Gender differences in physical and psychological outcomes after lower limb amputation in Iran: A comparative and mediation analysis study.

Abstract

This study investigates gender differences in mobility, quality of life (QoL), and self-esteem among individuals with unilateral lower limb amputation in Iran, with a focus on mediating roles of education, self-esteem, and time since amputation. In this cross-sectional study, 100 participants (52 women, 48 men) completed validated measures assessing locomotor function locomotion capability index, QoL (12-item short form survey), and self-esteem (Rosenberg Self-Esteem Scale). The sample consisted of 100 individuals (52 women, 48 men) with 44 ± 16 mean age for women and 45 ± 15 years for men. Mean years of education was 9.36 years an average duration of 13.32 years since amputation. Regarding the level of amputation, most participants had below-knee amputations (61%), followed by above-knee (21%), knee (11%), ankle (5%), and hip (2%) amputations. The primary causes of amputation were trauma (57%). Although no significant gender differences were found in mobility or overall QoL, women reported significantly lower self-esteem than men. Higher education levels were linked to enhanced self-esteem and better QoL. Mediation analyses revealed that gender influenced QoL indirectly through self-esteem, education, and time since amputation. Specifically, self-esteem was a key mediator linking gender to mental health outcomes, with women's lower self-esteem associated with reduced QoL. These findings suggest that cultural and societal factors in Iran may disparately affect women's psychological adjustment to amputation. The study highlights the importance of gender-sensitive rehabilitation strategies that address self-esteem and other aspects of psychosocial well-being for women with amputation in Iran.