Pamela Gallagher

Phantom limb pain and residual limb pain following lower limb amputation: a descriptive analysis

PURPOSE This research aimed to develop a clearer picture of the experience of residual limb pain and phantom limb pain following a lower limb amputation and to gain a greater understanding of their relationships with physical and psychosocial variables. METHOD One hundred and four participants completed the Trinity Amputation and Prosthesis Experience Scales (TAPES), which includes a section on each of, psychosocial issues, activity restriction, satisfaction with a prosthesis and pain (incidence, duration, level and extent of interference). RESULTS The results showed that 48.1% of the sample experienced residual limb pain and 69.2% experienced phantom limb pain. While fewer people experienced residual limb pain, those who did, experienced it for longer periods, at a greater level of intensity and with a greater amount of interference in their daily lifestyle, than people who were experiencing phantom limb pain. The experience of residual limb pain was associated with other medical problems and low levels of Adjustment to Limitation. Phantom limb pain was associated with older age, being female, above knee amputation, causes other than congenital causes, not receiving support prior to the amputation, the experience of other medical problems, low scores on Adjustment to Limitation and high scores on Aesthetic Satisfaction with the prosthesis. CONCLUSION These findings provide a greater understanding of the issues to be taken into consideration in the rehabilitation of people with a lower limb amputation.Purpose: This research aimed to develop a clearer picture of the experience of residual limb pain and phantom limb pain following a lower limb amputation and to gain a greater understanding of their relationships with physical and psychosocial variables. Method: One hundred and four participants completed the Trinity Amputation and Prosthesis Experience Scales (TAPES), which includes a section on each of, psychosocial issues, activity restriction, satisfaction with a prosthesis and pain (incidence, duration, level and extent of interference). Results: The results showed that 48.1% of the sample experienced residual limb pain and 69.2% experienced phantom limb pain. While fewer people experienced residual limb pain, those who did, experienced it for longer periods, at a greater level of intensity and with a greater amount of interference in their daily lifestyle, than people who were experiencing phantom limb pain. The experience of residual limb pain was associated with other medical problems and low levels of Adjustment to Limitation. Phantom limb pain was associated with older age, being female, above knee amputation, causes other than congenital causes, not receiving support prior to the amputation, the experience of other medical problems, low scores on Adjustment to Limitation and high scores on Aesthetic Satisfaction with the prosthesis. Conclusion: These findings provide a greater understanding of the issues to be taken into consideration in the rehabilitation of people with a lower limb amputation.

Adjustment to an Artificial Limb: A Qualitative Perspective

The purpose of this study was to identify factors considered to be important in the adjustment to amputation and the wearing of a prosthetic limb from the perspective of the person who has had a lower limb amputation. Hence, focus group methodology was employed as a means of acquiring perspectives within a population of young adults who had a lower limb amputation. Preliminary thematic analysis revealed that factors such as self-image, social, physical and practical concerns, the meaning attributed to and the acceptance of the amputation and support among others were important in the adjustment process. These findings have substantial implications for directing future research.

Psychological adjustment and coping in adults with prosthetic limbs.

The potential mediating effects of different coping strategies on the adjustment to living with a prosthetic limb were investigated in 44 adult amputees. Participants completed a questionnaire inquiring about coping, pain, emotional well-being, demographics, and disability-related variables. The coping strategy adopted and the extent of the adjustment to the prosthetic limb varied with age, site of limb loss, and cause of amputation. Furthermore, coping style mediated the adjustment to wearing a prosthetic limb. The results are discussed in terms of future applications and research.

Positive meaning in amputation and thoughts about the amputated limb

The majority of research conducted on the aftermath of amputation understandably concerns itself with its most distressing aspects. This research aimed to explore whether and how people think about their amputated limb, and whether and if they considered anything good had emerged from their amputation. One hundred and four (104) people completed the Trinity Amputation and Prosthesis Experience Scales (TAPES) and two openended questions. The majority of participants were young and had traumatic amputations. Fiftysix percent (56%) of people thought about their amputated limb. People with bilateral or a transfemoral amputation were more likely to think about their amputated limb than people with a transtibial amputation. Fortyeight percent (48%) considered that something good had happened as a result of the amputation. Furthermore, finding positive meaning was significantly associated with more favourable physical capabilities and health ratings, lower levels of Athletic Activity Restriction and higher levels of Adjustment to Limitation. Future research and clinical implications are discussed.

Sensitivity and specificity of the Distress Thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a 'help' question for psychological distress and psychiatric morbidity in patients with advanced cancer.

Brief screening tools may help clinicians in busy settings detect patients who are experiencing severe psychological distress. This study examined the performance of the Distress Thermometer (DT) and a two‐item depression screen [the Patient Health Questionnaire‐2 (PHQ‐2)] with a ‘help’ question in screening for distress and psychiatric morbidity among patients with advanced cancer.

Psychosocial adjustment to diabetes‐related lower limb amputation

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

Body image in people with lower-limb amputation: A Rasch analysis of the amputee body image scale

Gallagher P, Horgan O, Franchignoni F, Giordano A, MacLachlan M: Body image in people with lower-limb amputation: a Rasch analysis of the amputee body image scale. Am J Phys Med Rehabil 2007;86:205–215. Objective: The aim of this study was to examine the psychometric properties of the Amputee Body Image Scale (ABIS) through Rasch analysis, investigating the quality of its rating categories and its reliability and validity. Design: The ABIS (20 items; ratings of 1–5) and Trinity Amputation Prosthesis Experience Scales (TAPES) were administered by post and completed by 145 people with a lower-limb amputation and currently wearing a prosthesis. Results: According to Rasch analysis and expert review, some response categories were collapsed and six items were deleted. The remaining 14 items created a revised ABIS (ABIS-R) rated with a three-level rating scale. ABIS-R fitted the unidimensional construct that the scale was intended to measure and demonstrated good reliability (Cronbach’s alpha and person separation reliability = 0.87), targeting, and internal construct validity. Moreover, the correlations with the nine TAPES subscales (in particular, r = −0.54 with the general adjustment, r = −0.43 with the social activity restriction, and r = −0.40 with social adjustment) supported the convergent validity of ABIS-R. Conclusions: The 14-item ABIS-R demonstrates good psychometric characteristics for measuring body image disturbances in people with lower-limb amputation. These preliminary results suggest the general adequacy of the new instrument and provide a good foundation on which further validation and psychometric studies of the ABIS-R can be conducted.

Environmental barriers, activity limitations and participation restrictions experienced by people with major limb amputation

Background: Limited research is available that explores major limb amputation and the World Health Organization’s International Classification of Functioning, Disability and Health (ICF). Objectives: To investigate the barriers, participation restriction and functioning levels experienced by people with a major limb amputation. Study design: Secondary data analysis. Method: Relevant data for 148 people with major limb amputation were extracted from the National Physical and Sensory Disability Database in Ireland. Results: The most common environmental barriers encountered were climate, physical environment and income. Participation restriction was most commonly experienced in sports/physical recreation, leisure/cultural activity and employment/job-seeking. For daily activities and functioning, the most common difficulties were with standing for long periods, walking long distances and the emotional effects of disability. Differences were found between people with an upper limb or lower limb prosthesis. Conclusion: This paper addresses the limited information available on environmental barriers, activity limitation and participation restriction of people with a major limb amputation. Greater understanding of the impact of amputation andprosthesis type on activity, participation and environmental barriers is important to facilitate improved management and planning at the individual, service and societal level. Clinical relevance Improved understanding of environmental barriers and challenges, activity limitations and participation restrictions experienced by individuals with major limb amputation is a critical step in informing evidence-based service delivery, intervention and policy in order to improve outcomes for this group.

Trinity amputation and prosthesis experience scales: A psychometric assessment using classical test theory and rasch analysis

Gallagher P, Franchignoni F, Giordano A, MacLachlan M: Trinity Amputation and Prosthesis Experience Scales (TAPES): A psychometric assessment using classical test theory and Rasch analysis. Objective:To perform a detailed psychometric analysis using both classical test theory and Rasch analysis of the three main scales of the Trinity Amputation and Prosthesis Experience Scales (TAPES) in people with a lower-limb amputation. Design:A sample of 498 persons who were prosthesis users with a lower-limb amputation was retrospectively studied, pooled from a number of studies undertaken across the United Kingdom and Ireland in the past decade in which the TAPES had been completed as part of a postal survey. Both factor analysis techniques and Rasch analysis were performed on TAPES data. Dimensionality, item fit to the model, response category performance, and internal construct validity were assessed. Category collapsing and item removal were considered to improve the questionnaire. Results:The analyses suggested to restructure the TAPES as follows: (a) three psychosocial adjustment subscales with a four-point rating scale (and a reworded item); (b) an activity restriction scale based on ten items with their original three-point rating scale; and (c) two satisfaction with the prosthesis subscales using a three-point rating scale. All scales and subscales showed acceptable internal consistency and ability to define a distinct hierarchy of persons along the measured construct. Conclusions:This study empirically identified a revised version of the TAPES (TAPES-R) with a simplified general structure and psychometrically suitable for assessing the complex experience of amputation and adjustment to a lower-limb prosthesis. Additional studies are needed to confirm and further explore its measurement properties in other samples, thereby adding clinical validity to the instrument.

Understanding the benefits of prosthetic prescription: exploring the experiences of practitioners and lower limb prosthetic users

Purpose. While lower limb prosthetic prescription is reliant on many physical indicators, it is clear that psychosocial factors need to be emphasised to a greater extent within this field if the needs of users are to be appropriately addressed. The aim of this study is to explore and identify the outcomes of prosthetic prescription through qualitative inquiry. Method. Six focus groups with prosthetic service users and 10 semi-structured interviews with service providers were conducted and then analysed with inductive thematic analysis. Results. The outcomes identified were: independence, not being in a wheelchair, balance and safety, improved quality of life and reaching potential. Conclusions. These emergent themes challenge the predominating focus on physical functioning that many practitioners have. These findings are important for developing a user-based model of service provision and outcome evaluation.