Functional Outcomes Following Amputation in Electrical Burn Injuries: A Prospective Observational Study Utilizing the Sickness Impact Profile (SIP) and International Classification of Impairments, Disabilities, and Handicaps (ICIDH) Frameworks

Background and aim Electrical burns represent a severe injury subtype with disproportionately high rates of limb amputation. While amputation may be life-preserving, its impact on long-term function remains inadequately characterized in low-resource settings. This study aimed to prospectively evaluate functional outcomes following amputation in electrical burn patients using validated instruments and identify modifiable predictors of disability. Methods A prospective observational study was conducted from July 2024 to July 2025 at a tertiary burn center. Forty-nine consecutive patients (>12 years) undergoing amputation for electrical burns were enrolled. Exclusion criteria included crush injury mechanisms, preexisting neurovascular comorbidities, chronic kidney disease, and mortality during treatment. The primary outcome was functional status at three months postamputation, assessed using the validated Sickness Impact Profile (SIP) and a content-validated International Classification of Impairments, Disabilities, and Handicaps-based questionnaire developed from the International Classification of Functioning, Disability and Health core sets for upper limb amputation. Statistical analysis employed IBM SPSS Statistics for Windows, version 26.0 (released 2018; IBM Corp., Armonk, NY, USA). Results The cohort comprised 35 males (71.4%) and 14 females (28.6%), with a mean age of 29.2 ± 10.7 years. High-voltage injuries (>1000 V) accounted for 41 cases (83.7%). Amputation levels included below elbow in 26 patients (53.1%), bilateral/above elbow in 12 patients (24.5%), and digit disarticulations in eight patients (16.3%). SIP scores demonstrated a gradient inversely related to preserved limb length: bilateral/above elbow (36.8 ± 6.5), below elbow (23.1 ± 4.8), and digit disarticulations (17.3 ± 1.9; p < 0.001). High-voltage injuries correlated with significantly higher SIP scores vs. low-voltage injuries (26.8 ± 6.5 vs. 17.3 ± 1.9, p < 0.001). Multivariate analysis identified preoperative anemia (hemoglobin <10 g/dL; β = +3.1, p = 0.047) and poor patient motivation (β = +4.3, p = 0.031) as independent predictors of worse functional outcomes. Conclusions Amputation level and injury voltage are primary determinants of postamputation disability. Preoperative anemia and psychological state were associated with worse functional outcomes, suggesting they may be targets for preoperative optimization pending interventional validation. These findings suggest that integrated care pathways incorporating preoperative optimization warrant prospective evaluation and structured psychosocial rehabilitation. Limitations include a modest sample size (n = 49) from a single center, which may limit generalizability and precision of subgroup estimates.