Satisfaction with life in individuals with a lower limb amputation: The importance of active coping and acceptance

Experiences of persons with lower limb amputation after prosthetic rehabilitation in Ghana: A qualitative inquiry

BACKGROUND

Lower limb amputations (LLAs) have long been associated with physical, social, and psychological consequences. Individuals with LLAs have challenges with mobility and often become isolated from their social networks. Disability rehabilitation technologies such as prosthetic devices are used to improve the mobility capabilities of lower limb amputees. To improve clinical outcomes, feedback from the prosthetic users is a key element to consider.

OBJECTIVES

The study sort to explore the experiences of lower-limb prosthetic users after prosthetic rehabilitation in a prosthetic and orthotic rehabilitation center in the Eastern Region of Ghana.

STUDY DESIGN

This study adopted an exploratory descriptive qualitative study design.

METHODS

A purposive sampling technique and semistructured interview guide was used to interview 17 participants by the first author. The social model of disability underpinned the study. Lower-limb prosthetic users (≥18 years) with unilateral LLA attending outpatient follow-up at a prosthetic and orthotic rehabilitation center were recruited. The interviews were audio recoded, transcribed verbatim, and analyzed using the procedure for thematic content analysis by Braun and Clarke (2013).

RESULTS

Participants reported injuries and tingling in their residual limb. Internal stigma resulting from negative comments and labeling from the public were reported. Prosthetic users experienced empathy and being treated as weaklings by their family/peers. Participants avoided relationships because of recurrent rejection, embarrassment, fear of sexual abuse, and exploitation. As a coping method, some participants chose to isolate themselves to avoid humiliation and public disgrace. Other coping mechanisms included watching television, listening to music, conversing with others, ignoring criticism, and having faith in God.

CONCLUSION

Participants' narrative in this study gave insight into the varied lived experiences on the individual level, family/peer level, and the coping mechanisms used. Challenges relating to discomfort from the prosthesis, internal stigma, relationship avoidance, and altered sexual life should be given much attention and used in implementing initiatives to improve clinical outcomes.

Utilization and Perception of Peer-Support After Lower Limb Loss in the United States: Potential Benefits on Mobility Outcomes

OBJECTIVE

To examine participants' experiences with peer-support after lower limb loss (LLL) and the associations between the peer-support experience (perceived benefits and barriers) and mobility outcomes.

DESIGN

Quantitative and qualitative descriptive study with a cross-sectional design.

SETTING

National survey (distributed to 169 peer-support groups in 44 states in the US).

PARTICIPANTS

The survey was completed by 82 individuals with a major lower limb amputation (53% female, 54% over 55 years of age; N=82).

MAIN OUTCOME MEASURES

A 32-item survey to examine respondents' experiences in peer-support activities. Prosthetic mobility was measured using the Prosthetic Limb Users Survey of Mobility (PLUS-M).

RESULTS

Two out of 3 respondents received some forms of peer-support after amputation. Among them 75% reported peer-support having a positive effect on their outlook on life, and 78% reported that information gained from peer-support was helpful. Companionship, altruistic acts, and gaining information on how to cope with amputation were the top themes of why respondents enjoyed the peer-support experience. Nearly all (94%) respondents would recommend peer-support to other people with LLL. Individuals who received peer-support exhibited a trend of greater mobility (55th vs 36th percentile on PLUS-M; P=.055).

CONCLUSION

Individuals with LLL reported generally positive experiences regarding their engagement in peer-support activities. Peer-support groups are viewed as a helpful source for both information and emotional support, potentially benefiting functional and psychological recovery after amputation. Individuals who have received peer-support also exhibited greater mobility.

Sex and gender differences in quality of life and related domains for individuals with adult acquired lower-limb amputation: a scoping review

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.

Avoidant Coping Is Associated with Quality of Life in Persons with Multiple Sclerosis with High Cognitive Reserve

Objective

The goal of this study was to determine the impact of the relationship between cognitive reserve and coping strategy on quality of life (QoL) outcomes in persons with MS (PwMS) across multiple domains.

Methods

We examined the effect of the interactions between coping style and cognitive reserve on QoL and disease burden in 97 persons with MS (PwMS). Coping strategy, either active or avoidant, was measured using the COPE inventory. We defined cognitive reserve as a composite measure of years of education and scores on the Shipley-2 Vocabulary subtest. QoL and disease burden were assessed using the Functional Assessment of MS (FAMS) scale and the Expanded Disability Status Scale, respectively. We examined both the FAMS individual subscales and the overall QoL score.

Results

For those with higher cognitive reserve, greater avoidant coping was associated with lower QoL for the thinking and fatigue subscale (p < 0.001) and poorer overall QoL (p = 0.03); greater active coping was associated with poorer QoL for mobility (p = 0.001). However, these associations did not hold for those with lower cognitive reserve. Furthermore, there were no associations between coping strategy and cognitive reserve with disease burden.

Conclusions

This study extends previous findings by demonstrating that avoidant coping, rather than active coping, is associated with poorer thinking and fatigue and overall QoL only for PwMS with greater cognitive reserve. Counseling PwMS on the impact of coping strategies on QoL outcomes, especially for those with greater cognitive reserve, may improve quality of life outcomes in this population.

Leisure-time physical activity, coping and life satisfaction among Korean individuals with physical disabilities

A few studies explored the relationships among leisure-time physical activity (LTPA), coping, and life satisfaction among individuals with physical disabilities. This study aims to investigate how LPTA contributes to coping and life satisfaction among Korean individuals with physical disabilities. Using a purposive sampling strategy, a total of 351 people with physical disabilities participated in this study. The results of this study find that participation in LTPA leads to the development of active coping strategies that contribute to increased life satisfaction. This study suggests that encouraging LTPA participation can be a critical task to healthcare providers working with individuals with physical disabilities.

Testing of a Dual Process Model to Resolve the Socioeconomic Health Disparities: A Tale of Two Asian Countries

A wealth of past studies documented that individuals of lower socioeconomic status (SES) are more susceptible to both acute and chronic life stress than those of higher SES, but some recent evidence documents that not all individuals from the lower SES group experience immense stress. The present study was grounded in theories of coping and psychological adjustment, and a dual process model was formulated to address some resolved issues regarding socioeconomic disparities in health. For a robust test of the proposed dual process model, data were collected from two Asian countries—Hong Kong and Indonesia—with different socioeconomic heritage and conditions. Consistent with the predictions of our model, the present findings revealed that coping flexibility was a psychological mechanism underlying the positive association between social capital and health for the lower SES group, whereas active coping was a psychological mechanism underlying this positive association for the higher SES group. These patterns of results were largely replicable in both Asian samples, providing robust empirical support for the proposed dual process model.

Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities

Background: It is well-documented that active coping strategies can lead to better positive adjustment and psycho-social outcomes among individuals with disabilities and illnesses. However, little information exists related to exploring how coping is related to health benefits such as personal growth and life satisfaction in an international context. Thus, this study examined how the use of coping strategies is associated with personal growth and life satisfaction among individuals with physical disabilities in non-Western settings.

Methods: In this cross-sectional study, we employed a nonprobability methodology, purposivesampling, to recruit 351 participants who adults over the age of 18 living with a physicaldisability and currently enrolled in the Korean Disability Association. A hierarchical linearregression analysis was conducted to determine which types of coping strategies predictedpersonal growth and life satisfaction, while controlling for the effects of the demographicvariables (i.e., gender and age).

Results: With regard to personal growth, problem-solving coping strategy (β = 0.663, P < 0.001,95% CI [0.51, 0.70]) was the strongest predictor, followed by avoidance coping strategy(β = -0.263, P < 0.001, 95% CI [-0.37, -0.20]). As for life satisfaction, problem-solving copingstrategy (β = 0.268, P < 0.001, 95% CI [0.18, 0.70]) was the strongest predictor, followed bysocial support seeking coping strategy (β = 0.264, P < 0.001, 95% CI [-0.19, 0.10]).

Conclusion: Our study suggests that problem-focused and social support coping strategies playimportant roles in improving the personal growth and life satisfaction among Korean individualswith physical disabilities. This study provides implications for health professionals seeking waysto facilitate the personal growth and enhance the life satisfaction of individuals with physicaldisabilities.

Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation

Background

In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2).

Methods

Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS.

Results

Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47–86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3–119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history.

Conclusion

Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.

Evaluation of the quality of life in individuals with amputations in relation to the etiology of their amputation. A case-control study

Objectives: Several studies indicate that limb amputations have a negative influence in the quality of life of those individuals who underwent amputation surgery. The aims of this study were to evaluate the quality of life in Mexican individuals with limb amputations compared with a control group, to identify demographic and clinical differences related to the etiology of the amputation, and to determine if they are associated with the quality of life observed in these patients. Methods: All participants were recruited from the Hospital "Dr Gustavo A. Rovirosa Pérez". The quality of life of all participants was evaluated using SF-36. Results: Individuals with amputations of vascular or trauma etiology, showed a diminished health-related quality of life when compared with the control group (p < .001). We observed that individuals with amputations due to trauma were younger, mostly single, with more upper limb amputations and with a shorter period since amputation at the current assessment in comparison to individuals with amputations. Conclusions: Although limb amputation represents a surgical procedure necessary to preserve the life of a person, our results support that it negatively impacts the health-related quality of life of these individuals. Regardless of the etiology of the amputation, rehabilitation programs are primarily focused on reintegrating individuals to their everyday life. However, these programs may have poor results when patients have a poor quality of life. Therefore, quality of life assessment and early inclusion in programs that aim to improve the quality of life of individuals with amputations should be always taken into consideration.

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.