Transcript conference_presentation_mh2
Factors influencing psychological adjustment after amputation in adult lower limb amputees: A review
Mark Hudson 1 , Dr. Nathan Babiker 2 , & Dr. Ramesh Munjal 2 1 University of Sheffield & 2 Sheffield Teaching Hospitals NHS Foundation Trust
Contents 1. Background literature 2. Design of the present review 3. Results 4. Clinical and research implications
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Background literature.
Definition
• Psychological adjustment to chronic disease involves at least five key domains: 1. Cognitive 2. Emotional 3. Interpersonal 4. Functional 5. Disease-related (Stanton, Revenson, & Tennen, 2007).
Horgan & MacLachlan (2004)
• Factors linked to better adjustment: • Perceived sense of control • Social support • Positive meaning • Time since amputation • Cause (trauma or disease) had no relationship.
Horgan & MacLachlan (2004)
• Factors linked to poorer adjustment: • Body image anxiety • Social discomfort • Pain catastrophising • Phantom limb pain • Women and younger people in a sub-set.
• B/K amputees more depressed in one study.
26/04/2020 © The University of Sheffield
Current review: Design.
Rationale
• Horgan & MacLachlan (2004) called for more qualitative and longitudinal research, and broader focus on QoL. • Significant number of studies published since the last review.
• Increasing awareness of psychological risk factors in the MDT. • Increase own understanding to assist with treatment planning.
Search strategy
• The
Psychinfo and Web of Science
databases were searched, from 2004 up until February 2013. The following keyword search strategies were combined: • “psychological” or “psychosocial” • “adjustment” or “adaptation” • “amputation*” or “amputee*”
Selection criteria
• • • •
Population:
adults with a lower limb amputation
Measures
: At least one amputation-related, sociodemographic, or psychological predictor variable. A validated criterion measure of psychological adjustment.
Analysis:
at least one statistical test examining the link between the predictor variables and criterion measures.
Article type:
English language articles in peer reviewed journals.
Paper retrieval
Results.
Factors linked to better adjustment
• Greater levels of hope (Unwin, Kacperek, & Clarke, 2009) • Positive cognitive processing (Phelps, Williams, Raichle, Turner, & Ehde, 2008) • Increased problem solving ability (Desmond & MacLachlan, 2006a).
• Having a positive appraisal of the amputation (Couture, Desrosiers, & Caron, 2011)
Factors linked to better adjustment
• Less phantom limb pain (Desmond et al. 2008; Whyte & Carroll, 2004) • Social support (Williams et al., 2004; Unwin et al., 2009; Hanley et al., 2004; Desmond & MacLachlan, 2006a; Hawemdah et al., 2008; Jenkins et al., 2008; Nunes et al., 2012; Singh et al., 2007) • Below-knee amputation in sub-set (Desmond & Maclachlan, 2006a; Couture et al., 2011). • Number of co-morbidties (Nunes et al., 2012; Singh et al., 2007; 2009)
Factors linked to worse adjustment
• Negative cognitive processing (Phelps et al., 2008) • Avoidance (Desmond & MacLachlan, 2006a) • Pain catastrophising (Whyte & Carrol, 2004; Hanley et al., 2004) • Public self-consciousness (Atherton & Robertson, 2006) • Body-image disturbance (Coffey et al., 2009) • Younger people (Gunawardena et al., 2007; Singh et al., 2009; Desmond & MacLachlan, 2006a ) • Female gender (Nunes et al., 2012)
Mixed Findings
• Time since amputation • Recent amputation more distressing (Desmond et al., 2006a; Nunes et al., 2012) • Recent amputation less distressing (Singh, 2007; 2009) • Cause of amputation • Disease related Couture et al., 2011) (Coffey et al., 2009; Desmond & Maclachlan, 2006a; • Trauma related (Hawemdah et al., 2008; Kratz et al., 2010)
Common methodological issues
• Causality cannot be inferred • Self-report bias • Small sample sizes • Selection bias • Lack of control groups • Variability in measurement tools
Clinical and research implications.
Clinical implications
• Highlights those at risk of poor adjustment.
• Indicates models of coping and resilience (Lazarus & Folkman; 1984; Yates & Masten, 2004) • Suggests therapy targets: • Changing meaning • Developing acceptance or active coping style • Social support.
Research implications
• Few studies on residual limb pain. • Pre-operative, longitudinal designs, with appropriate control groups needed.
• Effect of ADM or alcohol/drug use.
• Effect of repeated infections.
Critique
• Search limited to two databases • No hand-searching of journals • Grey literature not consulted • Written by one author • Experts were not consulted
References
Atherton, R. & Robertson, N. (2006). Psychological adjustment to lower limb amputation amongst prosthesis users.
Disability and Rehabilitation, 28,
1201-1209 Coffey, L., Gallagher, P., Horgan, O., Desmond, D. & Maclachlan, M. (2009). Psychosocial adjustment to diabetes-related lower limb amputation.
Diabetic Medicine, 26,
1063-1067. Couture, M., Desrosiers, J., & Caron, C. D. (2011). Cognitive appraisal and perceived benefits of dysvascular lower limb amputation: A longitudinal study.
Archives of Gerontology and Geriatrics, 52,
5-11. Desmond, D. M. & MacLachlan, M. (2006a). Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations.
Social Science & Medicine, 62,
208-216. Desmond, D., Gallagher, P., Henderson-Slater, D., & Chatfield, R. (2008). Pain and psychosocial adjustment to lower limb amputation amongst prosthesis users.
Prosthetics and Orthotics International, 32,
244-252. Gunawardena, N., De A Senevirathne, R. & Athauda, T. (2007). Mental health outcome of unilateral lower limb amputee soldiers in two districts of Sri Lanka.
International Journal of Social Psychiatry, 53,
135-147.
References
Hanley, M. A., Jensen, M. P., Ehde, D. M., Hoffman, A. J., Patterson, D. R., & Robinson, L. R. (2004). Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain.
Disability and Rehabilitation, 26,
882-893. Hawemdeh, Z. M., Othman, Y. S., & Ibrahim, A I. (2008). Assessment of anxiety and depression after lower limb amputation in Jordanian patients.
Neuropsychiatric Disease and Treatment, 4,
627-633. Horgan, O., & MacLachlan, M. (2004).Psychosocial adjustment to lower limb amputation: a review.
Disability and Rehabilitation, 26,
837 –50. Jenkins, L. M., Andrewes, D. G., Hale, T., Coetzee, N., & Khan, F. (2009). Subjective attributes of depression, part 2: The contribution of self-perceived disability to depression following stroke.
Electronic Journal of Applied Psychology: General Articles, 5,
82-88. Kratz, A. L., Williams, R. M., Turner, A. P., Raichle, K. A., Smith, D. G., & Ehde, D. (2010). To lump or to split? Comparing individuals with traumatic and nontraumatic limb loss in the first year after amputation.
Rehabilitation Psychology, 55,
126-138 Nunes, M. A., de Barros Jr, N., Miranda Jr, F., & Baptista-Silva, J. C. (2012). Common mental disorders in patients undergoing lower limb amputation: A population-based sample.
World Journal of Surgery, 36,
1011-1015.
References
Phelps, L. F., Williams, R. M., Raichle, K. A., Turner, A. P., & Ehde, D. M. (2008). The importance of cognitive processing to adjustment in the 1st year following amputation.
Rehabilitation Psychology, 53,
28-38. Singh, R., Hunter, J., & Philip, A. (2007). The rapid resolution of depression and anxiety symptoms after lower limb amputation.
Clinical Rehabilitation, 21,
754-759. Singh, R., Ripley, D., Pentland, B., Todd, I., Hunter, J., Hutton, L., & Philip, A. (2009). Depression and anxiety symptoms after lower limb amputation: The rise and fall.
Clinical Rehabilitation, 23,
281-286. Stanton, A. L., Revenson, T. A., & Tennen, H. (2007). Health psychology: Psychological adjustment to chronic disease.
Annual Review of Psychology, 58,
565-592.
Unwin, J., Kacperek, L., & Clarke, C. (2009). A prospective study of positive adjustment to lower limb amputation.
Clinical Rehabilitation, 23,
1044-150. Whyte, A. & Carroll, L. J. (2004). The relationship between catastrophizing and disability in amputees experiencing phantom pain.
Disability and Rehabilitation, 26,
649-654. Williams, R. M., Ehde, D. M., Smith, D. G., Czerniecki, J. M., Hoffman, A. J. & Robinson, L. R. (2004). A two-year longitudinal study of social support following amputation.
Disability and Rehabilitation, 26,
862-874.
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