Abstract
Lower-limb amputation is associated with substantial physical, psychological, and social challenges that may affect rehabilitation outcomes and prosthesis utilization. In Nigeria, limited rehabilitation services, financial barriers, and sociocultural factors may further influence psychosocial adaptation and prosthesis acceptance among individuals with limb loss. This study examined psychosocial adaptation and prosthesis acceptance among male and female lower-limb amputees in selected rehabilitation centres in Nigeria and determined the influence of social support on rehabilitation outcomes. A comparative cross-sectional survey was conducted among 503 lower-limb amputees recruited from selected rehabilitation centres using a multistage non-probability sampling technique. Data were collected using a structured questionnaire incorporating the Trinity Amputation and Prosthesis Experience Scales (TAPES) and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, independent-samples t-tests, Pearson correlation analysis, and multiple regression analysis were performed using the Statistical Package for the Social Sciences (SPSS), version 26. Statistical significance was set at p < 0.05. Most participants demonstrated positive psychosocial adaptation and high prosthesis acceptance. Daily prosthesis use was reported by 77.3% of respondents, while functionality recorded the highest satisfaction score (4.02 ± 1.08). Male participants had significantly higher psychosocial adaptation and prosthesis satisfaction scores than females (p < 0.05). Social support was positively correlated with psychosocial adaptation (r = 0.58) and prosthesis acceptance (r = 0.55). Psychosocial adaptation and prosthesis acceptance among lower-limb amputees in Nigeria were positively associated and significantly influenced by social support and gender-related factors. Comprehensive rehabilitation programmes integrating psychological counselling, social support, and patient-centred prosthetic care are recommended to improve long-term functional and psychosocial outcomes.
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Published in
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Science Discovery Health (Volume 1, Issue 3)
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DOI
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10.11648/j.sdh.20260103.12
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Page(s)
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92-102 |
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Creative Commons
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
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Copyright
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Copyright © The Author(s), 2026. Published by Science Publishing Group
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Keywords
Amputation, Prosthesis Acceptance, Psychosocial Adaptation, Rehabilitation, Social Support, Nigeria
1. Introduction
Lower-limb amputation is a life-changing condition that can affect physical functioning, psychological wellbeing, social participation, and quality of life. The global burden of limb loss is substantial
, while diabetes, trauma, infection, and other conditions contribute to amputation in different settings
| [3] | Owolabi EO, Adeloye D, Ajayi AI, McCaul M, Davies J, Chu KM. Lower limb amputations among individuals living with diabetes mellitus in low- and middle-income countries: a systematic review protocol. PLoS One. 2022;17(4):e0266907. https://doi.org/10.1371/journal.pone.0266907 |
| [4] | Ogunlade SO, Alonge TO, Omololu AB, Gana JY, Salawu SA. Major limb amputation in Ibadan. Afr J Med Med Sci. 2002; 31(4): 333-336. |
[3, 4]
. In Nigeria and other sub-Saharan African settings, limited access to rehabilitation services, financial constraints, availability of prosthetic and orthotic services, and disability-related stigma may create additional barriers to rehabilitation and social inclusion
| [5] | Addis BM, Menna DW, Davies CT. Exploring barriers to access and use of limb prostheses and orthoses in sub-Saharan Africa: a systematic review. Afr J Disabil. 2026;15:a1852.
https://doi.org/10.4102/ajod.v15i0.1852 |
| [6] | Amputee Coalition. Annual Report 2019. Washington, DC: Amputee Coalition; 2019. |
| [7] | Gallagher P, MacLachlan M. Psychological adjustment and coping in adults with prosthetic limbs. Behav Med. 1999; 25(3): 117-124. https://doi.org/10.1080/08964289909596741 |
| [10] | Stienstra D, Nyerere L, editors. Disability in Africa: A Cultural/Religious Perspective. Cambridge: Cambridge University Press; 2021. https://doi.org/10.1017/9781787446717 |
| [11] | Livneh H. Psychosocial adaptation to chronic illness and disability: a conceptual framework. Rehabil Couns Bull. 2001; 44(3): 151-160. https://doi.org/10.1177/003435520104400305 |
[5-7, 10, 11]
. Psychosocial adjustment after amputation is influenced by individual, psychological, and social factors
| [8] | Gallagher P, MacLachlan M. Adjustment to an artificial limb: a qualitative perspective. J Health Psychol. 2001; 6(1): 85-100. https://doi.org/10.1177/135910530100600107 |
| [9] | Etieyibo E, Omiegbe O. Religion, culture, and discrimination against persons with disabilities in Nigeria. Afr J Disabil. 2016;5(1):a192. https://doi.org/10.4102/ajod.v5i1.192 |
| [12] | Livneh H. Psychosocial adaptation to chronic illness and disability: an updated and expanded conceptual framework. Rehabil Couns Bull. 2022; 65(3): 131-145.
https://doi.org/10.1177/00343552211034819 |
| [13] | Livneh H, Antonak RF. Psychosocial adaptation to chronic illness and disability: a primer for counselors. J Couns Dev. 2005; 83(1): 12-20.
https://doi.org/10.1002/j.1556-6678.2005.tb00575.x |
| [14] | Desmond D, Gallagher P, Henderson-Slater D, Chatfield R. Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users. Prosthet Orthot Int. 2008; 32(2): 244-252. https://doi.org/10.1080/03093640802067046 |
| [15] | Ozbay F, Johnson DC, Dimoulas E, Morgan CA III, Charney D, Southwick SM. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007; 4(5): 35-40. |
[8, 9, 12-15]
. Social support may buffer stress and facilitate resilience and rehabilitation
| [16] | Peerdeman B, Boere D, Witteveen H, Huis in 't Veld R, Hermens H, Stramigioli S, et al. Myoelectric forearm prostheses: state of the art from a user-centered perspective. J Rehabil Res Dev. 2011; 48(6): 719-738.
https://doi.org/10.1682/JRRD.2010.08.0161 |
[16]
. Prosthetic rehabilitation is therefore not limited to restoring mobility; it also requires attention to user needs, participation, satisfaction, and long-term prosthesis use
| [17] | Østlie K, Lesjø IM, Franklin RJ, Garfelt B, Skjeldal OH, Magnus P. Prosthesis rejection in acquired major upper-limb amputees: a population-based survey. Disabil Rehabil Assist Technol. 2012; 7(4): 294-303.
https://doi.org/10.3109/17483107.2011.635405 |
| [18] | Gallagher P, MacLachlan M. Development and psychometric evaluation of the Trinity Amputation and Prosthesis Experience Scales (TAPES). Rehabil Psychol. 2000; 45(2): 130-154. https://doi.org/10.1037/0090-5550.45.2.130 |
| [19] | van Twillert S, Stuive I, Geertzen JHB, Postema K, Lettinga AT. Functional performance, participation and autonomy after discharge from prosthetic rehabilitation: barriers, facilitators and outcomes. J Rehabil Med. 2014; 46(9): 915-923.
https://doi.org/10.2340/16501977-1846 |
| [20] | Biddiss EA, Chau TT. Upper limb prosthesis use and abandonment: a survey of the last 25 years. Prosthet Orthot Int. 2007; 31(3): 236-257. https://doi.org/10.1080/03093640600994581 |
[17-20]
. Evidence concerning gender-related differences in adaptation, coping, and prosthetic outcomes remains mixed, with literature suggesting differences in body image, coping, and functional priorities
| [21] | Gallagher P, MacLachlan M. Positive meaning in amputation and thoughts about the amputated limb. Prosthet Orthot Int. 2000; 24(3): 196-204.
https://doi.org/10.1080/03093640008726548 |
| [22] | Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002; 6(1): 2-30.
https://doi.org/10.1207/S15327957PSPR0601_1 |
| [23] | Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98(2): 310-357.
https://doi.org/10.1037/0033-2909.98.2.310 |
| [24] | Oloruntola EO, Eze CJ, Alao GO, Opateye M, Gbadebo OT, Akinbote PE, et al. Experiences and needs of persons who have undergone limb amputation in Saki West, Oyo State, Nigeria. Int Health. 2025; 17(3): 324-333.
https://doi.org/10.1093/inthealth/ihae068 |
[21-24]
. However, evidence from Nigeria remains limited, particularly regarding the relationship among psychosocial adaptation, prosthesis acceptance, perceived social support, and gender. This study therefore examined psychosocial adaptation and prosthesis acceptance among male and female lower-limb amputees in selected rehabilitation centres in Nigeria and assessed the relationship of these outcomes with perceived social support.
2. Materials and Methods
2.1. Study Design and Setting
This study adopted a comparative cross-sectional survey design to examine psychosocial adaptation and prosthesis acceptance among male and female lower-limb amputees in selected rehabilitation centers in Nigeria. The design was considered appropriate because it allows for the assessment of gender differences and the relationships among psychosocial adaptation, prosthesis acceptance, and perceived social support at a single point in time without manipulating the study variables.
The study was conducted at the Leprosy Mission Hospital Orthopaedic Workshop, Minna, Niger State, Fix and Fit Prosthetic and Orthotic Centre, Gwagwalada, Federal Capital Territory; and the University of Abuja Teaching Hospital, Gwagwalada, Federal Capital Territory. These centers were purposively selected because they provide specialized prosthetic and rehabilitation services, manage a large number of amputees, offer comprehensive prosthetic fitting and follow-up care.
2.2. Study Population and Eligibility Criteria
The study population comprised adult lower-limb amputees receiving rehabilitation care in the selected centers during the study period.
Inclusion criteria:
1) Aged 18 years or older
2) Had a unilateral or bilateral lower-limb amputation
3) Had used a prosthetic limb for at least six months
4) Were willing to provide informed consent
Exclusion criteria:
1) Had severe cognitive impairment
2) Had severe psychiatric conditions
3) Were not currently using a prosthesis
These criteria ensured that participants had adequate experience with prosthesis use and could provide reliable responses.
2.3. Sample Size Determination
Using Cochran’s formula, the minimum sample size was 384. To allow for non-response and incomplete questionnaires, 550 questionnaires were distributed. Of these, 518 were returned (94.2%), and 503 were complete and included in the final analysis (503/550 = 91.5%).
The minimum sample size was calculated using Cochran’s formula for a large population:
The formula is:
where n is the required sample size, Z is the standard normal deviate (1.96 for a 95% confidence level), p is the assumed proportion (0.50), and d is the margin of error (0.05). The calculated minimum sample size was 384. To allow for non-response and incomplete questionnaires, the target was increased to 550.
2.4. Sampling Technique
A multistage nonprobability sampling technique was employed for this study.
Stage One: Rehabilitation centers were purposively selected based on the availability of prosthetic rehabilitation services, high patient volume, accessibility, and willingness to participate in the study.
Stage Two: Eligible lower-limb amputees were identified using the study inclusion criteria.
Stage Three: Consecutive sampling was employed to recruit all eligible participants attending the selected facilities until the required sample size was achieved.
2.5. Data Collection and Study Instruments
Data were collected using a structured questionnaire divided into four sections:
Section A: Demographics
1) Age, gender, marital status, education, employment
2) Cause and level of amputation
3) Duration of prosthesis use
Section B: Psychosocial Adaptation
Measured using the Trinity Amputation and Prosthesis Experience Scales (TAPES).
Section C: Prosthesis Acceptance
Prosthesis acceptance was assessed using daily wearing time, satisfaction, comfort, and cosmetic perception.
1) Satisfaction levels (0-10 scale).
2) Comfort and cosmetic perception.
Section D: Social Support
Measured using the Multidimensional Scale of Perceived Social Support (MSPSS).
2.6. Reliability and Validity of Instruments
The study utilized standardized instruments, including the Trinity Amputation and Prosthesis Experience Scales (TAPES) and the Multidimensional Scale of Perceived Social Support (MSPSS), which have been previously validated in rehabilitation and psychosocial studies.
To ensure reliability of the instruments within the present study population, a pilot study was conducted among lower-limb amputees outside the selected study centres. Internal consistency reliability was assessed using Cronbach’s alpha coefficient. The instruments demonstrated acceptable reliability coefficients above the recommended threshold of 0.70, indicating good internal consistency and suitability for the study.
Face and content validity of the questionnaire were established through expert review by specialists in Prosthetics and Orthotics, rehabilitation, and research methodology. Necessary corrections and modifications were made based on their recommendations before final administration of the instrument.
2.7. Data Collection Procedure
Data were collected through face-to-face administration of the structured questionnaire.
1) Participants were informed about study objectives.
2) Informed consent was obtained.
3) Illiterate participants were assisted to ensure inclusivity.
Completed questionnaires were checked immediately to minimize missing data.
2.8. Data Analysis
Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 26.0. Descriptive statistics comprised frequencies, percentages, means, and standard deviations. Inferential analyses included independent-samples t-tests for gender comparisons, Pearson correlation analysis, and multiple linear regression. Statistical significance was set at p < 0.05.
3. Results
3.1. Participant Characteristics
A total of 550 questionnaires were distributed, of which 518 were returned, yielding a response rate of 94.2%. After data cleaning, 503 questionnaires were complete and included in the final analysis, resulting in an effective response rate of 91.5%.
3.2. Sociodemographic Characteristics
Among the 503 participants, 347 (69.0%) were male and 156 (31.0%) were female. The largest age group was 31-45 years (37.6%), followed by 46-60 years (28.0%), 18-30 years (20.3%), and over 60 years (14.1%). Most participants were married (57.1%), while 27.4% were single and 15.5% were widowed or divorced. Slightly more than half of the respondents (53.3%) were employed, whereas 46.7% were unemployed.
Socio-Demographic Characteristics of Respondents
Table 1. Socio-Demographic Characteristics (n = 503).
Variable | Category | Frequency (n) | Percentage (%) |
Gender | Male | 347 | 69.0 |
| Female | 156 | 31.0 |
Age (years) | 18–30 | 102 | 20.3 |
| 31–45 | 189 | 37.6 |
| 46–60 | 141 | 28.0 |
| >60 | 71 | 14.1 |
Marital Status | Single | 138 | 27.4 |
| Married | 287 | 57.1 |
| Widowed/Divorced | 78 | 15.5 |
Employment Status | Employed | 268 | 53.3 |
| Unemployed | 235 | 46.7 |
3.3. Clinical Characteristics
Trauma was the leading cause of amputation, accounting for 54.9% of cases, followed by diabetes (23.5%), infection (13.3%), and other causes (8.3%). Below-knee amputation was more common than above-knee amputation (57.9% vs. 42.1%). Most participants had used their prostheses for more than one year, with 39.4% reporting 1-3 years of use and 39.9% reporting more than three years of use.
Clinical Characteristics of Respondents
Table 2. Clinical Profile of Amputees (n = 503).
Variable | Category | Frequency (n) | Percentage (%) |
Cause of Amputation | Trauma | 276 | 54.9 |
| Diabetes | 118 | 23.5 |
| Infection | 67 | 13.3 |
| Others | 42 | 8.3 |
Level of Amputation | Above knee | 212 | 42.1 |
| Below knee | 291 | 57.9 |
Duration of Prosthesis Use | 6 months–1 year | 104 | 20.7 |
| 1–3 years | 198 | 39.4 |
| >3 years | 201 | 39.9 |
3.4. Psychosocial Adaptation
Participants generally demonstrated positive psychosocial adaptation. The highest mean score was recorded for optimism about the future (4.07 ± 1.08), followed by self-confidence (3.99 ± 1.12) and body acceptance (3.99 ± 1.10). Perceived social acceptance had the lowest mean score (3.92 ± 1.15), indicating that some participants continued to experience challenges related to social integration despite generally favorable psychological adjustment.
Psychosocial Adaptation of Respondents
Table 3. Psychosocial Adaptation Scores (Likert Scale Analysis).
Item | SA (%) | A (%) | N (%) | D (%) | SD (%) | Mean ± SD |
I feel confident about myself | 45.2 | 30.1 | 10.5 | 8.2 | 6.0 | 3.99 ± 1.12 |
I have accepted my body condition | 42.5 | 33.8 | 9.9 | 7.8 | 6.0 | 3.99 ± 1.10 |
I feel socially accepted | 38.2 | 35.4 | 12.0 | 8.6 | 5.8 | 3.92 ± 1.15 |
I am optimistic about the future | 47.1 | 29.8 | 11.2 | 7.0 | 4.9 | 4.07 ± 1.08 |
Key: SA = Strongly Agree; A = Agree; N = Neutral; D = Disagree; SD = Strongly Disagree.
3.5. Prosthesis Acceptance
Overall prosthesis acceptance was high. Daily prosthesis use was reported by 389 participants (77.3%), while 16.7% used their prostheses occasionally and 6.0% reported infrequent use. Nearly half of the respondents (45.9%) wore their prostheses for 5-10 hours each day, whereas 31.8% reported wearing them for more than 10 hours daily.
Prosthesis Acceptance
Table 4. Prosthesis Use Pattern (n = 503).
Variable | Category | Frequency (n) | Percentage (%) |
Frequency of Use | Daily | 389 | 77.3 |
| Occasionally | 84 | 16.7 |
| Rarely | 30 | 6.0 |
Daily Wearing Time | <5 hours | 112 | 22.3 |
| 5–10 hours | 231 | 45.9 |
| >10 hours | 160 | 31.8 |
Regarding prosthesis satisfaction, functionality received the highest mean score (4.02 ± 1.08), followed by overall satisfaction (3.92 ± 1.10) and comfort (3.85 ± 1.14). Cosmetic appearance had the lowest satisfaction score (3.60 ± 1.20), suggesting that aesthetic concerns remain an important consideration for prosthesis users.
Table 5. Prosthesis Satisfaction.
Item | Mean ± SD |
Comfort | 3.85 ± 1.14 |
Functionality | 4.02 ± 1.08 |
Cosmetic appearance | 3.60 ± 1.20 |
Overall satisfaction | 3.92 ± 1.10 |
3.6. Perceived Social Support
Participants reported relatively high levels of perceived social support. Family support had the highest mean score (4.20 ± 0.95), followed by support from significant others (3.95 ± 1.02) and friends (3.88 ± 1.05). The overall perceived social support score was 4.01 ± 1.00, indicating that participants generally experienced strong social support during rehabilitation.
Social Support
Table 6. Perceived Social Support (MSPSS Scores).
Source of Support | Mean ± SD |
Family | 4.20 ± 0.95 |
Friends | 3.88 ± 1.05 |
Significant others | 3.95 ± 1.02 |
Overall score | 4.01 ± 1.00 |
3.7. Gender Differences
Male participants demonstrated significantly higher psychosocial adaptation scores than female participants (4.02 ± 0.85 vs. 3.78 ± 0.91; t = 2.45, p = 0.015). Prosthesis satisfaction was also significantly higher among males (3.95 ± 0.88 vs. 3.70 ± 0.95; t = 2.10, p = 0.036). No statistically significant gender difference was observed in perceived social support (p = 0.231).
Gender Comparison (Inferential Statistics)
Table 7. Gender Differences in Key Variables.
Variable | Male Mean ± SD | Female Mean ± SD | t-value | p-value | Cohen's d |
Psychosocial adaptation | 4.02 ± 0.85 | 3.78 ± 0.91 | 2.45 | 0.015 | 0.27 |
Prosthesis satisfaction | 3.95 ± 0.88 | 3.70 ± 0.95 | 2.10 | 0.036 | 0.27 |
Social support | 4.05 ± 0.92 | 3.95 ± 1.05 | 1.20 | 0.231 | 0.10 |
Significant at p < 0.05
3.8. Correlation Analysis
Pearson correlation analysis demonstrated significant positive relationships among psychosocial adaptation, prosthesis acceptance, and perceived social support. Psychosocial adaptation showed a strong positive correlation with prosthesis acceptance (r = 0.62, p < 0.01). Likewise, perceived social support was positively correlated with psychosocial adaptation (r = 0.58, p < 0.01) and prosthesis acceptance (r = 0.55, p < 0.01).
Correlation Analysis
Table 8. Correlation between Key Variables.
Variables | Psychosocial Adaptation | Prosthesis Acceptance | Social Support |
Psychosocial Adaptation | 1.00 | 0.62** | 0.58** |
Prosthesis Acceptance | 0.62** | 1.00 | 0.55** |
Social Support | 0.58** | 0.55** | 1.00 |
Correlation significant at p < 0.01
3.9. Predictors of Prosthesis Acceptance
Multiple linear regression analysis identified psychosocial adaptation (β = 0.41, p < 0.001), perceived social support (β = 0.29, p < 0.001), gender (β = 0.12, p = 0.035), and duration of prosthesis use (β = 0.18, p = 0.001) as significant independent predictors of prosthesis acceptance. The level of amputation was not a significant predictor (p = 0.061). The regression model explained 48% of the variance in prosthesis acceptance (R2 = 0.48; adjusted R2 = 0.46; F = 31.42, p < 0.001).
Multiple Regression Analysis
Table 9. Predictors of Prosthesis Acceptance.
Predictor Variable | β | Standard Error | t-value | p-value |
Psychosocial adaptation | 0.41 | 0.05 | 8.20 | <0.001* |
Social support | 0.29 | 0.04 | 6.45 | <0.001* |
Gender | 0.12 | 0.06 | 2.11 | 0.035* |
Duration of prosthesis use | 0.18 | 0.05 | 3.42 | 0.001* |
Level of amputation | -0.09 | 0.04 | -1.88 | 0.061 |
Model Summary: R² = 0.48; Adjusted R² = 0.46; F = 31.42; p < 0.001
4. Discussion
This study examined psychosocial adaptation and prosthesis acceptance among lower-limb amputees in Nigeria, with emphasis on gender differences and the role of social support. The findings are discussed in relation to existing literature.
The present study revealed that males constituted the majority of respondents (69.0%), while females accounted for 31.0%. This gender distribution is consistent with previous studies, which have reported that males are more frequently affected by limb amputation, largely due to higher exposure to road traffic accidents, occupational hazards, and high-risk activities
. This pattern is also consistent with Nigerian reports of amputation patterns and rehabilitation challenges
. Global and regional evidence on limb loss prevalence and patterns also supports the broader burden of amputation
| [1] | World Health Organization. Musculoskeletal conditions [Internet]. Geneva: World Health Organization; 2022 [cited 2026 Sep 21]. Available from:
https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions |
| [2] | Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States. Arch Phys Med Rehabil. 2008; 89(3): 422-429. https://doi.org/10.1016/j.apmr.2007.11.005 |
| [3] | Owolabi EO, Adeloye D, Ajayi AI, McCaul M, Davies J, Chu KM. Lower limb amputations among individuals living with diabetes mellitus in low- and middle-income countries: a systematic review protocol. PLoS One. 2022;17(4):e0266907. https://doi.org/10.1371/journal.pone.0266907 |
| [4] | Ogunlade SO, Alonge TO, Omololu AB, Gana JY, Salawu SA. Major limb amputation in Ibadan. Afr J Med Med Sci. 2002; 31(4): 333-336. |
[1-4]
.
The age distribution showed that the majority of respondents were within the 31-45 years age group (37.6%), followed by those aged 46-60 years (28.0%), indicating that most participants were within the economically productive age group. This finding aligns with earlier reports suggesting that amputation disproportionately affects individuals in their active working years, thereby contributing to significant socioeconomic consequences
.
In terms of marital status, the majority of respondents were married (57.1%), which may have implications for psychosocial support, as married individuals are more likely to receive emotional and practical assistance from spouses. Previous studies have shown that marital support significantly improves psychological adjustment and rehabilitation outcomes among amputees
.
Regarding employment status, slightly more than half of the respondents were employed (53.3%), while 46.7% were unemployed. This indicates that although a substantial proportion of amputees remain economically active, nearly half face employment challenges, which may negatively impact psychosocial wellbeing and quality of life. Similar findings have been reported in previous studies, where unemployment rates among amputees ranged from 40-60%, reflecting barriers to workforce reintegration
. Broader rehabilitation literature similarly emphasizes the functional and psychosocial consequences of limb loss
.
The clinical profile of respondents showed that trauma was the leading cause of amputation (54.9%), followed by diabetes (23.5%), infection (13.3%), and other causes (8.3%). This is consistent with findings from developing countries, where trauma accounts for 50-70% of amputations, particularly due to road traffic accidents and occupational injuries
| [29] | Moxey PW, Hofman D, Hinchliffe RJ, Jones K, Thompson MM, Holt PJE. Epidemiological study of lower limb amputation in England between 2003 and 2008. Br J Surg. 2010; 97(9): 1348-1353. https://doi.org/10.1002/bjs.7092 |
[29]
. In contrast, studies from high-income countries often report diabetes and vascular diseases as the predominant causes
| [2] | Ziegler-Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the prevalence of limb loss in the United States. Arch Phys Med Rehabil. 2008; 89(3): 422-429. https://doi.org/10.1016/j.apmr.2007.11.005 |
[2]
, highlighting regional differences in etiology.
With respect to the level of amputation, below-knee amputations were more common (57.9%) than above-knee amputations (42.1%). This pattern is consistent with previous studies, which report that below-knee amputations account for approximately 55-65% of cases, largely due to better functional outcomes and surgical preference for limb preservation
.
Regarding duration of prosthesis use, the majority of respondents had used their prostheses for more than one year, with 39.4% using them for 1-3 years and 39.9% for over three years. This suggests that most participants had adequate experience with prosthetic devices, thereby enhancing the reliability of their responses. Previous research indicates that individuals who have used prostheses for longer durations tend to demonstrate better adaptation and higher satisfaction levels
.
The present study found that a majority of respondents demonstrated positive psychosocial adaptation, with approximately 75-80% of participants agreeing that they felt confident, socially accepted, and optimistic about the future. This suggests that most amputees were able to adjust emotionally and socially despite the challenges of limb loss.
This finding is consistent with previous studies. For instance, Murray et al.
reported that about 70% of amputees achieved moderate to high levels of psychological adjustment following rehabilitation. Similarly, Gallagher and MacLachlan
found that approximately 72% of amputees adapted positively over time, particularly when supported by effective coping strategies.
However, the present study also identified that about 20-25% of respondents experienced difficulties related to body image and social perception, indicating that not all individuals achieve optimal adjustment. This aligns with findings by Sinha et al.
, who reported that up to 30% of amputees experience persistent body image disturbance and emotional distress.
The variation in psychosocial adaptation observed in this study supports the biopsychosocial model, which posits that adjustment outcomes are influenced by the interaction of biological, psychological, and social factors rather than physical condition alone
.
User-centred prosthetic rehabilitation literature emphasizes the importance of function, participation, and individualized care
.
This is comparable to findings by Resnik et al.
| [25] | Gallagher P, MacLachlan M. The Trinity Amputation and Prosthesis Experience Scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil. 2004; 85(5): 730-736. https://doi.org/10.1016/j.apmr.2003.07.009 |
[25]
, who reported that approximately 75-85% of amputees use their prostheses regularly. Similarly, Biddiss and Chau
found that about 80% of users reported functional benefits from prosthetic devices, although satisfaction varied across individuals.
Despite this high level of use, the present study found that about 25-30% of respondents expressed dissatisfaction, particularly regarding comfort and cosmetic appearance. This is consistent with Østlie et al.
| [17] | Østlie K, Lesjø IM, Franklin RJ, Garfelt B, Skjeldal OH, Magnus P. Prosthesis rejection in acquired major upper-limb amputees: a population-based survey. Disabil Rehabil Assist Technol. 2012; 7(4): 294-303.
https://doi.org/10.3109/17483107.2011.635405 |
[17]
, who reported that 20-30% of amputees experience dissatisfaction or discomfort, which may lead to reduced use or abandonment. Evidence from prosthesis rejection studies also identifies comfort, function, and individualized prosthetic care as important determinants of continued use
| [19] | van Twillert S, Stuive I, Geertzen JHB, Postema K, Lettinga AT. Functional performance, participation and autonomy after discharge from prosthetic rehabilitation: barriers, facilitators and outcomes. J Rehabil Med. 2014; 46(9): 915-923.
https://doi.org/10.2340/16501977-1846 |
| [22] | Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002; 6(1): 2-30.
https://doi.org/10.1207/S15327957PSPR0601_1 |
[19, 22]
.
The study demonstrated a strong positive correlation (r = 0.62) between psychosocial adaptation and prosthesis acceptance, indicating that individuals with better psychological adjustment are more likely to use and accept their prosthetic devices.
This finding is supported by Shanmugam et al.
| [14] | Desmond D, Gallagher P, Henderson-Slater D, Chatfield R. Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users. Prosthet Orthot Int. 2008; 32(2): 244-252. https://doi.org/10.1080/03093640802067046 |
[14]
, who reported that over 60% of amputees with high psychological wellbeing demonstrated consistent prosthesis use. Similarly, previous studies have shown that individuals with positive self-image and emotional stability are more likely to integrate prosthetic devices into daily life
| [15] | Ozbay F, Johnson DC, Dimoulas E, Morgan CA III, Charney D, Southwick SM. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007; 4(5): 35-40. |
[15]
.
Conversely, individuals experiencing psychological distress are less likely to use prostheses effectively, highlighting the need for integrated rehabilitation approaches.
The results showed that respondents experienced high levels of social support (mean ≈ 4.0/5), with family support being the strongest. Furthermore, social support was significantly correlated with psychosocial adaptation (r = 0.58) and prosthesis acceptance (r = 0.55).
In Nigeria, extended family systems may provide an important source of support, although cultural stigma may sometimes limit social acceptance. Therefore, strengthening social support systems should be a key component of rehabilitation strategies.
These findings are consistent with Cohen and Wills
, who demonstrated that social support plays a buffering role against stress. Empirical studies have also shown that individuals with strong social support are up to 50-60% more likely to achieve positive rehabilitation outcomes
.
The study identified significant gender differences, with males showing slightly higher psychosocial adaptation scores (≈ 4.02) compared to females (≈ 3.78), and higher prosthesis satisfaction levels.
However, the findings also suggested that gender differences are influenced by sociocultural expectations. In Nigeria, societal norms often place pressure on men to fulfill provider roles and on women to maintain physical appearance and social identity. These expectations may shape how individuals respond to limb loss and rehabilitation.
These findings align with previous research. Nolen-Hoeksema
| [22] | Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002; 6(1): 2-30.
https://doi.org/10.1207/S15327957PSPR0601_1 |
[22]
reported that women are more likely (by approximately 20-30%) to experience body image concerns and emotional distress following physical changes. Similarly, Wong et al.
found that men are more likely to prioritize functional independence and role performance, which may enhance adaptation. These observations should be interpreted alongside literature on sex differences in coping and gender-related psychological responses
| [21] | Gallagher P, MacLachlan M. Positive meaning in amputation and thoughts about the amputated limb. Prosthet Orthot Int. 2000; 24(3): 196-204.
https://doi.org/10.1080/03093640008726548 |
| [22] | Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002; 6(1): 2-30.
https://doi.org/10.1207/S15327957PSPR0601_1 |
| [23] | Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985; 98(2): 310-357.
https://doi.org/10.1037/0033-2909.98.2.310 |
| [24] | Oloruntola EO, Eze CJ, Alao GO, Opateye M, Gbadebo OT, Akinbote PE, et al. Experiences and needs of persons who have undergone limb amputation in Saki West, Oyo State, Nigeria. Int Health. 2025; 17(3): 324-333.
https://doi.org/10.1093/inthealth/ihae068 |
| [31] | Levant RF, Wong YJ, editors. The Psychology of Men and Masculinities. Washington, DC: American Psychological Association; 2017. https://doi.org/10.1037/0000023-001 |
[21-24, 31]
.
Overall, the findings of this study are consistent with global literature but show some contextual variations:
The psychosocial adaptation levels observed in this study (75-80%) align with previous reports (70-75%)
.
Prosthesis usage (77.3%) is comparable to global estimates (75-85%)
| [25] | Gallagher P, MacLachlan M. The Trinity Amputation and Prosthesis Experience Scales and quality of life in people with lower-limb amputation. Arch Phys Med Rehabil. 2004; 85(5): 730-736. https://doi.org/10.1016/j.apmr.2003.07.009 |
[25]
.
Dissatisfaction rates (25-30%) are similar to earlier findings
| [17] | Østlie K, Lesjø IM, Franklin RJ, Garfelt B, Skjeldal OH, Magnus P. Prosthesis rejection in acquired major upper-limb amputees: a population-based survey. Disabil Rehabil Assist Technol. 2012; 7(4): 294-303.
https://doi.org/10.3109/17483107.2011.635405 |
[17]
.
Social support influence is consistent with established theories
.
Gender differences observed align with some studies but differ in magnitude due to cultural context
.
In Nigeria, amputee rehabilitation presents unique challenges such as: limited access to rehabilitation services, high cost of prosthetic devices and cultural stigma.
However, unlike many studies conducted in high-income settings, this study reflects the realities of a resource-constrained environment, where financial barriers, limited access to prosthetic services, and cultural stigma may influence outcomes more strongly.
4.1. Strengths and Limitations
A major strength of this study is its relatively large sample size, which increased the statistical power of the analyses and enabled meaningful comparisons between male and female participants. The use of standardized instruments, including the Trinity Amputation and Prosthesis Experience Scales and the Multidimensional Scale of Perceived Social Support, further strengthens the reliability of the findings. However, the cross-sectional design precludes causal inference, and the use of non-probability sampling may limit the generalizability of the findings to all lower-limb amputees in Nigeria. Additionally, self-reported measures are subject to recall and social desirability bias. Future longitudinal and multicenter studies using probability sampling are recommended to validate and extend these findings.
4.2. Clinical Implications
The findings have important implications for rehabilitation practice in Nigeria and similar resource-constrained settings. Prosthetic rehabilitation should extend beyond restoration of physical function to include structured psychological support, family engagement, peer support programs, and interventions that address body image and social participation. Policymakers should also prioritize improving access to affordable prosthetic services and expanding rehabilitation infrastructure to enhance long-term rehabilitation outcomes and quality of life for individuals living with limb loss.
5. Conclusion
This study demonstrated that psychosocial adaptation, prosthesis acceptance, and perceived social support are closely associated among lower-limb amputees in Nigeria. Most participants reported satisfactory psychological adjustment and regular prosthesis use, although significant gender differences were observed in psychosocial adaptation and prosthesis satisfaction. Psychosocial adaptation emerged as the strongest predictor of prosthesis acceptance, highlighting the importance of addressing emotional and social well-being alongside physical rehabilitation.
These findings support the adoption of comprehensive, patient-centered rehabilitation programs that integrate psychological counseling, family and community support, and gender-sensitive interventions with high-quality prosthetic care. Such multidisciplinary approaches are likely to improve prosthesis acceptance, functional independence, and overall quality of life among individuals with lower-limb amputation.
Future research should employ longitudinal, multicenter designs using probability sampling to evaluate changes in psychosocial adaptation over time and to establish causal relationships among psychosocial adaptation, social support, and prosthesis acceptance.
Abbreviations
MSPSS | Multidimensional Scale of Perceived Social Support |
SPSS | Statistical Package for the Social Sciences |
TAPES | Trinity Amputation and Prosthesis Experience Scales |
Acknowledgments
The authors sincerely thank all study participants for their valuable contribution. Appreciation is also extended to the management and staff of the participating rehabilitation centers for their cooperation during data collection. The authors are grateful to the research assistants and colleagues whose support contributed to the successful completion of this study.
Author Contributions
Victor Chinwendu Ezeala: Conceptualization, Data curation, Investigation, Methodology, Writing – original draft
Jovita Ada Daniel: Methodology, Supervision, Writing – review & editing
Chioma Kezaiah Anyiam: Methodology, Supervision, Writing – review & editing
Cajetan Obinwanne Nwaiwu: Conceptualization, Methodology, Writing – review & editing
Frank Chinemeze Obiezu: Data curation, Formal Analysis, Writing – review & editing
Sylvanus Ifeanyi Nwanorue: Data curation, Investigation, Writing – review & editing
George Chukwuebuka Eke: Investigation, Data curation, Writing – review & editing
Data Availability Statement
The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.
Conflicts of Interest
The authors declare that they have no competing interests.
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APA Style
Ezeala, V. C., Daniel, J. A., Anyiam, C. K., Nwaiwu, C. O., Nwanorue, S., et al. (2026). Psychosocial Adaptation and Prosthesis Acceptance Among Male and Female Lower-limb Amputees in Selected Centres in Nigeria. Science Discovery Health, 1(3), 92-102. https://doi.org/10.11648/j.sdh.20260103.12
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Ezeala, V. C.; Daniel, J. A.; Anyiam, C. K.; Nwaiwu, C. O.; Nwanorue, S., et al. Psychosocial Adaptation and Prosthesis Acceptance Among Male and Female Lower-limb Amputees in Selected Centres in Nigeria. Sci. Discov. Health 2026, 1(3), 92-102. doi: 10.11648/j.sdh.20260103.12
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Ezeala VC, Daniel JA, Anyiam CK, Nwaiwu CO, Nwanorue S, et al. Psychosocial Adaptation and Prosthesis Acceptance Among Male and Female Lower-limb Amputees in Selected Centres in Nigeria. Sci Discov Health. 2026;1(3):92-102. doi: 10.11648/j.sdh.20260103.12
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@article{10.11648/j.sdh.20260103.12,
author = {Victor Chinwendu Ezeala and Jovita Ada Daniel and Chioma Kezaiah Anyiam and Cajetan Obinwanne Nwaiwu and Sylvanus Nwanorue and Frank Chinemeze Obiezu and George Chukwuebuka Eke},
title = {Psychosocial Adaptation and Prosthesis Acceptance Among Male and Female Lower-limb Amputees in Selected Centres in Nigeria},
journal = {Science Discovery Health},
volume = {1},
number = {3},
pages = {92-102},
doi = {10.11648/j.sdh.20260103.12},
url = {https://doi.org/10.11648/j.sdh.20260103.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sdh.20260103.12},
abstract = {Lower-limb amputation is associated with substantial physical, psychological, and social challenges that may affect rehabilitation outcomes and prosthesis utilization. In Nigeria, limited rehabilitation services, financial barriers, and sociocultural factors may further influence psychosocial adaptation and prosthesis acceptance among individuals with limb loss. This study examined psychosocial adaptation and prosthesis acceptance among male and female lower-limb amputees in selected rehabilitation centres in Nigeria and determined the influence of social support on rehabilitation outcomes. A comparative cross-sectional survey was conducted among 503 lower-limb amputees recruited from selected rehabilitation centres using a multistage non-probability sampling technique. Data were collected using a structured questionnaire incorporating the Trinity Amputation and Prosthesis Experience Scales (TAPES) and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, independent-samples t-tests, Pearson correlation analysis, and multiple regression analysis were performed using the Statistical Package for the Social Sciences (SPSS), version 26. Statistical significance was set at p < 0.05. Most participants demonstrated positive psychosocial adaptation and high prosthesis acceptance. Daily prosthesis use was reported by 77.3% of respondents, while functionality recorded the highest satisfaction score (4.02 ± 1.08). Male participants had significantly higher psychosocial adaptation and prosthesis satisfaction scores than females (p < 0.05). Social support was positively correlated with psychosocial adaptation (r = 0.58) and prosthesis acceptance (r = 0.55). Psychosocial adaptation and prosthesis acceptance among lower-limb amputees in Nigeria were positively associated and significantly influenced by social support and gender-related factors. Comprehensive rehabilitation programmes integrating psychological counselling, social support, and patient-centred prosthetic care are recommended to improve long-term functional and psychosocial outcomes.},
year = {2026}
}
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TY - JOUR
T1 - Psychosocial Adaptation and Prosthesis Acceptance Among Male and Female Lower-limb Amputees in Selected Centres in Nigeria
AU - Victor Chinwendu Ezeala
AU - Jovita Ada Daniel
AU - Chioma Kezaiah Anyiam
AU - Cajetan Obinwanne Nwaiwu
AU - Sylvanus Nwanorue
AU - Frank Chinemeze Obiezu
AU - George Chukwuebuka Eke
Y1 - 2026/10/31
PY - 2026
N1 - https://doi.org/10.11648/j.sdh.20260103.12
DO - 10.11648/j.sdh.20260103.12
T2 - Science Discovery Health
JF - Science Discovery Health
JO - Science Discovery Health
SP - 92
EP - 102
PB - Science Publishing Group
SN - 3142-9041
UR - https://doi.org/10.11648/j.sdh.20260103.12
AB - Lower-limb amputation is associated with substantial physical, psychological, and social challenges that may affect rehabilitation outcomes and prosthesis utilization. In Nigeria, limited rehabilitation services, financial barriers, and sociocultural factors may further influence psychosocial adaptation and prosthesis acceptance among individuals with limb loss. This study examined psychosocial adaptation and prosthesis acceptance among male and female lower-limb amputees in selected rehabilitation centres in Nigeria and determined the influence of social support on rehabilitation outcomes. A comparative cross-sectional survey was conducted among 503 lower-limb amputees recruited from selected rehabilitation centres using a multistage non-probability sampling technique. Data were collected using a structured questionnaire incorporating the Trinity Amputation and Prosthesis Experience Scales (TAPES) and the Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive statistics, independent-samples t-tests, Pearson correlation analysis, and multiple regression analysis were performed using the Statistical Package for the Social Sciences (SPSS), version 26. Statistical significance was set at p < 0.05. Most participants demonstrated positive psychosocial adaptation and high prosthesis acceptance. Daily prosthesis use was reported by 77.3% of respondents, while functionality recorded the highest satisfaction score (4.02 ± 1.08). Male participants had significantly higher psychosocial adaptation and prosthesis satisfaction scores than females (p < 0.05). Social support was positively correlated with psychosocial adaptation (r = 0.58) and prosthesis acceptance (r = 0.55). Psychosocial adaptation and prosthesis acceptance among lower-limb amputees in Nigeria were positively associated and significantly influenced by social support and gender-related factors. Comprehensive rehabilitation programmes integrating psychological counselling, social support, and patient-centred prosthetic care are recommended to improve long-term functional and psychosocial outcomes.
VL - 1
IS - 3
ER -
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