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Milosevic S, Strange H, Morgan M, Ambler GK, Bosanquet DC, Waldron CA, Thomas-Jones E, Harris D, Twine CP, Brookes-Howell L. Rehabilitation experiences following major lower limb amputation due to complications of vascular disease: a UK qualitative study. Disabil Rehabil 2024:1-10. [PMID: 38622944 DOI: 10.1080/09638288.2024.2329747] [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: 08/17/2023] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Rehabilitation experiences of lower limb amputees with poorer physical health have not been fully explored. This study aimed to qualitatively explore experiences of rehabilitation amongst patients who had recently undergone amputation due to complications of vascular disease. METHODS Semi-structured, face-to-face interviews were conducted with 14 patients participating in the PLACEMENT randomised controlled feasibility trial (ISRCTN: 85710690; EudraCT: 2016-003544-37), which investigated the effectiveness of using a perineural catheter for postoperative pain relief following major lower limb amputation. Framework analysis was used to identify key themes and compare participant data. FINDINGS Three main themes and corresponding sub-themes were identified: (i) other patients as inspiration; (ii) other patients as competition; and (iii) imagined futures. Perceptions relating to other patients played a key role in rehabilitation, providing a source of motivation, support, and competition. Participants' imagined futures were uncertain, and this was compounded by a lack of information and delays in equipment and/or adaptations. CONCLUSIONS Findings highlight the importance of fellow patients in supporting rehabilitation following lower limb amputation. Enabling contact with other patients should thus be a key consideration when planning rehabilitation. There is a clear unmet need for realistic information relating to post-amputation recovery, tailored to the needs of individual patients.
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Affiliation(s)
- Sarah Milosevic
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Heather Strange
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Melanie Morgan
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Graeme K Ambler
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, United Kingdom; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - David C Bosanquet
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, United Kingdom; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Emma Thomas-Jones
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Christopher P Twine
- Department of Vascular Surgery, Aneurin Bevan University Health Board, Newport, United Kingdom; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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Murray CD, Havlin H, Molyneaux V. Considering the psychological experience of amputation and rehabilitation for military veterans: a systematic review and metasynthesis of qualitative research. Disabil Rehabil 2024; 46:1053-1072. [PMID: 36856319 DOI: 10.1080/09638288.2023.2182915] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Research highlights the differences and unique experiences of military veterans experiencing amputation compared to civilians. This review aimed to synthesise qualitative research exploring the experience of amputation and rehabilitation among existing or previous members of the military. METHODS A systematic search of six databases (PsycINFO, AMED, MEDLINE, CINAHL, Web of Science and Scopus) was undertaken in March 2022. The results of 17 papers reporting 12 studies published between 2009 and 2022 were synthesised using a meta-ethnographic approach to generate new interpretations reflecting the experiences of members of the military who have experienced limb loss. RESULTS Three themes were developed from the data: (1) Making the physical and psychological transition to life after amputation; (2) The role of the military culture in rehabilitation; and (3) The impact of relationships and the gaze of others during rehabilitation and beyond. CONCLUSIONS Military veterans with limb loss experience difficulties in navigating civilian healthcare systems and gaining appropriate support away from the military. Rehabilitation professionals, with psychological training or mentoring, involved in the care of military veterans following amputation could offer psychological support during the transition to civilian life and targeted therapies to veterans experiencing high levels of pain, and facilitate peer support programmes.
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Affiliation(s)
- Craig D Murray
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Heather Havlin
- Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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3
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Cimino SR, Vijayakumar A, MacKay C, Mayo AL, Hitzig SL, Guilcher SJT. Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review. Disabil Rehabil 2022; 44:6899-6925. [PMID: 34546799 DOI: 10.1080/09638288.2021.1974106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To understand what is known about sex and gender differences in quality of life (QoL) and related domains for individuals with an adult acquired lower limb amputation (LLA). METHODS A computer-assisted literature search of four online databases was completed. Articles were included if they incorporated sex or gender as part of their data analysis with a focus on QoL-related domains. Data were analyzed using descriptive numerical analysis and thematic analysis. RESULTS One hundred and eleven articles were included in this review. Women were under-represented across studies, with most of the participants being men. No articles described the inclusion of trans or non-binary persons. Differences by sex or gender were reported by 66 articles. Articles reporting on gender seldom provided descriptions of how gender was defined. Overall, women/females seemed to have worse outcomes in terms of prosthesis-related outcomes, mental health, and return to occupations. CONCLUSION Articles included in this review were not clear with how gender was defined. In order for more targeted interventions that account for sex and gender differences, studies need to be more forthcoming about how they use and define gender. Future research should seek to include gender non-conforming participants to identify additional needs.Implications for rehabilitationSex and gender are important constructs that influence outcomes following lower limb amputation.Rehabilitation professionals should consider sex and gender-specific outcomes when tailoring programs to ensure ethical clinical care.
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Affiliation(s)
- Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | | | - Crystal MacKay
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,West Park Health Care Centre, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- St. John's Rehabilitation Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,St. John's Rehabilitation Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
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4
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Hajek A, König HH. Flexible goal adjustment moderates the link between self-rated health and subjective well-being. Findings from the general population. Aging Ment Health 2021; 25:1345-1350. [PMID: 32420761 DOI: 10.1080/13607863.2020.1765313] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine whether flexible goal adjustment moderates the link between self-rated health and subjective well-being longitudinally. METHOD Longitudinal data from 2002 to 2011 taken from a nationally representative sample of middle aged and older adults (≥ 40 years) - the German Ageing Survey. A single-item measure was used to assess self-rated health (ranging from 1 = very good to 5 = very bad). Flexible goal adjustment was measured using a scale developed by Brandstaedter and Renner. Subjective well-being was quantified using the Positive and Negative Affect Schedule and the Satisfaction with Life Scale. RESULTS Fixed effects (FE) regressions showed that worsening self-rated health is associated with a decrease in positive affect (β=-.07, p<.001) and life satisfaction (β=-.09, p<.001) as well as an increase in negative affect (β=.04, p<.001). Flexible goal adjustment significantly moderated the link between self-rated health and positive (β=.03, p<.05) as well as negative affect (β=-.05, p<.01), i. e., the higher flexible goal adjustment is, the weaker the link is between self-rated health and well-being. CONCLUSION Study findings suggest that strategies to enhance flexible goal adjustment may be useful in maintaining well-being among older adults suffering from worsening self-rated health.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Goal coping resources scales: Psychometric properties and mediation analysis among individuals with visual impairment. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Miller MJ, Blankenship JM, Kline PW, Melanson EL, Christiansen CL. Patterns of Sitting, Standing, and Stepping After Lower Limb Amputation. Phys Ther 2020; 101:6039323. [PMID: 33336706 PMCID: PMC7921296 DOI: 10.1093/ptj/pzaa212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/10/2020] [Accepted: 10/29/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objectives of this study were to describe sitting, standing, and stepping patterns for people with lower limb amputation (LLA) and to compare sitting, standing, and stepping between people with dysvascular LLA and people with traumatic LLA. METHODS Participants with dysvascular or traumatic LLA were included if their most recent LLA was at least 1 year earlier, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Sitting, standing, and stepping were measured using accelerometry. Daily sitting, standing, and stepping times were expressed as percentages of waking time. Time spent in bouts of specified durations of sitting (<30, 30-60, 60-90, and >90 minutes), standing (0-1, 1-5, and >5 minutes), and stepping (0-1, 1-5, and >5 minutes) was also calculated. RESULTS Participants (N = 32; mean age = 62.6 [SD = 7.8] years; 84% men; 53% with dysvascular LLA) spent most of the day sitting (median = 77% [quartile 1 {Q1}-quartile 3 {Q3} = 67%-84%]), followed by standing (median = 16% [Q1-Q3 = 12%-27%]) and stepping (median = 6% [Q1-Q3 = 4%-9%]). One-quarter (median = 25% [Q1-Q3 = 16%-38%]) of sitting was accumulated in bouts of >90 minutes, and most standing and stepping was accrued in bouts of <1 minute (standing: median = 42% [Q1-Q3 = 34%-54%]; stepping: median = 98% [Q1-Q3 = 95%-99%]). Between-etiology differences included proportion of time sitting (traumatic: median = 70% [Q1-Q3 = 59%-78%]; dysvascular: median = 79% [Q1-Q3 = 73%-86%]) and standing (traumatic: median = 23% [Q1-Q3 = 16%-32%]; dysvascular: median = 15% [Q1-Q3 = 11%-20%]). CONCLUSION Participants had high daily volumes of long durations of sitting. Further, these individuals accumulated most physical activity in bouts of <1 minute. IMPACT High levels of sedentary behavior and physical inactivity patterns may place people with LLA at greater mortality risk relative to the general population. Interventions to minimize sedentary behaviors and increase physical activity are potential strategies for improving poor outcomes of physical therapy after LLA.
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Affiliation(s)
| | - Jennifer M Blankenship
- Division of Endocrinology, Metabolism, and Diabetes, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Paul W Kline
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
| | - Edward L Melanson
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA,Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora, Colorado, USA
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Hajek A, König HH. The moderating role of flexible goal adjustment in the link between pain and depressive symptoms: findings based on a nationally representative sample of older adults. Psychogeriatrics 2020; 20:602-607. [PMID: 32131145 DOI: 10.1111/psyg.12537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/06/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pain is a frequent phenomenon in old age. It has been shown that increases in pain are longitudinally associated with depressive symptoms. This strong link can be attenuated by coping strategies like resilience. However, to date, there is a lack of longitudinal studies, based on nationally representative samples that have examined whether flexible goal adjustment moderates the relation between pain and depressive symptoms. Thus, the purpose of this study was to identify whether there is a longitudinal association between pain and depressive symptoms, and to examine whether flexible goal adjustment moderates this link. METHODS Longitudinal data (wave 3 and wave 4; 5582 observations) were taken from a sample (German Ageing Survey) which is nationally representative for middle-aged and older adults (40 years and over). A widely used pain measurement (single-item measure) served as the key independent variable. An instrument created by Brandstaedter and Renner was used to quantify flexible goal adjustment. The 15-item version of the Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. RESULTS Linear fixed effects regressions demonstrated that an increase in pain was associated with an increase in depressive symptoms (β = 0.42, P < 0.001). Moreover, flexible goal adjustment significantly moderated this association (β = -0.39, P < 0.01). With regard to potential confounders, an increase in depressive symptoms was associated with increasing age and worsening self-rated health. CONCLUSION The study findings showed that increasing pain leads to more depressive symptoms using a longitudinal approach. In addition, flexible goal adjustment moderated this link. Therefore, programs aiming at improving flexible goal adjustment may assist in avoiding an increase in depressive symptoms alongside pain increases among older adults.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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8
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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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9
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Nurses' Perspective of Treating Patients With an Amputation Due to Diabetic Foot Syndrome. CLIN NURSE SPEC 2020; 34:107-115. [PMID: 32250992 DOI: 10.1097/nur.0000000000000519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Expert nurses must provide both physical and emotional care to patients with diabetic foot syndrome (DFS) who require an amputation. This includes helping patients and families to cope with this situation, while ensuring the maximum level of comfort. PURPOSE The aim of this study was to explore the perspective of expert nurses on the needs and hospital care of people requiring an amputation due to DFS. METHOD This was a qualitative multicenter study involving 8 hospitals in Spain and Portugal. In-depth interviews with expert nurses were transcribed verbatim to enable content analysis. RESULTS Twenty-four expert nurses were interviewed about their knowledge and experience of treating patients with diabetic foot disease. Two themes emerged from the qualitative analysis: (1) poor self-care and the disease trajectory, and (2) effective hospital care. CONCLUSIONS The results of this study highlight the key role that expert nurses play in the care of patients with DFS. Expert nurses considered that amputation leaves the individual physically and psychologically vulnerable, especially upon discharge from hospital. It is therefore essential to provide these patients with comprehensive and multidisciplinary care that includes emotional support.
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10
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Miller MJ, Jones J, Anderson CB, Christiansen CL. Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis. Disabil Rehabil 2019; 41:3141-3150. [PMID: 30261758 PMCID: PMC6437000 DOI: 10.1080/09638288.2018.1492031] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
Purpose: Identifying factors associated with physical activity after dysvascular lower limb amputation (LLA) could provide targets for improving rehabilitation outcomes. The purpose of this meta-synthesis was to identify modifiable factors that may influence physical activity after LLA, a condition characterized by amputation in the setting of older age, diabetes mellitus (DM), and/or peripheral artery disease (PAD).Methods: A systematic search of the literature identified qualitative studies exploring the perceptions of physical activity in people with lower limb amputation, older age, DM, or PAD. Qualitative rigor was assessed using the McMaster University's Guidelines for Qualitative Review. Meta-synthesis was undertaken to analyze the findings of included studies.Results: Fourteen studies of variable methodological quality were included for analysis. Three overarching factors that may influence physical activity after LLA emerged: 1) educational experiences and motivation, 2) support and self-efficacy, and 3) special concerns after lower limb amputation (e.g., prosthesis, equipment, and environment).Conclusions: Physical activity after LLA is influenced by relationships among health understanding, motivation, support, and self-efficacy in the presence of disability. Themes from this meta-synthesis can be used to develop and test behavior-based interventions to improve physical activity after LLA.Implications for rehabilitationPhysical activity participation after dysvascular lower limb amputation is complicated by the presence of chronic conditions, severe disability, and unaddressed psychosocial factors.Addressing a patient's self-efficacy, social support, motivation, and understanding during physically focused rehabilitation may improve participation in physical activity after dysvascular lower limb amputation.Rehabilitation professionals can address self-efficacy, motivation, and understanding by using collaborative, empathetic communication strategies known to enhance a patient's sense of support.
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Affiliation(s)
- Matthew J Miller
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | | | - Chelsey B Anderson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Cory L Christiansen
- Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
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11
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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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12
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Wettstein M, Wahl HW, Heyl V. Assimilative and accommodative coping in older adults with and without sensory impairment: four-year change and prospective relations with affective well-being. Aging Ment Health 2019; 23:1255-1262. [PMID: 30407084 DOI: 10.1080/13607863.2018.1479833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Sensory impaired older adults may be particularly dependent on coping strategies such as assimilation (or tenacious goal pursuit [TGP]) and accommodation (or flexible goal adjustment [FGA]) to secure high levels of well-being. We investigated if late-life changes in these coping strategies and prospective associations of TGP and FGA with affective well-being vary according to sensory impairment status. Method: Our study sample consisted of 387 adults aged 72-95 years (M = 82.50 years, SD =4.71 years) who were either visually impaired (VI; n = 121), hearing impaired (HI; n = 116), or sensory unimpaired (UI; n = 150). One hundred sixty-eight individuals were reassessed after approximately 4 years. Results: Both VI and HI revealed a decrease in TGP, whereas TGP remained stable in UI. For FGA, a significant increase in HI was observed, whereas a significant decline emerged in UI. Controlling for age, gender, and cognitive abilities, higher TGP at baseline was significantly associated with higher negative affect 4 years later in VI. Moreover, the positive association between baseline FGA and subsequent positive affect was stronger in HI than in UI older adults. Conclusion: Our findings suggest that older adults with sensory impairments reveal trajectories of assimilative and accommodative coping and associations of TGP and FGA with affective well-being that are different from sensory unimpaired individuals.
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Affiliation(s)
- Markus Wettstein
- a Department of Psychological Ageing Research, Institute of Psychology , Heidelberg University , Heidelberg , Germany.,b German Centre of Gerontology , Berlin , Germany
| | - Hans-Werner Wahl
- a Department of Psychological Ageing Research, Institute of Psychology , Heidelberg University , Heidelberg , Germany
| | - Vera Heyl
- c Institute of Special Education, University of Education , Heidelberg , Germany
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13
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Richardson LJ, Molyneaux V, Murray CD. Being a peer support mentor for individuals who have had a lower limb amputation: an interpretative phenomenological analysis. Disabil Rehabil 2019; 42:3850-3857. [DOI: 10.1080/09638288.2019.1611954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | | | - Craig D. Murray
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
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14
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Em S, Karakoc M, Sariyildiz MA, Bozkurt M, Aydin A, Cevik R, Nas K. Assessment of sexual function and quality of life in patients with lower limb amputations. J Back Musculoskelet Rehabil 2019; 32:277-285. [PMID: 30347588 DOI: 10.3233/bmr-170873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial. OBJECTIVE The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function. METHODS Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function (IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36). RESULTS Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p< 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α= 0.01). CONCLUSION The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life.
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Affiliation(s)
- Serda Em
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mehmet Karakoc
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mustafa Akif Sariyildiz
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mehtap Bozkurt
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Abdulkadir Aydin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Remzi Cevik
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Kemal Nas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sakarya University, Adapazarı, Turkey
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15
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van Diemen T, van Nes IJW, Geertzen JHB, Post MWM. Coping Flexibility as Predictor of Distress in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:2015-2021. [PMID: 29966646 DOI: 10.1016/j.apmr.2018.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 05/09/2018] [Accepted: 05/31/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Examine whether coping flexibility at admission to first spinal cord injury (SCI) rehabilitation was predictive of distress 1 year after discharge. DESIGN Longitudinal inception cohort study. SETTING Rehabilitation center. PARTICIPANTS Of the 210 people admitted to their first inpatient SCI rehabilitation program, 188 met the inclusion criteria. n=150 (80%) agreed to participate; the data of participants (N=113) with a complete dataset were used in the statistical analysis. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Coping flexibility was operationalized by (1) flexible goal adjustment (FGA) to given situational forces and constraints and (2) tenacious goal pursuit (TGP) as a way of actively adjusting circumstances to personal preference. The Assimilative-Accommodative Coping Scale was used to measure FGA and TGP. The Hospital Anxiety and Depression Scale was used to assess distress. RESULTS Scores on FGA and TGP measured at admission were negatively associated with the scales depression (r= -.33 and -.41, respectively) and anxiety (r= -.23 and -.30, respectively) 1 year after discharge. All demographic and injury-related variables at admission together explained a small percentage of the variance of depression and anxiety. FGA, TGP, and the interaction term together explained a significant additional 16% of the variance of depression and 10% of anxiety. CONCLUSIONS The tendency to pursue goals early postonset of the injury seems to have a protecting effect against distress 1 year after discharge. People with low TGP may experience protection against distress from high FGA.
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Affiliation(s)
- Tijn van Diemen
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands; Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands.
| | - Ilse J W van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jan H B Geertzen
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands
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Heinitz K, Lorenz T, Schulze D, Schorlemmer J. Positive organizational behavior: Longitudinal effects on subjective well-being. PLoS One 2018; 13:e0198588. [PMID: 29933367 PMCID: PMC6014654 DOI: 10.1371/journal.pone.0198588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
Increasing individual subjective well-being has various positive outcomes, knowledge about its antecedents and the mediators of this relationship can therefore help to increase subjective well-being and the accompanying positive effects. The more future oriented facets of psychological capital, i.e. optimism, hope and self-efficacy have been shown in several studies to be positively related to subjective well-being and negatively to ill-being. Furthermore, recent studies suggest coping strategies as mediators for these relationships. In our study, we examined the longitudinal relation of optimism, hope and self-efficacy with subjective well-being and ill-being in a German panel dataset and tested the mediating effect of flexible goal adjustment in a path model. Our results show a statistically significant positive effect of self-efficacy and optimism on subjective well-being as well as a statistically significant negative effect of optimism on depression over three years. All three predictors show a statistically significant relation with flexible goal adjustment, but flexible goal adjustment did not mediate the effect on subjective well-being or depression.
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Affiliation(s)
- Kathrin Heinitz
- Department of Education and Psychology, Freie Universitaet Berlin, Berlin, Germany
| | - Timo Lorenz
- Department of Education and Psychology, Freie Universitaet Berlin, Berlin, Germany
| | - Daniel Schulze
- Department of Education and Psychology, Freie Universitaet Berlin, Berlin, Germany
| | - Julia Schorlemmer
- Department of Occupational Medicine, Charité Berlin, Berlin, Germany
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Arends RY, Bode C, Taal E, Van de Laar MA. A mixed-methods process evaluation of a goal management intervention for patients with polyarthritis. Psychol Health 2016; 32:38-60. [DOI: 10.1080/08870446.2016.1240173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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Taylor M, McKay D, Eid M, Schuklenk U, Pichora D. What are the ethical issues in treating a patient with bilateral leg gangrene incapable of consenting to amputation secondary to psychiatric illness? Clin Orthop Relat Res 2015; 473:3998-4003. [PMID: 25697445 PMCID: PMC4626515 DOI: 10.1007/s11999-015-4199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bilateral and simultaneous lower extremity amputations unrelated to diabetes and peripheral vascular disease are uncommon, although they may be necessary in patients with severe blast injuries. Such amputations, however, usually are performed in patients who are able to understand and consent to the treatment. CASE DESCRIPTION We present the case of a 29-year-old woman who experienced drug-induced psychosis and underwent substantial hypothermic injuries; most notably, irreversible frostbite injuries to both lower extremities, leading to dry and mummified gangrene. As a result of her psychiatric illness, fluctuating catatonic state, and lack of insight into her clinical condition, she was deemed incapable of making decisions regarding her medical care and her mother was made substitute decision maker. The orthopaedic service was consulted regarding possible surgical treatment of her gangrenous feet that were stable and aseptic after limb preservation efforts (including hyperbaric oxygen) had been tried without success. They recommended close clinical monitoring and continued psychiatric treatment. The family, including the substitute decision maker, citing the patient's best interest, rejected the recommendations of the surgical team and demanded immediate surgical transtibial amputation of both lower legs. LITERATURE REVIEW To our knowledge, such a unique case has not been reported. CLINICAL RELEVANCE We examined the decision-making process, the difficulties of caring for such a patient, and the ethical issues that arose.
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Affiliation(s)
- Michel Taylor
- />Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada , />Kingston General Hospital, Kingston, ON Canada
| | - Douglas McKay
- />Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada , />Hotel Dieu Hospital, Kingston, ON Canada
| | - Moustafa Eid
- />Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada , />Kingston General Hospital, Kingston, ON Canada
| | - Udo Schuklenk
- />Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - David Pichora
- />Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada , />Kingston General Hospital, Kingston, ON Canada
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Stefanic N, Caputi P, Lane L, Iverson DC. Exploring the nature of situational goal-based coping in early-stage breast cancer patients: A contextual approach. Eur J Oncol Nurs 2015; 19:604-11. [DOI: 10.1016/j.ejon.2015.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
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Coffey L, Gallagher P, Desmond D, Ryall N, Wegener ST. Goal Management Tendencies Predict Trajectories of Adjustment to Lower Limb Amputation Up to 15 Months Post Rehabilitation Discharge. Arch Phys Med Rehabil 2014; 95:1895-902. [DOI: 10.1016/j.apmr.2014.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/30/2014] [Accepted: 05/12/2014] [Indexed: 11/26/2022]
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Scobbie L, Duncan EA, Brady MC, Wyke S. Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Disabil Rehabil 2014; 37:1291-8. [PMID: 25243765 DOI: 10.3109/09638288.2014.961652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. METHODS We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. RESULTS Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. CONCLUSIONS Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Profession (NMAHP) Research Unit, University of Stirling , Stirling, Scotland , UK
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Bailly N, Gana K, Hervé C, Joulain M, Alaphilippe D. Does flexible goal adjustment predict life satisfaction in older adults? A six-year longitudinal study. Aging Ment Health 2014; 18:662-70. [PMID: 24479829 DOI: 10.1080/13607863.2013.875121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the relationship between flexible goal adjustment and life satisfaction (as an enduring component of subjective well-being) using six-year longitudinal data from a sample of older adults. METHODS The study included 704 participants aged 63-97 years assessed four times over a six-year period. Simultaneous and lagged models were specified and estimated using structural equation modeling. RESULTS Both simultaneous and lagged coefficients indicated that a high score on flexible goal adjustment significantly predicted subsequent levels of life satisfaction. CONCLUSION In line with successful aging theory, our findings support the view that the ability to adjust personal goals flexibly is a central resource when unattainable goals are encountered and it contributes to well-being in old age.
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Affiliation(s)
- Nathalie Bailly
- a Department of Psychology , University François Rabelais , Tours , France
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