Factors influencing psychological adjustment after amputation in adult

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 11/26/2020 © The University of Sheffield

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 & Mac. Lachlan (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 & Mac. Lachlan (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. 11/26/2020 © The University of Sheffield

Current review: Design.

Rationale • Horgan & Mac. Lachlan (2004) called for more qualitative and longitudinal research, and broader focus on Qo. L. • 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 peerreviewed 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 & Mac. Lachlan, 2006 a). • 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 & Mac. Lachlan, 2006 a; Hawemdah et al. , 2008; Jenkins et al. , 2008; Nunes et al. , 2012; Singh et al. , 2007) • Below-knee amputation in sub-set (Desmond & Maclachlan, 2006 a; 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 & Mac. Lachlan, 2006 a) 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 & Mac. Lachlan, 2006 a ) • Female gender (Nunes et al. , 2012)

Mixed Findings • Time since amputation • Recent amputation more distressing (Desmond et al. , 2006 a; Nunes et al. , 2012) • Recent amputation less distressing (Singh, 2007; 2009) • Cause of amputation • Disease related (Coffey et al. , 2009; Desmond & Maclachlan, 2006 a; Couture et al. , 2011) • 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. & Mac. Lachlan, M. (2006 a). 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. , & Mac. Lachlan, 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 1 st 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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