Psychological Symptoms and Phantom Limb Pain as a Predictor of Prosthesis Implantation in Lower Limb Amputees: A 6-Month Prospective Study

Abstract Background: A limited number of retrospective studies evaluated the factors associated with prosthesis fitting. No study has explored the relationship between psychological disorders and phantom limb pain with prosthesis fitting in lower limb amputees. Methodology: This longitudinal study recruited 100 eligible patients (out of 138) with lower limb amputation in an emergency trauma clinic. At the baseline, patients were evaluated for psychological disorders on the Hamilton Anxiety Depression scale, substance use, and cognitive impairment criteria as per DSM-5 and phantom limb pain as per the criteria given by Pare. At the 6-month follow-up, 100 patients completed the follow-up with or without successful prosthesis fitting. Results: The mean age of patients was 37.7 years (14.6), with a mean number of years of education of 8.1 (standard deviation = 4.3). Majority were males (87.0%), married (70%), of middle socioeconomic status (83%), and were on paid employment (95.0%). Half of them were from rural areas (53%) and from nonnuclear families (61%). Most of them presented with roadside traffic injury (86%) and with Grade 3c wounds (73%). 60% had below-knee amputation (60%). Presence of anxiety ( P = 0.013) and depression ( P = 0.032), presence of phantom limb pain ( P = 0.022), and presence of substance use disorder ( P = 0.011) were found to be significant predictors of not being able to get the prosthesis at 6 months. Conclusion: Presence of depression, anxiety, phantom limb pain, and substance use at the baseline had a negative impact on prosthesis fitting at 6 months. Emphasis should be placed on more supportive sessions, including evidence-based treatment for patients with the presence of psychological disorders, phantom limb pain, and substance use.