###### Abstract  
Background. Assessing the patient's perceived body image is essential to measure the impact of lower limb amputation on quality of life and psychological well-being. Objective. The aim of this study was to develop a Spanish version of the Amputee Body Image Scale (ABIS-E) for Spanish-speaking lower limb amputees. Methods. A cross-sectional study was conducted including amputee patients in Madrid, Spain. Clinical outcomes of body image (Amputee Body Image Scale, ABIS), health-related quality of life (EuroQol-5D-5L), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), pain (Brief Pain Inventory-Short Form, BPI-SF), and functional capacity (Prosthesis Evaluation Questionnaire, PEQ) were collected. Results. Seventy-three participants were assessed. Excellent test-retest reliability (ICC = 0.847) and good internal consistency (Cronbach's alpha = 0.753) were obtained. Factor analyses extracted three factors. Convergent validity with [PERSON]'s and [PERSON]'s correlation coefficients were calculated for depression and anxiety questionnaires (HADS) (values between 0.57 and 0.67), functional capacity (PEQ) (values between \(-\)0.35 and 0.71), and quality of life (EQ-5D-5L) (values between \(-\)0.37 and 0.61). Conclusions. The ABIS-E is a reliable and valid instrument to measure body image in the Spanish population with lower limb amputation, potentially useful in primary care to identify psychosocial problems. amputation; body image; validation study; reproducibility of results +
Footnote †: journal:In addition, the amputation has an important emotional, psychological, and perceptual impact due, among other reasons, to the loss of body image, understood as the appreciation of one's own body and its appearance [6]. It can be understood as a dynamic concept influenced by internal perceptions, social interactions, and environmental factors [7]. This disappointment with self-image (anatomy alignment, perceived beauty, and movement possibilities) is significantly associated with depression and generalized anxiety, a poor perception of quality of life and self-esteem, low prosthetic acceptance, and lower participation in physical activities [8]. The presence of depression in amputee patients has been widely investigated--prevalence rates are between 20.8 and 45%. Palliating this situation is a crucial factor in achieving successful rehabilitation, as it can compromise functional recovery [9]. Typically, patients with post-amputation wounds after lower extremity amputation are discharged home from hospital and are primarily managed in the primary care setting by nurses who support the patient's transition to stability and normality. Effective primary care wound management as part of the continuum of care is, therefore, essential for patients' physical and psychosocial recovery. Several recent qualitative studies have explored issues related to patient mobility, focusing on the perceptions of reduced functionality and complicated prosthesis fitting by people living with amputation [10; 11; 12]. These issues highlight the challenge and complexity of the rehabilitation phase of major amputations after wound healing [13]. Moreover, [PERSON] and [PERSON] [14] revealed that a lack of social support is associated with a poor perception of quality of life and an increase in depressive symptoms. For these reasons, assessing accommodation to a different body image may be a way to measure psychosocial adaptation to amputation [14] and, thus, a surrogate for the other factors involved. It is indeed under the hypothesis of a relationship between body image and psychosocial well-being that the Amputee Body Image Scale (ABIS), a self-administered questionnaire [5], was developed to assess the body image of the amputee patient from their own perspective. [PERSON]'s original study [6] showed a Cronbach's alpha of 0.88 and good and significant concurrent validity with scales of anxiety, depression, self-esteem, and life satisfaction. It is currently validated in French, Chinese, Turkish, and Portuguese [8; 15; 16; 17].