Health utility in community-dwelling adults with dysvascular lower limb loss

Sander L Hitzig; Jorge Rios; Michael Devlin; Sara J T Guilcher; Crystal MacKay; Steven Dilkas; Michael W Payne; Ricardo Viana; Ahmed Kayssi; Stephanie R Cimino; Amanda L Mayo

doi:10.1007/s11136-023-03357-6

Health utility in community-dwelling adults with dysvascular lower limb loss

Qual Life Res. 2023 Jul;32(7):1871-1881. doi: 10.1007/s11136-023-03357-6. Epub 2023 Feb 9.

Authors

Sander L Hitzig^{1

2

3}, Jorge Rios⁴, Michael Devlin⁵, Sara J T Guilcher^{6

7

8

9}, Crystal MacKay^{6

5

9}, Steven Dilkas^{5

10}, Michael W Payne¹¹, Ricardo Viana¹¹, Ahmed Kayssi^{12

13}, Stephanie R Cimino⁶, Amanda L Mayo^{4

10

14}

Affiliations

¹ Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. sander.hitzig@utoronto.ca.
² St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. sander.hitzig@utoronto.ca.
³ Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. sander.hitzig@utoronto.ca.
⁴ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
⁵ West Park Healthcare Centre, Toronto, ON, Canada.
⁶ Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁷ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
⁸ Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁹ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁰ Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
¹² Schulich Heart Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹³ Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

PMID: 36757573
DOI: 10.1007/s11136-023-03357-6

Abstract

Purpose: Adults with dysvascular lower extremity amputation (LEA) experience a large number of secondary health conditions yet there is a gap in the literature on health utility scores for this population. A health utility score relates to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). This study aimed to provide a descriptive account of health utility scores in community-dwelling adults with dysvascular LEA.

Methods: Participants were adults with dysvascular LEA who were 3 months post-amputation. Data collected included socio-demographic characteristics, the Special Interest Group in Amputee Medicine (SIGAM) grades, the dysvascular conditions scale (DCS), which is a scale developed for this study, and the Short Form-36 (SF-36). SF-6D health utility scores were derived from the SF-36 using a software algorithm. Participants were grouped into low-impact and high-impact groups based on self-reported severity of symptoms using the DCS. Health utility scores were compared between the low-impact and high-impact groups using independent t-tests.

Results: A total of 231 participants were enrolled in the study. The mean SF-6D health utility score was 0.689 (0.127). A significant association was found between health utility score and SIGAM grade (p < 0.001, η2 = .09). Health utility was positively associated with age (r = 0.137, p = 0.037) and months post-amputation (r = 0.141, p = 0.032), and negatively associated with DCS severity (r = -0.526, p < 0.001). Health utility scores were lower for participants in the DCS high-impact groups for conditions such as diabetes mellitus, phantom limb pain, musculoskeletal pain, back pain, psychological distress, depression, vision problems, and other pain.

Conclusion: Cost-utility analyses rely on health utility estimates and our findings provide data for future economic evaluations that may assist policy makers in evidence informed allocation of healthcare resources for this population.

Keywords: Amputation; Health utility scores; SF-6D; Secondary health conditions.

MeSH terms

Adult
Amputees*
Back Pain
Humans
Independent Living
Infant, Newborn
Lower Extremity
Quality of Life* / psychology
Surveys and Questionnaires