ARTICLE INFO

Article Type

Original Research

Authors

Fahimi   M. (1 )
Kamali   M. (* )
Saeedi   H. (1 )






(* ) “Rehabilitation Research Center”, “Rehabilitation Management Department, Rehabilitation Sciences School”, Iran University of Medical Sciences, Tehran, Iran
(1 ) Orthosis & Prothosis Department, Rehabilitation Sciences School, Iran University of Medical Sciences, Tehran, Iran

Correspondence

Article History

Received:  December  18, 2013
Accepted:  June 11, 2014
ePublished:  July 20, 2014

BRIEF TEXT


… [1] Amputation affects mental status and social performance of patients and leads to disorders in quality of life [2, … 3, … 4, 5, 6]. Concerning definition of quality of life, four domains are taken into account, including ‘healthy physical performance’, ‘responds and mental and psychic attitudes’, ‘social and economic conditions’, and ‘family relationship’, which are dependent to each other, and disorders in each one affects other domains [7].

Non-declared

The aim of this study was to compare the prevalence of depression with quality of life in patients with amputation due to an accident (including veterans and other patients).

This is a cross-sectional descriptive-analytic study.

Referred persons to men’s Below the Knee Prosthesis Fabrication Unit at Rehabilitation Center of Tehran Red Crescent Society Rehabilitation and Kowsar Orthotics and Prosthetics Center of Martyr and Veterans Foundation were studied in 2013 (April to June).

… [8-15, … 16, 17] According to the similar studies [18] and computations done by Cochran’s formula, sample size was estimated 60 persons. Inclusion criteria included the age between 30 and 55years; under knee amputations due to either war or occupational accidences, or car accidence; normal BMI; mean stump length; 5 to 25 years of prosthesis usage.

Data were collected using demographic, SF-36, and Beck’s Depression Questionnaires. The three-section demographic questionnaire (age, height, weight, sex, marital status, educational level, type of residence, occupation status, life expenses, prosthesis expenses paid by insurance, cause of amputation, amputation length, and the number of received prosthesis). … [19] SF-36 is compounded of eight dimensions including physical performance (10 items); performance limitations resulting in physical problems (4 items); physical pain (2 items); general health (2 items); vitality (9 items); social performance (1 item); performance limitations leading to mental problems (4 items); mental health (5 items) (with their 36 items totally) [20]. These eight dimensions are assessed in physical component summary (PCS) and mental component summary (MCS) [21]. Scores of quality of life range from zero (the worst situation) to 100 (the best situation). Its validity and reliability is confirmed in various groups of patients [22]. Reliability of SF-36 questionnaire has been reported between 0.65 and 0.9, in Iran [23]. Beck’s Depression Questionnaire (assessing depressed patients’ sings and feedbacks, based on observation and summarizing the attitudes and current signs among these patients) Beck’s Questionnaire contains 21 questions on emotions (2 questions), cognition (11 questions), apparent behaviours (2 questions), physical signs (5 questions), and interpersonal semiotics (1 question). According to 4-point Likert scale, the scores ranging from zero to three for the questions, showing ‘mild’ to ‘very severe’ respectively. Its total score domain is from minimum ‘zero’ (the best situation) to maximum ‘63’ (the worst situation) [24]. Demarcation of depression disease is as the followings [25]: Without depression (zero to 10); mild depression (11-16); mean depression (17-30); severe depression (31-40); very severe depression (41-63) There are various reports regarding reliability of the questionnaire, showing 0.48 to 0.86 (from Beck et al.) and 0.78 (from Tashakkori and Mehryar) [26]. (In this study, the patients’ monthly expenses were assessed.) Data were coding using SPSS 16 software. To analyse data, Independent T test (to compare dimensions of life quality and its sub-scales in veterans and other patients), Pearson Correlation test (to assess the correlation of depression level and mental and physical health scale scores), and Chi Square test (to compare depression between veterans and other patients groups) were used.

All 30 persons (50%) of the veterans’ group had amputations due to the war. From other patients’ group, 11 (18.3%) and 19 (31.7%) persons were with amputations caused by occupational accident and car accident, respectively. Of men with under knee amputation, 51 persons (85%) were married. Average age of all the samples was 44.85±7.70years (Table 1).‏ According to scores from Beck’s Depression Questionnaire, 11 persons had depression, including 3 persons (10%) of the veterans’ group and 8 persons (26.7%) of other patients’ group. Average depression of the veterans (6.9±5.7) was significantly less than other patients (8.2±6.6). In total score of quality of life, there was no significant difference between veterans (66.2±15.3) and other patients (70.2±14.8) groups. In addition, there was no significant difference between the veterans and others in physical and mind health scale domains. The only significant difference between two groups was in average mental health and physical pain (Table 2). There was no significant relation between demographic variables and average score of life quality. Nevertheless, there was a significant relation only between monthly expenses variable and life quality. There was a reverse and significant relation between depression level and score of physical and mental health scale in both groups, i. e. the less the depression level, the more the score was.

… [27] While the results showed 10% (among veterans), 26.7% (among other patients), and 18.33% (totally) of the subjects with depression, there are various reports on prevalence of depression or other mental diseases among injured soldiers and patients with amputations, including 53.75% [16], about half [28], 31% [29], and 25% to 33% [31] of the subjects, as well as a high level of anxiety and depression among the patients [30]. Results of the present study, showing higher physical health than mind health, are inconsistent with the results of a study, in which, alongside lower physical health scores than psychiatric health scores among veterans, psychiatric problems and social performance have taken minimum and maximum scores, respectively [32]. Results of a study, reporting minimum and maximum average scores for physical pain and social performance respectively [5], are complitely inconsistent with the results of the present study. … [33] There are various reported scores and percentages of quality of life among patients with blindness, amputations, chemical injuries, and stroke complications, including 59.2 scores given by blind persons [34] (compare with 66.2 scores in the present study), 71.5% of the chemically injured persons with mean quality of life [35], satisfaction with less functional limitations among patients with above-knee amputation using smart and simple mechanical prosthetic knee joints [36], and reverse correlation between depression after brain stroke and quality of life [37]. Quality of life of veterans with spinal cord injury is less than that of other patients with the same injury [38]. However, in the present study, there was no significant difference in quality of life between the two groups.

Additional and more extended researches ought to be conducted, directed on various domains related to quality of life among patients with amputation.

Non-declared

Among patients with amputations, there is a relation between depression and quality of life; and it is possible to increase the patients’ quality of life with early rehabilitation aimed at decrease in depression.

The researchers feel grateful to all the veterans, who participated in the study.

Non-declared

Non-declared

Iran University of Medical Sciences funded the research.

TABLES and CHARTS

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