Laura Coffey

Psychosocial adjustment to diabetes‐related lower limb amputation

Aim  To examine psychosocial adjustment in persons with lower limb amputations related to diabetes.

Cognitive functioning in persons with lower limb amputations: a review

Purpose: To review the literature on cognitive functioning in persons with lower limb amputations. Method: A search of the MEDLINE, PsycINFO and Web of Science databases was carried out. Results: Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation. Conclusions: These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients’ strengths so that maximal mobility and independence is achieved. Implications for Rehabilitation Cognitive impairment appears to be more prevalent among persons with lower limb amputations than in the general population. Cognitive impairment is negatively associated with mobility, prosthesis use, and maintenance of independence following amputation. Cognitive screening prior to rehabilitation could assist in determining patients’ suitability for prosthetic or wheelchair use, ascertaining appropriate goals, and tailoring rehabilitation to patients’ strengths so as to optimise their mobility and independence.

Goal Pursuit and Goal Adjustment as Predictors of Disability and Quality of Life Among Individuals With a Lower Limb Amputation: A Prospective Study

OBJECTIVE (1) To identify significant changes in disability and quality of life (QOL) across 3 time points (t1: admission to rehabilitation; t2: 6wk postdischarge; t3: 6mo postdischarge) in individuals with lower limb amputation, and (2) to examine whether goal pursuit and goal adjustment at t1 were predictive of these outcomes at t3. DESIGN Prospective cohort study. SETTING Inpatient rehabilitation. PARTICIPANTS Consecutive sample of persons (N=64) aged ≥18 years with major lower limb amputation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). RESULTS Mean WHODAS 2.0 scores were in the 95th percentile at each time point. Scores on the WHODAS 2.0 and the physical, psychological, and social relations domains of the WHOQOL-BREF remained stable across the study period. Environmental QOL scores decreased from t1 to t2 but returned to near-baseline levels between t2 and t3. Having a greater tendency toward goal pursuit at t1 was predictive of higher physical and psychological QOL at t3, whereas having a stronger disposition toward goal adjustment at t1 predicted lower disability and higher environmental QOL at t3. CONCLUSIONS High levels of disability were experienced from admission to rehabilitation up to 6 months postdischarge. QOL in the physical, psychological, and social relations domains remained stable over the study period. Stronger goal pursuit and goal adjustment tendencies on admission predicted lower disability and higher QOL 6 months postdischarge.

Goal pursuit, goal adjustment, and affective well‐being following lower limb amputation

OBJECTIVES This study examined the relationships between tenacious goal pursuit (TGP), flexible goal adjustment (FGA), and affective well-being in a sample of individuals with lower limb amputations. DESIGN Cross-sectional, quantitative. METHODS Ninety-eight patients recently admitted to a primary prosthetic rehabilitation programme completed measures of TGP, FGA, positive affect, and negative affect. RESULTS Hierarchical regression analyses revealed that TGP and FGA accounted for a significant proportion of the variance in both positive and negative affect, controlling for sociodemographic and clinical characteristics. TGP was significantly positively associated with positive affect, while FGA was significantly negatively associated with negative affect. Moderated regression analyses indicated that the beneficial effect of FGA on negative affect was strongest at high levels of amputation-related pain intensity and low levels of TGP. DISCUSSION TGP and FGA appear to influence subjective well-being in different ways, with TGP promoting the experience of positive affect and FGA buffering against negative affect. TGP and FGA may prove useful in identifying individuals at risk of poor affective outcomes following lower limb amputation and represent important targets for intervention in this patient group. STATEMENT OF CONTRIBUTION What is already known on this subject? The loss of a limb has a significant impact on several important life domains. Although some individuals experience emotional distress following amputation, the majority adjust well to their limb loss, with some achieving positive change or growth as a result of their experiences. Theories of self-regulation propose that disruptions in goal attainment have negative affective consequences. The physical, social, and psychological upheaval caused by limb loss is likely to threaten the attainment of valued goals, which may leave individuals vulnerable to negative psychosocial outcomes if they do not regulate their goals in response to these challenges. According to the dual-process model of adaptive self-regulation, individuals manage discrepancies between perceived and desired goal attainment by either modifying their life situation or behaviour to fit their goals (tenacious goal pursuit [TGP]) or adjusting their goals to situational constraints (flexible goal adjustment [FGA]). Examining psychosocial adjustment to amputation from this perspective may offer some insight into the diversity of affective outcomes observed. What does this study add? Contributes to our understanding of the mechanisms underlying adjustment to acquired disability. Offers a theory-based explanation for the diversity of psychosocial outcomes observed post-amputation. Identifies important targets for interventions to enhance adjustment in this population.

Psychological variables associated with quality of life following primary treatment for head and neck cancer: a systematic review of the literature from 2004 to 2015

There has been a recent proliferation of research on quality of life (QoL) in head and neck cancer (HNC). The objective of this review was to systematically examine the evidence on psychological factors associated with QoL outcomes for HNC survivors in the post‐treatment period published during 2004–2015.

Goal Management Tendencies Predict Trajectories of Adjustment to Lower Limb Amputation Up to 15 Months Post Rehabilitation Discharge

OBJECTIVES To explore patterns of change in positive affect, general adjustment to lower-limb amputation, and self-reported disability from rehabilitation admission to 15 months postdischarge, and to examine whether goal pursuit and goal adjustment tendencies predict either initial status or rates of change in these outcomes, controlling for sociodemographic and clinical covariates. DESIGN Prospective cohort study with 4 time points (t1: on admission; t2: 6wk postdischarge; t3: 6mo postdischarge; t4: 15mo postdischarge). SETTING Inpatient rehabilitation. PARTICIPANTS Consecutive sample (N=98) of persons aged ≥18 years with major lower-limb amputation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Positive affect subscale of the Positive and Negative Affect Schedule; general adjustment subscale of the Trinity Amputation and Prosthesis Experience Scales-Revised; and World Health Organization Disability Assessment Schedule 2.0. RESULTS Positive affect decreased from t1 to t4 for the overall sample, whereas general adjustment increased. Self-reported disability scores remained stable over this period. Stronger goal pursuit tendencies were associated with greater positive affect at t1, and stronger goal adjustment tendencies were associated with more favorable initial scores on each outcome examined. With regard to rates of change, stronger goal pursuit tendencies buffered against decreases in positive affect and promoted decreases in self-reported disability over time, whereas stronger goal adjustment tendencies enhanced increases in general adjustment to lower-limb amputation. CONCLUSIONS Greater use of goal pursuit and goal adjustment strategies appears to promote more favorable adjustment to lower-limb amputation over time across a range of important rehabilitation outcomes.

“If I can do it I will do it, if I can’t, I can’t”: a study of adaptive self-regulatory strategies following lower limb amputation

Abstract Purpose: To explore the goal-related strategies employed by people following lower limb amputation using a framework based on the dual-process model of adaptive self-regulation. Methods: Semi-structured interviews were conducted with 30 individuals with a lower limb amputation. Results: Theoretical thematic analysis identified four broad assimilative/goal pursuit strategies; internal resource use, planning, technology use and help use. The most common strategies were maintaining a specific leisure activity (n = 20), seeking instrumental help (n = 15) and determination (n = 15). Three broad categories of accommodative/goal adjustment strategies were also identified; interpersonal accommodation, managing limitations and meaning-making. The most common were accepting limitations (n = 18), emotional support from friends and family (n = 17) and adjusting goals to constraints (n = 16). There was also evidence of strategies that combined the use of accommodative and assimilative strategies, and the use of avoidant strategies. Conclusions: The findings point towards key assimilative/goal pursuit and accommodative/goal adjustment strategies that may be adaptive following lower limb amputation. The study highlights the potential usefulness of the dual-process model in understanding how individuals adapt to functional disability, while bringing to light issues warranting further explication within this framework. Implications for Rehabilitation People adopt specific adaptive goal pursuit and goal adjustment strategies in response to goal disruptions following limb loss. Being aware of the processes involved in regulating goals in response to challenges is useful for understanding adjustment to limb loss. Greater understanding of adaptive and maladaptive goal strategies may help the rehabilitation team to foster positive outcomes in people with lower limb amputation.

A prospective study of the importance of life goal characteristics and goal adjustment capacities in longer term psychosocial adjustment to lower limb amputation

Objective: To explore the life goal characteristics and goal adjustment capacities of persons with lower limb amputation on admission to rehabilitation, and to examine their efficacy as predictors of psychosocial outcomes six months post discharge. Design: Prospective, descriptive. Setting: Two specialist inpatient rehabilitation facilities in Ireland. Subjects: A consecutive sample of 64 patients with lower limb amputation. Main measures: On admission to rehabilitation, life goal characteristics (goal importance, goal disturbance) were assessed using the Goal Facilitation Index and goal adjustment capacities (goal disengagement, goal re-engagement) were measured using the Goal Adjustment Scale. The Beck Depression Inventory-II and the Trinity Amputation and Prosthesis Experience Scales-Revised assessed depressive symptomatology and psychosocial adjustment to amputation at six months post discharge. Results: The highest average importance ratings were assigned to goals associated with interpersonal relationships, independence and subjective well-being. Goals related to physical limitations and disruptions in daily activities received the highest hindrance ratings. Goal importance (β = −0.33) and goal disengagement (β = −0.29) on admission significantly predicted depressive symptomatology six months post discharge (P ≤ 0.05). Goal importance (β = 0.32), goal disturbance (β = −0.26), and goal re-engagement (β = −0.21) on admission significantly predicted general adjustment to lower limb amputation at six months post discharge (P ≤ 0.05), while goal importance (β = −0.32) and goal disturbance (β = 0.30) significantly predicted social adjustment (P ≤ 0.05). Conclusions: Life goal characteristics and goal adjustment capacities on admission to rehabilitation predicted psychosocial outcomes six months post discharge among individuals with lower limb amputation.

Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis

PurposeSelf-management interventions improve patient outcomes across a range of long-term conditions but are often limited by low uptake and completion rates. The aim of this paper was to conduct a meta-synthesis of qualitative studies exploring cancer survivors’ views and experiences of engaging with adjustment-focused self-management interventions in order to inform the development of future interventions targeting this population.MethodsFour electronic databases were systematically searched. Studies that used qualitative methods to explore cancer survivors’ views and experiences of engaging with adjustment-focused self-management interventions were included. A meta-ethnographic approach was used to synthesize the findings.ResultsThirteen studies met the inclusion criteria. Engaging with adjustment-focused self-management interventions enabled cancer survivors to gain emotional and informational support from peers and/or facilitators in an open, non-judgemental environment, become empowered through enhancing knowledge and skills and regaining confidence and control, and move beyond cancer by accepting illness experiences, reprioritising goals and adopting a positive outlook. However, the extent to which they engaged with, and benefited from, such interventions was mitigated by diverse preferences regarding intervention design, content and delivery. Personal obstacles to engagement included low perceived need, reticence to discuss cancer-related experiences and various practical issues.ConclusionsCancer survivors derive a range of benefits from participating in adjustment-focused self-management interventions; potential barriers to engagement should be addressed more comprehensively in intervention marketing, design and delivery.Implications for Cancer SurvivorsThe findings suggest some key considerations for the development and implementation of future adjustment-focused self-management interventions that may help to optimize their appeal and effectiveness among cancer survivors.

Self‐management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis

Head and neck cancer (HNC) survivors encounter unique challenges following treatment. This study aimed to identify self‐management strategies that HNC survivors use to overcome these posttreatment challenges.