Pain and health-related quality of life for children with lower limb absence: An exploratory study.

ObjectiveTo investigate health-related quality of life, pain, socket comfort and residual limb conditions in children with lower limb absence.DesignThis is a cross-sectional study with patient-reported outcomes measures collected from children with congenital and acquired lower limb absence. Outcomes included health-related quality of life, body pain mapping, socket comfort score and clinical evaluation of the residual limb. Effects of age, prosthetic technology, school attendance and pain on health-related quality of life and socket comfort were investigated.SettingData from 31 children were collected in prosthetic centres in the UK (N = 15) and Cambodia (N = 16).ResultsThis cohort had a clinically important reduction in health-related quality of life compared to normative data (Δ = 13.21). Psychosocial health declined with age (ρ = -0.394, p = 0.014). Low intensity pain in the residual limb, back and intact joints was frequent and negatively correlated with health-related quality of life (ρ = -0.327, p = 0.036). Socket comfort was positively correlated with physical well-being (ρ = 0.398, p = 0.013). Unplanned emergency amputations resulted in worse residual limb outcomes than planned surgeries (p = 0.02).ConclusionThis cohort experience significant, under-addressed challenges in physical and mental well-being. Declining mental well-being underscores the urgent need for age-appropriate psychological support that addresses the evolving social and emotional demands of growing up with a disability. The prevalence of widespread pain highlights the need for targeted gait training and improved prosthetic fit and design. Poorer residual limb health outcomes following emergency amputations reinforce the importance of paediatric-specific surgical and post-operative protocols. Holistic, child-centred care integrating physical, psychological and social support is essential.