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Hutchison A, D'Cruz K, Ross P, Anderson S. Exploring the barriers and facilitators to community reintegration for adults following traumatic upper limb amputation: a mixed methods systematic review. Disabil Rehabil 2024; 46:1471-1484. [PMID: 37042419 DOI: 10.1080/09638288.2023.2200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/01/2023] [Indexed: 04/13/2023]
Abstract
PURPOSE Traumatic upper limb amputation (ULA) is a profound injury impacting participation in activities of daily living, including those within the community setting. The objective of this work was to review literature exploring barriers, facilitators, and experiences of community reintegration in adults following traumatic ULA. METHODS Databases were searched using terms synonymous with the amputee population and community participation. Study methodology and reporting were evaluated using McMaster Critical Review Forms, with a convergent segregated approach to synthesis and configuration of the evidence. RESULTS A total of 21 studies met the inclusion criteria, including quantitative, qualitative and mixed-method study designs. Restoring function and cosmesis with prostheses facilitated work participation, driving and socialisation. Positive work participation was predicted by male gender, younger age, medium-high education level and good general health. Work role and environmental modifications were common, as were vehicle modifications. Qualitative findings provided insight into social reintegration from a psychosocial perspective, particularly negotiating social situations, adjusting to ULA and re-establishing identity. The review findings are limited by the absence of valid outcome measures and clinical heterogeneity across the studies. CONCLUSION There is a dearth of literature on community reintegration following traumatic upper limb amputation, indicating a need for further research with strong methodological rigour.Implications for RehabilitationUpper limb amputation can restrict participation in activities in the community including work, socialisation, driving, leisure, and recreation.Clinicians can support community reintegration by addressing personal and environmental factors that both facilitate or inhibit participation in community activities.Prosthetics can be a facilitator for participation in community activities through the restoration of function and cosmesis.Clinicians can facilitate return to work through work modification recommendations or supported transitions to more suitable roles.
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Affiliation(s)
- Abby Hutchison
- La Trobe University, Melbourne, Victoria, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Kate D'Cruz
- La Trobe University, Melbourne, Victoria, Australia
| | - Pamela Ross
- Epworth Healthcare, Melbourne, Victoria, Australia
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Esfandiari E, Miller WC, King S, Ashe MC, Mortenson WB. A qualitative study of clinicians' and individuals' with lower limb loss perspectives on the development of a novel online self-management program. Disabil Rehabil 2024:1-10. [PMID: 38468472 DOI: 10.1080/09638288.2024.2326185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE To explore the rehabilitation preferences and experiences of clinicians and patients for education after lower limb loss to facilitate the development of an online self-management program. METHODS A qualitative descriptive approach was used. Thirty-one clinicians (physiotherapists, occupational therapists, and prosthetists), and 26 patients with lower limb loss (transtibial and transfemoral amputation; mean age (SD) of 63.3 (9.1), years) were recruited. We used semi-structured focus groups and one-on-one interviews, and audio recorded the interviews. Data were analyzed using conventional content analysis. RESULTS Three themes were identified: (1) Needing education in rehabilitation described the education in current practice as one-on-one discussion and booklets and highlighted the limitations of education such as its length, static nature, and inaccessible for patients living in remote areas. (2) Getting back to activities prior to amputation emphasized how goal setting and social support could assist patients and facilitate self-management. (3) Augmenting learning highlighted the need for an accessible complementary source for education and potential solutions to overcome the barriers of online delivery. CONCLUSIONS Our findings underscore the importance of education in the rehabilitation of patients to help them get back to their activities. An online accessible tool may improve education by providing information and peer support.
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Affiliation(s)
- Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
| | - William C Miller
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Sheena King
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
| | - W Ben Mortenson
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
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Wafi A, Ribeiro L, Kolli V, Azhar B, Budge J, Loftus IM, Holt PJE. Predicting Prosthetic Mobility at Discharge From Rehabilitation Following Major Amputation in Vascular Surgery. Eur J Vasc Endovasc Surg 2023; 66:832-839. [PMID: 37734438 DOI: 10.1016/j.ejvs.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/30/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE This study aimed to construct a decision aid to estimate the likelihood of independence with a prosthesis following rehabilitation for limb loss secondary to advanced ischaemia (acute or chronic limb threatening ischaemia) or diabetic foot disease (DFD). A secondary aim was to determine whether prosthetic independence is a surrogate marker of long term survival. METHODS A retrospective cohort study of a prospectively maintained database of unilateral amputations due to ischaemia or DFD entering rehabilitation between 2007 and 2020 was performed. Predictors of independent prosthetic mobility (IPM) were used in construction of the IPM prediction model, which underwent bootstrap internal and criterion validation through correlation with predictors of other measures of function: Timed Up and Go (TUG) and two minute walk test. Kaplan-Meier and Cox regression analyses were performed to address the secondary aim. RESULTS Of the 771 patients included, only 49.9% of amputees achieved IPM. Independent negative predictors of IPM were age > 75 years, female sex, higher amputation level, active malignancy, cerebrovascular disease, end stage renal disease, and cognitive impairment. The model yielded high discrimination (C statistic 0.778), and internal validation was demonstrated with bootstrapping (C statistic 0.778), confirming no over optimism. There was a strong correlation between IPM, TUG, and two minute distance and their predictors, confirming strong criterion validity. The IPM group had a median survival of 93.7 (80.7, 105) months, whereas the non-IPM group fared worse with a median survival of 56.6 (48.5, 66.7) months (p < .001). CONCLUSION An internally validated decision aid for estimating the likelihood of independence with a prosthesis after major amputation was constructed. A strong association between female sex and poorer prosthetic mobility was observed. Prosthetic function was shown to be a surrogate marker of long term survival. Future research will involve external validation studies to confirm the generalisability of the decision aid in clinical practice.
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Affiliation(s)
- Arsalan Wafi
- St George's Vascular Institute, St George's University Hospital, London, UK.
| | - Luis Ribeiro
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Vijay Kolli
- Douglas Bader Rehabilitation Unit, Queen Mary's Hospital, London, UK
| | - Bilal Azhar
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - James Budge
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Ian M Loftus
- St George's Vascular Institute, St George's University Hospital, London, UK
| | - Peter J E Holt
- St George's Vascular Institute, St George's University Hospital, London, UK
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McGiffin JN, Ehde DM, Williams RM, Bonanno GA. Heterogeneous trajectories of depression and resilience following limb amputation. PM R 2023. [PMID: 37916584 DOI: 10.1002/pmrj.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To identify longitudinal trajectories of depression in the first 6 months following limb loss and to explore baseline predictors of trajectories, including pain and demographic factors. A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6 months. DESIGN Secondary longitudinal data analysis of an inception cohort study of persons with new-onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months). SETTING Hospitalized care, acute rehabilitation, ambulatory care, and community. PARTICIPANTS Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4 years (2002-2007). The final sample (n = 203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4 years (standard deviation [SD] = 14.6). MAIN OUTCOME MEASURE(S) Depression was assessed via the Patient Health Questionnaire-9 (PHQ-9); posttraumatic stress symptoms were measured via the PTSD checklist- Civilian Version (PCL-C). RESULTS Four trajectories of depression were identified via Latent Growth Mixture Modeling: Resilience (73.2%), Chronic Depression (11.2%), Emerging Depression (8.9%), and Recovery (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the Chronic Depression class predicted elevated 6-month PTS compared to all other classes; membership in the Resilience class predicted lower PTS than in the Chronic and Emerging Depression classes but did not differentiate from the Recovery trajectory. CONCLUSIONS Findings reveal that the course of depression post-amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as Resilient, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (Emerging Depression), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.
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Affiliation(s)
- Jed N McGiffin
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- VA Puget Sound Health Care System, Seattle Division, Rehabilitation Care Services, Seattle, Washington, USA
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York City, New York, USA
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Cho Y, Hamm JM, Heckhausen J, Cramer SC. Downward adjustment of rehabilitation goals may facilitate post-stroke arm motor recovery. Psychol Health 2023:1-17. [PMID: 37183390 DOI: 10.1080/08870446.2023.2211991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Objective: Patients starting with physical rehabilitation often hold unrealistically high expectations for their recovery. Because of a lower-than-expected rate of recovery, such unrealistic goals have been linked to adverse effects on mental health. Additionally, overtraining due to overly ambitious goals can lead to suboptimal recovery. We investigated the effectiveness of adjusting rehabilitation goals to a more realistic level as a strategy to select appropriate exercise intensity and achieve better recovery outcomes. Design: Patients with arm paralysis from recent stroke were recruited and went through 6-8 weeks of telerehabilitation and in-clinic rehabilitation programme conducted at 11 US sites (N = 124). Main Outcome Measures: Adjustment of recovery goal was assessed in two timepoints during the rehabilitation programme and arm motor function was assessed before and after the clinical trial. Results: Greater use of goal adjustment strategies predicted better recovery of arm motor function, independent from therapy compliance. This pattern was observed only when the choice of exercises is patient-regulated rather than directed by a physical therapist. Conclusion: Benefits from goal adjustment were more pronounced among patients who entered the programme with poorer motor functions, suggesting that goal adjustment is the most beneficial when goals of complete recovery are most unrealistic.
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Affiliation(s)
- Yongwon Cho
- Department of Psychological Science, University of CaliforniaIrvine, Irvine, CA, USA
| | - Jeremy M Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Jutta Heckhausen
- Department of Psychological Science, University of CaliforniaIrvine, Irvine, CA, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles, CA, USA; and California Rehabilitation Institute, Los Angeles, CA, USA
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Esfandiari E, Miller WC, King S, Payne M, Mortenson WB, Underwood H, MacKay C, Ashe MC. Protocol for a randomized controlled trial to assess the effect of Self-Management for Amputee Rehabilitation using Technology (SMART): An online self-management program for individuals with lower limb loss. PLoS One 2023; 18:e0278418. [PMID: 36952517 PMCID: PMC10035895 DOI: 10.1371/journal.pone.0278418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/14/2022] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Lower limb loss (LLL) is a distressing experience with psychological, physical, and social challenges. Education is needed to enhance the coping skills and confidence of patients to improve LLL outcomes. However, access to rehabilitation services and education is limited outside of urban centers. To address this service gap, we co-created an eHealth platform, called Self-Management for Amputee Rehabilitation using Technology (SMART). OBJECTIVES First, we will test the effect of SMART and usual care compared with usual care only on walking capacity and confidence among individuals with LLL. Second, we will describe key implementation factors for program delivery and adoption at the person- and provider-level. METHODS This is a Type 1 Effectiveness-Implementation Hybrid Design, mixed-methods, multi-site (British Columbia and Ontario, Canada), parallel, assessor-blinded randomized controlled trial. Participants will include adults with unilateral LLL, during early prosthetic fitting (<2 years after casting for initial prosthesis). Participants in both groups will receive usual care. The experimental group will receive SMART with weekly support sessions from a trained peer mentor for goal setting and action planning for six weeks. Participants will be encouraged to continue using SMART for an additional four weeks. The control group will receive usual care, and weekly social contacts for six weeks. The primary outcome measure is walking capacity operationalized as the performance based Timed Up and Go test. The secondary outcome is walking confidence using the Ambulatory Self-Confidence Questionnaire. Outcome measures will be assessed at baseline, immediately post-intervention, and four weeks follow-up. We will describe key implementation factors (such as, participant experience, intervention adoption, fidelity) throughout the study using questionnaires, semi-structured interviews, and direct observation. RESULTS No participants have been enrolled. CONCLUSIONS SMART has the potential to provide knowledge and skill development to augment rehabilitation outcomes for adults with LLL. TRIAL REGISTRATION NCT04953364 in Clinical Trial Registry (https://clinicaltrials.gov/).
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Affiliation(s)
- Elham Esfandiari
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
| | - W C Miller
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Sheena King
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Michael Payne
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - W Ben Mortenson
- Graduate Program in Rehabilitation Sciences, The University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Research Lab, Vancouver Coastal Research Institute, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Heather Underwood
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Crystal MacKay
- West Park Healthcare Centre, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
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7
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Al‐Sahan MM, MacEntee MI, Bryant SR. A metatheory explaining how patients manage tooth loss. Gerodontology 2020; 37:258-270. [DOI: 10.1111/ger.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/15/2019] [Accepted: 11/28/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Maha M. Al‐Sahan
- Department of Oral Health Sciences Faculty of Dentistry University of British Columbia Vancouver BC Canada
- Department of Prosthetic Dental Sciences College of Dentistry King Saud University Riyadh Saudi Arabia
| | - Michael I. MacEntee
- Department of Oral Health Sciences Faculty of Dentistry University of British Columbia Vancouver BC Canada
| | - S. Ross Bryant
- Department of Oral Health Sciences Faculty of Dentistry University of British Columbia Vancouver BC Canada
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Miller MJ, Mealer ML, Cook PF, So N, Morris MA, Christiansen CL. Qualitative analysis of resilience characteristics of people with unilateral transtibial amputation. Disabil Health J 2020; 13:100925. [PMID: 32312526 DOI: 10.1016/j.dhjo.2020.100925] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/06/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Resilience characteristics are a significant factor in the highly variable rehabilitation outcomes for people in middle age or later with transtibial amputation. OBJECTIVE The purpose of this study was to describe resilience characteristics meaningful to people with transtibial amputation in middle age or later, who use a prosthesis. METHODS Semi-structured interviews were conducted, audio recorded, and transcribed with eighteen participants. Interview transcripts were coded and analyzed using a directed content analysis approach, guided by Charney's theory of resilience and Connor-Davidson Resilience Scale scores. RESULTS Five main resilience characteristics (themes) were identified: coping skills, cognitive flexibility, optimism, skill for facing fear, and social support. Participants with higher resilience scores generally described effective use of coping skills, cognitive flexibility, optimism, skills in facing fears, and social support to attain meaningful goals. In contrast, participants with lower resilience scores discussed passive coping strategies, cognitive rigidity, general pessimism, avoidance of activities due to fear, or social support limitations. CONCLUSION Coping skills, cognitive flexibility, optimism, skills for facing fear, and social support were identified as meaningful resilience characteristics for people with transtibial amputation in middle age or later. These characteristics can be targeted and enhanced using resilience interventions. Future research should consider these characteristics when designing and testing rehabilitation focused resilience interventions for people with TTA.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA; Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Meredith L Mealer
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; Mental Illness Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Paul F Cook
- College of Nursing, University of Colorado, Aurora, CO, USA
| | - Noel So
- Department of Physical Medicine and Rehabilitation, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Consortium of Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Cory L Christiansen
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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Costa MSA, Machado JC, Pereira MG. Longitudinal changes on the quality of life in caregivers of type 2 diabetes amputee patients. Scand J Caring Sci 2020; 34:979-988. [PMID: 31985865 DOI: 10.1111/scs.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/17/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE To explore changes in the quality of life of caregivers of amputees due to type 2 diabetes ten months after amputation. METHODS This is a longitudinal study with three moments of evaluation (T1: one month after surgery, T2: 7 months, T3: 10 months). The sample comprised 110, 101, and 84 caregivers of amputated patients with type 2 diabetes. Caregivers answered a Socio-demographic questionnaire; the Self-Assessment Caregiver; the Family Disruption from Illness Scale; and the Short Form Health Survey (SF36). RESULTS Stress levels were not significantly reflected in changes on mental quality of life over time, except in the caregivers who presented less stress, emphasizing the adverse role of stress when experienced on a continuous basis for ten months on the caregivers' mental well-being. Caregivers presented greater number of physical symptoms at T2 that decreased at T3. CONCLUSIONS According to the results, in order to promote caregivers' physical and mental quality of life, it would be important to evaluate stress levels especially in patients who presented somatic complaints.
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Affiliation(s)
| | - José C Machado
- Institute of Social Sciences, University of Minho, Braga, Portugal
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10
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MATOS DR, NAVES JF, ARAUJO TCCFD. Quality of life of patients with lower limb amputation with prostheses. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2020. [DOI: 10.1590/1982-0275202037e190047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Quality of life is often acknowledged as an important outcome of rehabilitation programs for people with amputation. Despite the importance of the subject, the number of studies focusing on the multiplicity of factors influencing this matter is still limited. These assessments are increasingly needed to demonstrate changes related to intervention over time. In order to evaluate the quality of life of patients with lower limb amputation and wearing prostheses, a study was conducted with 49 patients followed in a rehabilitation hospital in the Midwest region of Brazil. A generic instrument (Medical Outcomes Study 36-Item Short-Form Health Survey) for quality of life assessment and Trinity Amputation and Prosthesis Experience Scale-Revised that is specific for people with amputation were used in addition to a functional assessment measure. The results showed that the time since amputation, male gender and below-knee amputations were predictors of a better perception of quality of life and better adjustment to amputation.
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11
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Al-Sahan MM, MacEntee MI, Thorne S, Bryant SR. A qualitative synthesis of theories on psychosocial response to loss of breasts, limbs or teeth. J Dent 2020; 103S:100014. [DOI: 10.1016/j.jjodo.2020.100014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
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Pedras S, Vilhena E, Carvalho R, Pereira MG. Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study. Psychiatry 2020; 83:47-57. [PMID: 31652411 DOI: 10.1080/00332747.2019.1672438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.
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13
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Arewasikporn A, Roepke AM, Turner AP, Alschuler KN, Williams RM, Amtmann D, Molton IR. Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability. J Aging Health 2019; 31:214S-240S. [PMID: 31718416 DOI: 10.1177/0898264319827142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; MAGE = 58.3 years, range = 46-68; MDISEASEDURATION = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.
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Affiliation(s)
- Anne Arewasikporn
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Ann Marie Roepke
- Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Aaron P Turner
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Rhonda M Williams
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Dagmar Amtmann
- University of Washington School of Medicine, Seattle, USA
| | - Ivan R Molton
- University of Washington School of Medicine, Seattle, USA
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14
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Pedras S, Preto I, Carvalho R, Graça Pereira M. Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study. Psychol Health 2019; 34:535-549. [PMID: 30632805 DOI: 10.1080/08870446.2018.1545907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation. DESIGN A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients. MAIN OUTCOME MEASURES IES-R, WOC and HADS. RESULTS Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment. CONCLUSIONS Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.
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Affiliation(s)
- Susana Pedras
- a School of Psychology , University of Minho , Braga , Portugal
| | - Isabel Preto
- b Faculty of Engineering , University of Porto , Porto , Portugal
| | | | - M Graça Pereira
- a School of Psychology , University of Minho , Braga , Portugal
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Costa MSA, Machado JC, Pereira MG. Burden changes in caregivers of patients with type 2 diabetes: A longitudinal study. J Adv Nurs 2018; 74:2322-2330. [PMID: 29846975 DOI: 10.1111/jan.13728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to explore changes in the burden of caregivers of patients with type 2 diabetes experiencing lower limb amputation after surgery. BACKGROUND Literature suggests the burden overload experienced by the caregivers of new amputees is related to an imbalance between the demands and the resources available to these caregivers. DESIGN The study followed a longitudinal design assessing caregiver burden at 1 (T1), 7 (T2) and 10 (T3) months after the patient's surgery. METHODS We used a convenience sample of caregivers of patients with type 2 diabetes amputated with recent lower limb amputation. Data were collected in several hospital units over 18 months in 2014-2015. Sample size included at T1, T2 and T3 110, 101 and 84. Participants completed the socio-demographic questionnaire, the Burden Assessment Scale and the Self-Assessment Caregiver Questionnaire scale. RESULTS Caregivers who received help reported lower levels of burden from at baseline with no variation over time. Those caregivers with high levels of stress showed an increase in burden over time, although these results were not significant. Also, caregivers who did not receive help showed higher levels of burden and stress over time compared with the initial baseline that decreased over time. CONCLUSION These results highlight the importance of receiving help, in care, especially among caregivers who care for patients who have undergone major amputation.
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Affiliation(s)
| | - José C Machado
- Institute of Social Sciences, University of Minho, Braga, Portugal
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16
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Desmond D, Layton N, Bentley J, Boot FH, Borg J, Dhungana BM, Gallagher P, Gitlow L, Gowran RJ, Groce N, Mavrou K, Mackeogh T, McDonald R, Pettersson C, Scherer MJ. Assistive technology and people: a position paper from the first global research, innovation and education on assistive technology (GREAT) summit. Disabil Rehabil Assist Technol 2018; 13:437-444. [DOI: 10.1080/17483107.2018.1471169] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Deirdre Desmond
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - Natasha Layton
- Department of Health Professions, Swinburne University, Hawthorn, Australia
| | - Jacob Bentley
- Department of Clinical Psychology, Seattle Pacific University and School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fleur Heleen Boot
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | | | | | - Pamela Gallagher
- Faculty of Science and Health, School of Nursing, Dublin City University, Dublin, Ireland
| | - Lynn Gitlow
- Occupational Therapy, Ithaca College, Ithaca, NY, USA
| | | | - Nora Groce
- Leonard Cheshire Research Centre, University College London, London, UK
| | - Katerina Mavrou
- School of Academic and Pedagogy, European University Cyprus, Nicosia, Cyprus
| | - Trish Mackeogh
- Centre for Behaviour Analysis, Queens University Belfast, Belfast, UK
| | - Rachael McDonald
- Department of Health and Medical Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Cecilia Pettersson
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Goteborg, Sweden
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17
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Christensen J, Langberg H, Doherty P, Egerod I. Ambivalence in rehabilitation: thematic analysis of the experiences of lower limb amputated veterans. Disabil Rehabil 2017. [DOI: 10.1080/09638288.2017.1342281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jan Christensen
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, Faculty of Health, CopenRehab, University of Copenhagen, Copenhagen, Denmark
| | - Henning Langberg
- Department of Occupational and Physiotherapy, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ingrid Egerod
- Neurointensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Resnik L, Borgia M, Silver B. Measuring Community Integration in Persons With Limb Trauma and Amputation: A Systematic Review. Arch Phys Med Rehabil 2017; 98:561-580.e8. [DOI: 10.1016/j.apmr.2016.08.463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
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19
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Federici S, Bracalenti M, Meloni F, Luciano JV. World Health Organization disability assessment schedule 2.0: An international systematic review. Disabil Rehabil 2016; 39:2347-2380. [PMID: 27820966 DOI: 10.1080/09638288.2016.1223177] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument. METHOD Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases. RESULTS We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry). CONCLUSIONS The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.
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Affiliation(s)
- Stefano Federici
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Marco Bracalenti
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Fabio Meloni
- a Department of Philosophy, Social & Human Sciences and Education , University of Perugia , Perugia , Italy
| | - Juan V Luciano
- b Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan De Déu , St. Boi De Llobregat , Spain.,c Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Madrid , Spain
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20
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Arends RY, Bode C, Taal E, van de Laar MAFJ. The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility. Br J Health Psychol 2016; 21:469-89. [PMID: 26726041 DOI: 10.1111/bjhp.12182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/26/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Due to their disease, patients with polyarthritis face the task of reconciling their threatened personal goals with their capabilities. Previous cross-sectional research on patients with chronic disease related higher levels of goal management strategies to lower levels of distress and higher levels of well-being. This study was the first to focus longitudinally on goal management patterns that combined strategies originating from different goal management theories. Our first study objective was to identify patterns that consisted of various strategies of goal management among patients with polyarthritis. Subsequently, the cross-sectional and longitudinal relationships between these patterns and the psychological health of the patients were studied. METHODS A longitudinal questionnaire study with three measurements of goal management and psychological health was conducted among 331 patients with polyarthritis. Stability of goal management over time was analysed with ANOVAs. Patterns were identified using cluster analysis at baseline, based on the following strategies: Goal maintenance, goal adjustment, goal disengagement, and goal reengagement. Longitudinal relationships between the patterns and psychological health (specifically: Depression, anxiety, purpose in life, positive affect, and social participation) were analysed using a generalized estimating equations analysis. RESULTS Three goal management patterns were found: 'Moderate engagement', 'Broad goal management repertoire', and 'Holding on'. Patients with the 'Broad goal management repertoire' pattern had the highest level of psychological health. The 'Holding on' pattern was identified as the most unfavourable in terms of psychological health. Over time, stable differences in levels of psychological health between the patterns were found. CONCLUSIONS This study was the first to reveal patterns of several goal management strategies and their longitudinal relationship to psychological health. Psychosocial support for arthritis patients with lower psychological health should focus on helping patients to become familiar with a broad range of goal management strategies when dealing with threatened goals. STATEMENT OF CONTRIBUTION What is already known on this subject? Polyarthritis is a collective term for a variety of disorders associated with autoimmune pathologies that may affect all aspects of a person's physical, psychological, and social functioning. Patients often experience difficulties in maintaining and achieving goals in several domains of life due to disease symptoms. The process of emotional adaptation to polyarthritis is characterized by searching equilibrium between desires and constraints and reacting constructive to stressors. Goal management strategies are ways to minimize the perceived disparity between the actual and the preferred situation with regard to personal goals and are applied both consciously and unconsciously. Cross-sectional, higher levels of goal management strategies have been related to lower levels of distress and higher levels of well-being both in patients with polyarthritis and in other patient groups. What does this study add? Contributes to our understanding of how combinations of goal management strategies relate to psychological health. Identifies patterns of goal management that are longitudinally related to psychological health. Provides clear guidance for improving psychological health of people with polyarthritis.
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Affiliation(s)
- Roos Y Arends
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Mart A F J van de Laar
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Department for Rheumatology and Clinical Immunology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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Jesus TS, Silva IL. Toward an evidence-based patient-provider communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehabil 2015; 30:315-28. [DOI: 10.1177/0269215515585133] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/12/2015] [Indexed: 12/20/2022]
Abstract
Background: There is a growing interest in linking aspects of patient-provider communication to rehabilitation outcomes. However, the field lacks a conceptual understanding on: (a) ‘how’ rehabilitation outcomes can be improved by communication; and (b) through ‘which’ elements in particular. This article elaborates on the conceptual developments toward informing further practice and research. Methods: Existing models of communication in healthcare were adapted to rehabilitation, and its outcomes through a comprehensive literature review. Results: After depicting mediating mechanisms and variables (e.g. therapeutic engagement, adjustment toward disability), this article presents the ‘4 Rehab Communication Elements’ deemed likely to underpin rehabilitation outcomes. The four elements are: (a) knowing the person and building a supportive relationship; (b) effective information exchange and education; (c) shared goal-setting and action planning; and (d) fostering a more positive, yet realistic, cognitive and self-reframing. Discussion: This article describes an unprecedented, outcomes-oriented approach toward the design of rehabilitation communication, which has resulted in the development of a new intervention model: the ‘4 Rehab Communication Elements’. Further trials are needed to evaluate the impact of this whole intervention model on rehabilitation outcomes.
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Affiliation(s)
- Tiago Silva Jesus
- Health Psychology Department, Medical School, Universidad Miguel Hernández, Elche, Spain
- Universidade Fernando Pessoa, Oporto, Portugal
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