Disparities in functional recovery after dysvascular lower limb amputation are associated with employment status and self-efficacy

Health Disparities Across the Spectrum of Amputation Care: A Review of Literature

Limb loss is a common and disabling experience for patients, frequently caused by critical limb ischemia or deterioration of chronic wounds. Disparities in outcomes for prevention of amputation, level of amputation, and postamputation outcomes have been described. Understanding the nature of these disparities and the populations most affected can help clinicians and policymakers target interventions and programs. This article reviews existing literature regarding disparities in amputation care, including prevention methods, surgical outcomes, and postamputation outcomes. The authors identified several potential racial, socioeconomic, and gender disparities, particularly affecting Black, Native American, and Latino/a/x patients, female gender, and those in rural settings.

Reintegration Following Amputation: A Biopsychosocial Approach

Reintegration back into one's life following limb loss is heavily influenced by the interaction among the individual's mental health, environment, and physical factors (eg, pain and prostheses). While many patients experience posttraumatic growth and successfully reintegrate back into their lives, others have a more difficult adjustment. Interdisciplinary teams can best facilitate reintegration through early screening for barriers to reintegration such as depression, pain, body image, and inaccessible environments, to intervene early after amputation. With these barriers addressed, amputees may be able to return to driving and other valued activities more quickly, resulting in improved reintegration across life domains.

Peer mentor contributions to an early intervention vocational rehabilitation specialist service following trauma: A qualitative study

BACKGROUND

Peer mentors have a role in facilitating the participation, health and well-being of people who have had a traumatic injury. Few studies have explored the involvement of peer mentors in an early intervention vocational rehabilitation (EIVR) service following trauma.

OBJECTIVE

This study aimed to explore the experience of implementing peer support within the context of an EIVR service from the perspectives of the peer mentors themselves, the vocational therapists supervising them, and the patients that received peer mentoring.

METHODS

Semi-structured interviews were conducted with twenty participants from three groups: peer mentors (n = 4); vocational therapists (n = 3); and patients who received the EIVR intervention (n = 24). Data were thematically analysed.

RESULTS

Three themes were identified: The value of peer input in an EIVR service, The facilitators impacting the value of peer involvement as part of the EIVR service, The challenges impacting peer input as part of an EIVR service.

CONCLUSIONS

The inclusion of peer mentors early after major traumatic injury was a unique and valuable addition to the EIVR service. Offering peer support early on in rehabilitation enabled patients to gain a sense of hope for their future, and the expectation that returning to work was a realistic option. The careful selection of peer mentors, and ensuring they receive adequate preparation and ongoing supervision are vital to support their well-being during the intervention. Aiming to match peer mentors with similar injuries and work backgrounds to patients is an important contributor to the likely ongoing engagement of the mentee with the mentor.

Racial disparities in prosthesis abandonment and mobility outcomes after lower limb amputation from a dysvascular etiology in a veteran population

BACKGROUND

Non-Hispanic Black (NHB) individuals have higher rates of amputation and increased risk of a transfemoral amputation due to dysvascular disease than non-Hispanic White (NHW) individuals. However, it is unclear if NHB individuals have differences in prosthesis use or functional outcomes following an amputation.

OBJECTIVE

To determine if there are racial disparities in prosthesis abandonment and mobility outcomes in veterans who have undergone their first major unilateral lower extremity amputation (LEA) due to diabetes and/or peripheral artery disease.

DESIGN

National cohort study that identified individuals retrospectively through the Veterans Affairs (VA) Corporate Data Warehouse (CDW) from March 1, 2018, to November 30, 2020, then prospectively collected their self-reported prosthesis abandonment and mobility. Multiple logistic regression was used to control for potential confounders and identify potential effect modifiers.

SETTING

The VA CDW, participant mailings and phone calls.

PARTICIPANTS

Three hundred fifty-seven individuals who underwent an incident transtibial or transfemoral amputation due to diabetes and/or peripheral arterial disease.

INTERVENTIONS

Not applicable.

MAIN OUTCOMES MEASURES

(1) Self-reported prosthesis abandonment. (2) Level of mobility assessed using the Locomotor Capabilities Index.

RESULTS

Rurally located NHB individuals without a major depressive disorder (MDD) had increased odds of abandoning their prosthesis (adjusted odds ratios [aOR] = 5.3; 95% confidence interval [CI]: [1.3-21.1]). This disparity was nearly three times as large for rurally located NHB individuals with MDD diagnosis, compared with other races from rural areas and with MDD (aOR = 15.8; 95% CI, 2.5-97.6). NHB individuals living in an urban area were significantly less likely to achieve advanced mobility, both with MDD (aOR=0.16; 95% CI: [0.04-7.0]) and without MDD (aOR = 0.26; 95% CI: [0.09-0.73]).

CONCLUSIONS

This study demonstrated that health care disparities persist for NHB veterans following a dysvascular LEA, with increased prosthesis abandonment and worse mobility outcomes.

Returning to work after dysvascular lower limb amputation-A novel multivariate approach to examine relative contributions of biopsychosocial predictors

BACKGROUND

Returning to work is a key outcome of rehabilitation and social re-integration after lower limb amputation. It is important to understand what biopsychosocial factors contribute to returning to work after dysvascular amputation.

OBJECTIVE

Examining relative contributions of functional and contextual predictors of returning to work in participants with lower limb amputation due to diabetes and other dysvascular diseases.

STUDY DESIGN

Cross-sectional.

METHODS

Return-to-work outcome, biopsychosocial characteristics including physical functioning, self-efficacy & perceived ability, and socioeconomical support data were collected from a purposive sample (n = 57) in a multi-state collaborative research network. Grouped Weighted Quantile Sum model analysis was conducted to evaluate relative contributions of biopsychosocial predictors.

RESULTS

Less than 30% of the participants returned to work after their amputation. Physical functioning (odds ratio = 10.19; 95% CI 2.46-72.74) was the most important predictor group. Working before amputation, prosthetic mobility, and access to rehabilitation care were also identified as key factors associated with returning to work.

CONCLUSIONS

Fewer than 1 in 3 participants with dysvascular amputation returned to work, despite an average age of only 54 years at the time of amputation. Physical functioning was shown to be the most important predictor, while socioeconomic factors such as a lack of access to care also contribute to not returning to work after dysvascular amputation.