Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review

<b>Purpose:</b> Most veterans live for many years after their war-related traumatic lower-limb amputation, which is why understanding which factors influence health-related quality of life (HRQoL) remains important to their long-term management. The objective of this study was to perform a review of the literature to summarize any evidence on the physical and social determinants for HRQoL in veterans with uni- or bilateral lower-limb amputation(s). <b>Method:</b> MEDLINE, EMBASE, PEDro, CINAHL, Scopus and Cochrane databases were searched systematically for eligible studies. Inclusion criteria were: traumatic lower-limb amputation(s), HRQoL outcome and veterans. Physical and social factors that influence HRQoL were extracted. <b>Results:</b> The literature search identified 2073 citations, leading to the inclusion of 10 studies in the systematic review. Physical activity level, sport participation, level of amputation, back pain, years of education, as well as duration and severity of phantom pain were found to be determining factors for HRQoL among veterans with lower-limb amputation. <b>Conclusions:</b> The identified physical and social determinants were similar to those found in civilian traumatic amputees. More high quality research designs, interventions and complex statistical analyses are warranted to identify the physical and social factors that influence the HRQoL of veteran amputees. Implications for RehabilitationRehabilitation staff should promote physical activity and participation in sport among veterans with lower-limb amputation(s).Level of amputation, back pain severity, years of education, duration of phantom pain and severity of phantom pain have been found to be determining factors for HRQoL and should be taken into consideration when planning rehabilitation programs for veterans with lower-limb amputations. Rehabilitation staff should promote physical activity and participation in sport among veterans with lower-limb amputation(s). Level of amputation, back pain severity, years of education, duration of phantom pain and severity of phantom pain have been found to be determining factors for HRQoL and should be taken into consideration when planning rehabilitation programs for veterans with lower-limb amputations.

**研究目的**：多数退伍军人在经历战争相关创伤性下肢截肢后仍可存活多年，因此明确影响其健康相关生命质量（health-related quality of life, HRQoL）的相关因素，对其长期管理仍具有重要意义。本研究旨在通过文献综述，总结单侧或双侧下肢截肢退伍军人健康相关生命质量的躯体与社会决定因素相关研究证据。
**研究方法**：系统检索MEDLINE、EMBASE、PEDro、CINAHL、Scopus及Cochrane数据库中符合条件的研究。纳入标准为：创伤性下肢截肢、以健康相关生命质量为结局指标、研究对象为退伍军人。提取影响健康相关生命质量的躯体与社会相关因素。
**研究结果**：本次文献检索共检索到2073篇文献引用，最终纳入10项研究进行系统综述。研究发现，体力活动水平、体育参与度、截肢平面、背痛、受教育年限，以及幻痛的持续时间与严重程度，均为下肢截肢退伍军人健康相关生命质量的决定因素。
**研究结论**：本次研究明确的躯体与社会决定因素，与平民创伤性截肢患者的相关因素具有相似性。未来需开展更多高质量研究设计、干预研究及复杂统计分析，以进一步明确影响退伍军人截肢患者健康相关生命质量的躯体与社会因素。
康复启示：康复从业人员应鼓励下肢截肢退伍军人参与体力活动及体育参与。截肢平面、背痛严重程度、受教育年限、幻痛持续时间及幻痛严重程度均被证实为影响健康相关生命质量的决定因素，在为下肢截肢退伍军人制定康复方案时应将上述因素纳入考量。康复从业人员应鼓励下肢截肢退伍军人参与体力活动及体育参与。截肢平面、背痛严重程度、受教育年限、幻痛持续时间及幻痛严重程度均被证实为影响健康相关生命质量的决定因素，在为下肢截肢退伍军人制定康复方案时应将上述因素纳入考量。