Page 55 - Read Online

Zargaran et al. Plast Aesthet Res 2023;10:10 https://dx.doi.org/10.20517/2347-9264.2022.42 Page 3 of 7

contacted and asked to complete the surveys at two time points: pre-operatively, and at the time of
interview. For pain measures, we used the 11-point numerical (Pain) rating scale (NRS), where 0 indicates
“no pain” and 10 indicates “the worst possible pain”. Pain levels were identified separately as either NP and
PLP, pre-operatively and at the time of the interview. As previously indicated, NP was defined as pain
occurring within the stump – located over the ends of the nerve stumps, and PLP was defined as painful
sensations perceived in the absent limb.

Quality of life was evaluated using the EuroQol EQ5D-5L questionnaire (with permission from EuroQol).
The seven metrics provided by the EQ-5D questionnaire were evaluated (five domains, an index score, and
a Visual Analogue Scale/VAS score).

Surgical technique
The surgical techniques used by the Relimb unit are based on Kuiken and Dumanian’s description of TMR
[12]
[13]
surgery and these have been described previously .
Statistical analysis
A statistical analysis was performed with IBM SPSS Statistics (IBM Corporation, Armonk, New York, USA).
The NRS data were evaluated using the Wilcoxon Signed Rank Test, identifying any changes pre and post-
surgical intervention. The EQ-5D VAS data were analysed using a paired sample t-test, evaluating HRQoL
pre and post-surgical intervention.

RESULTS
A total of 15 patients completed the evaluation. The mean age of the study participants was 55.8 years, and
five of the 15 participants were female (33%). All patients underwent TMR surgery between October 2013
and September 2021. The indication for TMR in these patients was for secondary treatment of NP or
residual limb pain (RLP) and/or PLP, sequelae of upper limb amputation. As such, TMR surgery was
offered to our patients several years after their initial amputation surgery.

The data show a statistically significant reduction in both PLP (pre-operative mean: 7.6, post-operative
mean: 2.7, P < 0.05) and NP (pre-operative mean: 6.4, post-operative mean: 2.5, P < 0.05) [Figure 1].

Table 1 demonstrates the changes in score across each of the EQ-5D domains. The green colour denotes an
improvement in a domain and red denotes a reduction in domain function. A total of 12 patients
experienced a change in their EQ-5D domains. Nine patients noted improvements and five patients noted
reductions in functionality.

Ten of the 11 patients reporting changes in pain as part of their EQ-5D found an improvement in this
domain. Changes in HRQoL were observed for the EQ-VAS scale, and these demonstrate an improvement
in quality of life from 68 pre-operatively to 78 post-procedure (P < 0.05).

DISCUSSION
In many instances since 2008, the evaluation of the quality of life has been based on the EQ-5D, Euroqol
questionnaires . Ernstsson and colleagues evaluated the use of EQ-5D questionnaire to assess HRQoL
[14]
following lower limb amputation surgery. They highlight the correlation between factors such as pain due to
NP/RLP or PLP, reduced mobility and impaired activities of daily living with poor HRQoL. The authors
conclude that the EQ-5D-5L questionnaire has high validity and feasibility to assess HRQoL, particularly in
[15]
lower limb amputees . Globally, access to healthcare can be challenging due to limited resources,