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A Qualitative Study of Factors Influencing the Decision to Have an Elective Amputation
Deanna L. Quon, MD; Nancy L. Dudek, MD, MEd, FRCPC; Meridith Marks, MD, MEd, FRCPC; Michael Boutet, MA; Lara Varpio, PhD
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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The Ottawa Hospital Rehabilitation Centre, 505 Smyth Road, Rooms 1200 (D.L.Q.), 1105D (N.L.D.), 1200 (M.M.), Ottawa, ON K1H 8M2, Canada. E-mail address for D.L. Quon: dquon@ottawahospital.on.ca
Academy for Innovation in Medical Education (AIME), Faculty of Medicine, University of Ottawa, 451 Smyth Road, Rooms 2211 (M.B.) and 2156 (L.V.), Ottawa, ON K1H 8M5, Canada
Investigation performed at the Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 16;93(22):2087-2092. doi: 10.2106/JBJS.J.01998
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Some patients with a functionally impaired lower limb choose to have an elective amputation, whereas others do not. Functional outcomes do not favor either type of treatment, making this a complex decision. The experiences of patients who have chosen elective amputation were analyzed to identify the key factors in this decision-making process.


Patients from a tertiary care amputee clinic who had chosen to undergo elective amputation of a functionally impaired lower limb participated in the present study. A qualitative research design involved the use of one-on-one semi-structured interviews, which were audio recorded and transcribed. Narrative analysis was used by three researchers to provide triangulation. Recurrent key themes and patterns were described. Personal factors in the decision-making process were identified.


Factors that had the largest impact on the decision-making process were pain, function, and participation. Body image, self identity, and the opinions of others had little influence. Satisfaction with the surgical outcome was related to how closely the result matched the patient's expectations. Patients who were better informed prior to surgery had more realistic expectations about living with an amputation.


The severity of pain and the desire for improved function are strong drivers for patients deciding to undergo elective amputation of a functionally impaired lower extremity. While patients do not want others’ opinions, information regarding life with an amputation helps to set realistic expectations regarding outcome.

Clinical Relevance: 

Health-care professionals can assist patients facing this decision by providing realistic information regarding life with an amputation. Connecting these patients to peers with amputations can supplement information provided by professionals.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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