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

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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.

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Data availability

The data for this study is not available for public access.

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Funding

Funding provided by the Physicians’ Services Inc. Foundation and the Ontario Association for Amputee Care.

Author information

Authors and Affiliations

  1. Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sander L. Hitzig, Sara J. T. Guilcher, Crystal MacKay & Stephanie R. Cimino

  2. St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sander L. Hitzig, Jorge Rios & Amanda L. Mayo

  3. Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sander L. Hitzig

  4. West Park Healthcare Centre, Toronto, ON, Canada

    Michael Devlin, Crystal MacKay & Steven Dilkas

  5. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    Sara J. T. Guilcher

  6. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Sara J. T. Guilcher

  7. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Sara J. T. Guilcher & Crystal MacKay

  8. Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Steven Dilkas & Amanda L. Mayo

  9. Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Michael W. Payne & Ricardo Viana

  10. Schulich Heart Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Ahmed Kayssi

  11. Division of Vascular Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Ahmed Kayssi

  12. St. John’s Rehab, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Amanda L. Mayo

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Correspondence to Sander L. Hitzig.

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The study was approved by the Research Ethics Boards at Sunnybrook Health Sciences Centre (#2588), West Park Healthcare Centre (#18-001-WP), and the University of Toronto.

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Hitzig, S.L., Rios, J., Devlin, M. et al. Health utility in community-dwelling adults with dysvascular lower limb loss. Qual Life Res 32, 1871–1881 (2023). https://doi.org/10.1007/s11136-023-03357-6

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