Disability and quality of life in Canadian Aboriginal and non-Aboriginal diabetic lower-extremity amputees

Objective: To compare and contrast disability and quality of life (QOL) in Aboriginal and non-Aboriginal subjects with diabetes who had lower-extremity amputation (LEA) and were living in urban and rural communities in Canada. Design: Descriptive study using an interviewer-administered questionnaire and hospital medical record review. Setting: Tertiary care center. Participants: Forty-four diabetic subjects (minimum age, 18y) not receiving dialysis, including 21 Aboriginal (8 urban, 13 rural) and 23 non-Aboriginal (16 urban, 7 rural) subjects. Subjects were living in their current residence and had undergone LEA above the level of the ankle 6 months or more before interview. Interventions: Not applicable. Main Outcome Measures: Qualitative and quantitative data about symptoms, impairment, and QOL. Results: Aboriginal subjects were younger than non-Aboriginal subjects at the time of diabetes diagnosis (Aboriginal, 42 +/- 10y; non-Aboriginal, 52 +/- 14y; P <.005) and first major LEA (Aboriginal, 57 +/- 7y; non-Aboriginal, 64 +/- 11y; P <.015). All subjects received rehabilitation after amputation. More rural non-Aboriginal subjects (83%) used their prosthesis both in and outside the home for all movements than other subjects (P <.048). Rural non-Aboriginal subjects had the lowest and urban non-Aboriginal subjects had the highest frequency of walking-aid use outside the home. Assistance with personal care was required by a minority of subjects, but assistance with daily housework was required by the majority of subjects. Qualitative analysis revealed that participants were, in most cases, comfortable with their postamputation life. Conclusions: Although the majority of participants in this study generally felt satisfied with their current status, major functional changes were noted after LEA that had a large negative impact on QOL.