Self-Management Improves Outcomes in Persons With Limb Loss

Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 04/2009; 90(3):373-80. DOI: 10.1016/j.apmr.2008.08.222
Source: PubMed


To test the acceptance and effectiveness of a community-based self-management (SM) intervention designed to improve outcomes after limb loss. A priori hypothesis was that an SM intervention will be more effective than standard support group activities in improving outcomes.
Randomized controlled trial.
General community.
Intervention (N=287) and control participants (N=235) with major limb loss.
Nine, 90-minute SM group sessions delivered by trained volunteer leaders. Retention rates at immediate postintervention and 6-month follow-up were 97% and 91% for the SM group.
Primary outcomes were depression, positive mood, and self-efficacy. Secondary outcomes were improved functional status and quality of life.
By using intent-to-treat analyses, the odds for being depressed are significantly lower for those in SM group, 50% less likely at treatment completion (95% confidence interval [CI]=0.3-0.9) and 40% less likely at the 6-month follow-up (95% CI=.03-1.1). Treatment completers have a 70% reduction in likelihood of being depressed at posttreatment (P<.01) and this persists at six months (P<.05). For those in the SM group, functional limitations were significantly lower at 6 months (P<.05), and general self-efficacy was significantly higher at immediate posttreatment (P<.05) and at 6 months (P<.05). Treatment completers have generally significantly larger effect sizes at all follow-up points. Pain intensity, self-efficacy for pain control, and quality of life were not significantly different between the groups. Subgroup analyses indicated the impact of the intervention was greater for participants who were less than 3 years postamputation, participants who were less than 65 years of age, or participants who showed at least 1 secondary condition at baseline.
The study provides evidence that SM interventions can improve the outcomes of persons with limb loss beyond benefits offered by support groups.

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    • "The model was fit adjusting for age, gender, education, income, diabetes, asthma, smoking and insurance status. received this intervention in the first six months had a larger response to treatment [55]. Recognizing the need for early interventions to address the burdens of MV-related injuries, trauma centers are beginning to implement multi-modal programs to manage the psychosocial sequelae of injury and prevent secondary complications [56] [57]. "
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    ABSTRACT: Despite decline in U.S. traffic fatalities, non-fatal injuries remain a main cause of reduced self-reported health. The authors used a nationally representative survey to examine the long-term (≥1 year) implications of traffic injuries on self-care, depression, mobility, pain and activity domains of a widely used measure assessing Health-Related Quality of Life (HRQOL). 30,576 participants from panels (2000-2002) of the Medical Expenditure Panel Survey (MEPS) were followed for about two years. The associations between reporting a traffic injury in the first follow-up year and the five domains of the Euroqol Health index (EQ-5D) were assessed using mixed logistic models with outcome severe/moderate problem in each domain. Models adjustment variables included age, gender, education, income, diabetes, asthma, smoking and insurance status. 590 participants reported traffic injuries. In the first follow-up analysis, having an injury was associated with deficits in all domains of the EQ-5D. With the exception of self-care, similar findings were reported in the second follow-up (≥1 year) after injuries with strongest associations between traffic injuries and both mobility and activity (both OR=2.9, P<0.01). Traffic injuries are significantly associated with long-term reduced HRQOL. Injured individuals may benefit from early intervention programs to prevent the development of secondary complications and reduced HRQOL. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    • "For example, the Amputee Coalition of America (ACA) offers over 300 support groups nationally for persons with limb loss, and no single group is limited to individuals with a particular etiology (Amputee Coalition of America, 2009). In the largest known randomized clinical trial of a self-management program for individuals with limb loss, investigators collaborated with the ACA to recruit individuals with all types of amputation etiologies into a common study (Wegener, Ephraim, Ehde, Williams & MacKenzie, 2009 ). Though they did not compare outcomes by amputation etiology, they did discover differences in treatment benefits based on age and comorbidity, two factors that overlap with etiology. "
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    ABSTRACT: To compare individuals with traumatic (TE) vs. nontraumatic (NTE) amputation etiology on pain, psychological, and social variables over the first 12 months postamputation, and to explore changes in mean levels of and correlations between these variables over time. There were 111 adults with newly acquired limb loss. A VA medical center and a Level I trauma hospital in a large metropolitan area. Characteristic Pain Severity, Pain Interference, Patient Health Questionnaire depression module, Posttraumatic Stress Disorder Checklist, Social Constraints Scale, Aversive Emotional Support Scale, Centers for Disease Control and Prevention single item Social Support measure, single item loneliness measure. The NTE group was significantly older, had lower income, and had greater medical comorbidity, preamputation pain, and physical disability. The etiology groups did not differ significantly in mean levels of outcome variables except that the TE group reported greater aversive emotional support at 6 and 12 months. The TE group demonstrated a quadratic change in pain interference, with highest levels at 6 months and a linear increase in social constraints. Both etiology groups showed a linear increase in PTSD symptoms over time. Correlations between physical, psychological, and social distress were observed earlier in the year for the NTE group. Despite significant demographic and preamputation experience differences, few differences in outcomes emerged by etiology group in the first year after amputation. Findings suggest that the year after amputation may be a time of greater change for those with traumatic amputation compared to those with nontraumatic amputation.
    Full-text · Article · May 2010 · Rehabilitation Psychology
    • "Positive affect also is associated with resiliency following severe physical injuries (Quale & Schanke, 2010). Furthermore, positive affect is inversely associated with avoidance coping in inpatient rehabilitation (Kortte, Veiel, Batten, & Wegener, 2009) and with attrition rates in outpatient rehabilitation programs (Grindley, Zizzi, & Nasypany, 2008). "

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