Patient perspectives on major lower limb amputation: A qualitative systematic review

Introduction: Major lower limb amputation is a significant event with substantial implications for patients' quality of life. Care, treatment, and rehabilitation are largely governed by evidence-based recommendations, and patients' preferences are sparsely represented. The aim of this systematic review was to explore patients’ perspectives on major lower limb amputation resulting from vascular disease. Methods: We searched PubMed, CINAHL, Embase, and PsycINFO for studies with a qualitative design. We included interview studies describing patients’ perspectives on major lower limb amputation from the moment of decision to several years after. All studies were assessed using the Critical Appraisal Skills Program (CASP) checklist, and thematic synthesis of the extracted qualitative data was performed. Findings: Thirteen qualitative studies from 2010 to 2021 with prosthetic and non-prosthetic users were included. Six main themes emerged from the synthesis: 1) Confronting the amputation, 2) Emotional response, 3) Concerns about a new way of life, 4) Physical changes to the body, 5) Interactions with relations, and 6) Healthcare and information requirements. Conclusions: Patients with major lower limb amputation experience physical, mental, practical, and financial worries and challenges. Support and empathy are important for helping patients to cope with the emotions, uncertainty, mobility issues, and expectations of autonomy and level of functioning following amputation, and to enable them to adjust to their new normality.