Environmental barriers and impact on quality of life in adults with lower limb loss in Canada

The purpose of this cross-sectional, web-based survey was to identify environmental barriers to accessibility experienced by people with lower limb loss and evaluate the association between environmental barriers and quality of life. Eligibility criteria include people aged 18 years old, have a major lower limb loss (at the ankle or above), greater than or equal to 3 months post-amputation surgery, using a prosthesis for mobility (beyond transfers), are no longer receiving prosthesis-related rehabilitation care, and understand English. Demographic and clinical characteristics were collected through self-report. Outcome measures collected were the Prosthesis Evaluation Questionnaire Mobility Scale, Perceived Environmental Barriers to Outdoor Mobility Scale, Craig Hospital Inventory of Environmental Factors, and WHO Quality of Life-Brief Questionnaire. Descriptive statistics summarized clinical, demographic, and survey variables. Simple linear regression modeling evaluated the association between environmental barriers and quality of life. Seventy-eight [mean age: 59.3 (14.0) years, 67% male, and 59% transtibial] individuals participated. A one-unit increase on the Craig Hospital Inventory of Environmental Factors Scale, indicating greater environmental barriers to mobility, was significantly associated with an 8.07 decrease on the WHO Quality of Life-Brief (95% confidence interval: -15.46 to -0.68, R2 = 0.38). A safe and barrier-free environment is crucial for accessibility following lower limb loss. Future research should enhance accessibility through collaboration among end users, clinicians, and policymakers to address the built environmental needs of this population.