Long-Term Functional Outcomes and Quality of Life After Major Limb Amputation in Nigeria: A Multi-Centre Prospective Study With Patient-Reported Outcome Measures

Major limb amputation represents a life-altering surgical outcome that demands rigorous longitudinal evaluation of functional recovery, prosthetic rehabilitation access, psychological adjustment, and quality of life, yet no multi-centre prospective outcome study exists for the Nigerian context across geopolitical zones. This study examines the long-term functional outcomes and quality of life of adults following major limb amputation at six tertiary hospitals across all geopolitical zones over a 36-month prospective follow-up period. A prospective cohort of 500 adult major limb amputation patients (upper and lower extremity) is enrolled at six sites and followed at 1, 6, 12, 24, and 36 months. Primary outcomes are assessed using the SF-36v2 health-related quality of life instrument, the Trinity Amputation and Prosthetics Experience Scale, and the Timed Up and Go Test for mobility. Secondary outcomes include prosthetic provision rate, return to employment or productive activity, depressive symptom burden using the PHQ-9, pain intensity, and stump complication rates. Multilevel linear mixed-effects models in Stata estimate functional trajectory, with predictors including amputation level, aetiology, prosthetic access, social support, and pre-amputation functional status. The International Classification of Functioning, Disability and Health and Lazarus Coping Theory provide the analytical framework. Original contributions include the first multi-centre longitudinal patient-reported outcome study after major amputation in Nigeria, generating normative data for rehabilitation service planning. Findings will inform the Federal Ministry of Health on prosthetic provision policy and amputee rehabilitation service standards. Keywords: limb amputation, quality of life, patient-reported outcomes, prosthetic rehabilitation, Nigeria.