}, {Hans G. W.} and Ho, {Gwan H.} and {van der Laan}, Lijckle",
year = "2019",
doi = "10.1016/j.ejvs.2018.10.024",
language = "English",
volume = "57",
pages = "547--553",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders Ltd",
number = "4",

}

Quality of life and not health status improves after major amputation in the elderly critical limb ischaemia patient. / Peters, Chloe M. L.; de Vries, Jolanda; Lodder, Paul; Steunenberg, Stijn L.; Veen, Eelco J.; de Groot, Hans G. W.; Ho, Gwan H.; van der Laan, Lijckle.

In: European Journal of Vascular and Endovascular Surgery, Vol. 57, No. 4, 2019, p. 547-553.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Quality of life and not health status improves after major amputation in the elderly critical limb ischaemia patient

AU - Peters, Chloe M. L.

AU - de Vries, Jolanda

AU - Lodder, Paul

AU - Steunenberg, Stijn L.

AU - Veen, Eelco J.

AU - de Groot, Hans G. W.

AU - Ho, Gwan H.

AU - van der Laan, Lijckle

PY - 2019

Y1 - 2019

N2 - Objectives: A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation.Methods: Patients suffering fromCLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not. The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL. The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up.Results: Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45), p = 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46), p = 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57; -0.63), p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78; -2.23), p = 0.003).Conclusions: There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when assessing the HS or QoL outcome of patients undergoing hospital care. With respect to shared decision making, distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, provide a very important outcome measurement and should be used in future research.

AB - Objectives: A patient-oriented appraisal of treatment has become extremely important, particularly in elderly patients with critical limb ischaemia (CLI). Quality of life (QoL) is an important patient-reported outcome in vascular surgery. Frequently, the physical domain of QoL questionnaires represents an 'objective' evaluation of performing activities, which is expected to be impaired after major limb amputation. However, an objective appraisal of physical function is an assessment of health status (HS) and not of QoL. Little is known about the subjective appraisal of physical health (QoL). The goal of this study was to evaluate, prospectively, QoL in relation to HS in elderly CLI patients undergoing major limb amputation.Methods: Patients suffering fromCLI aged 70 years or older were included in a prospective observational cohort study with a follow-up period of 1 year. Patients were divided according to having had an amputation or not. The World Health Organization Quality Of Life-BREF (WHOQOL-BREF) was used to asses QoL. The 12-Item Short Form Health Survey (SF-12) was used to measure HS. These self-reported questionnaires were completed five times during follow-up.Results: Two-hundred patients were included of whom 46 underwent a major limb amputation within one year. Amputees had a statistically significant improvement of their physical QoL after six months (14.0 vs. 9.0 (95% CI -7.84;-1.45), p = 0.005) and after a one-year follow-up (14.0 vs. 9.0 (95% CI -9.58;-1.46), p = 0.008). They did not however show any statistically significant difference in HS. For non-amputees, both physical QoL and HS improved. An instant statistically significant improvement of the physical QoL appeared 1 week after inclusion (12.0 vs. 10.9 (95% CI -1.57; -0.63), p<0.001). Similarly, statistically significant improvement in the physical HS first occurred at 1 week follow-up (29.0 vs. 28.9 (95% CI -5.78; -2.23), p = 0.003).Conclusions: There is a clear difference between patients' functioning (HS) and the patients' appraisal of functioning (QoL). In elderly CLI patients, this study clearly suggests a discrepancy between the physical QoL (WHOQOL-BREF) and HS (SF-12) measurements in vascular amputees. This raises the question, which outcome measurement is the most relevant for elderly CLI patients. Individual treatment goals should be kept in mind when assessing the HS or QoL outcome of patients undergoing hospital care. With respect to shared decision making, distinctive and subjective QoL questionnaires, like the WHOQOL-BREF, provide a very important outcome measurement and should be used in future research.

KW - Quality of life

KW - Health status

KW - Amputation

KW - Peripheral arterial disease

KW - Frail elderly

KW - FUNCTIONAL STATUS

KW - DISEASE

KW - OUTCOMES

KW - SURGERY

KW - RELIABILITY

KW - MORTALITY

U2 - 10.1016/j.ejvs.2018.10.024

DO - 10.1016/j.ejvs.2018.10.024

M3 - Article

VL - 57

SP - 547

EP - 553

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

IS - 4

ER -