This paper discusses the quality of life, the level of acceptance of the illness, and the nutritional status of patients after amputation due to diabetic foot. In 2016 Gau et al assessed the nutritional status of the patients after amputation due to diabetic foot and concluded that the mean MNA score was 20.6 ± 3.4, which corresponded to the group of patients "at risk of malnutrition" . Their results were similar to ours, which was 22.66 ± 3.0, and also meant being - at risk of malnutrition. According to Gau et al’s research, age was an independent factor influencing nutritional status (p = 0.015). In the current study age also proved to be significantly associated with nutritional status (p = 0.013). The older the patient was, the more malnourished they were.
Cwajda-Białasik et al revealed that patients with lower limb ulcerations of a mainly vascular (venous, arterial or mixed – arteriovenous) etiology, including diabetic foot, moderately accepted their disease (the mean AIS score was 23.5 ± 8.15) . Yet in comparison the mean AIS score was 27.65 ± 8.3 in our study. What is more, Cwajda-Białasik et al showed that men (score 29.48 ± 7.11) accepted the disease better than women (score 27.09 ± 8.59), which is in line with the results of the current study. Cwajda-Białasik et al also showed that other socio-demographic factors, such as: age, place of living, marital status or education, did not significantly influence the acceptance of the illness. However, in the current study it was proved that there was a statistical correlation between age and acceptance of illness.
In our paper p-value of the association between gender and somatic domain of QoL was 0.081, so it had a tendency to statistical significance. We believe it could reach statistical significance with a larger sample.
Many researchers have shown that the quality of life of diabetic amputees in the physical domain is worse than QoL in the social domain. Using the SF-36 questionnaire Aprile et al showed that QoL in the physical domain (mean value was 39.5) was worse in comparison with QoL in the social domain (mean value was 52.5) . In the current study QoL (in the social domain) was 64.48 compared to 54.69 for QoL (in the physical domain). Using the SF-36 questionnaire, Boutoille et al revealed that QoL in the physical domain (mean score was 55) was worse than QoL in the mental domain (mean score was 61) . The respondents reported the highest QoL in the environmental domain (score 69). Similarly, in the present study the QoL in the physical domain (mean value 54.69) was worse than QoL in the mental domain (mean value 59.61) or QoL in the environmental domain (mean value 63.04).
Ribu et al found that the QoL in the mental domain was significantly worse in women than in men (p < 0.05) . In the current study, the mean score of QoL in the mental domain for women (mean score 58.86) was worse than that for men (mean score 62.09). However, there was not statistical correlation between gender and all the domains of QoL (p > 0.05). On the contrary, Cox et al found that females were more likely to cope and function better with the disability than males . De Godoy et al. compared the QoL between amputees and control normal subjects and have found that the amputees were worse in six out of the eight domains, suggesting an unsatisfactory QoL of these patients . This study confirms how much the mutilation affects the QoL of these patients. Patel et al demonstrated that minor amputation did not impact the physical or mental QoL . The authors concluded that QoL is comparable with a normalized population if limb salvage is successful and QoL is decreased significantly when failure to walk occurs. Quigley et al indicated that amputation, regardless of level, appeared to have little impact upon QoL, and QoL was negatively affected by the long-term complications associated with diabetes .
In 2012 Kurpas et al examined the level of acceptance of illness in a group of diabetic patients, including diabetic amputees, and revealed a mean AIS score of 29 . In the current study, the mean AIS score was 27.65 ± 8.3. What is more, Kurpas et al proved the correlation between the acceptance of illness and quality of life. Similarly to our study, the better the acceptance of illness was, the better the quality of life was in all the domains.
In our paper p-value of the association between the nutritional status and the acceptance of the disease was 0.062, so it had a tendency to statistical significance. We believe it could reach statistical significance with a larger sample.
In the literature there are no papers focusing of the connection between acceptance of illness and nutritional status nor the connection between nutritional status and quality of life in diabetic amputees. Therefore, there is still a need to conduct the further studies. Diabetes and its complications, such as diabetic foot and the threatened consequent amputation, constitute a real challenge which lowers the quality of life of patients.
STUDY LIMITATIONS. The study group was not numerous. The study was a single-center analysis that did not reflect the general Polish population. The impact of some variables (e.g. muscle strength, daily activity, NYHA grades, or co-morbidities) on QoL, AIS and MNA was not evaluated. Future randomized and large studies should focus on quality of life after lower limb amputations.