Abstract
Purpose: There are around 800 lower limb amputations performed each year in Scotland, however one unpublished study showed that 20% of fitted transtibial amputees do not use, and 20% only occasionally use, their prosthesis at one-year follow-up. This finding has implications for patients' well-being and healthcare cost efficiency. Leventhal's common sense self-regulation model (CS-SRM), a social cognition model in health psychology, was used to determine if psychological variables would predict prosthetic use and activity limitations in lower limb amputees.
Method: A longitudinal study recruited 166 peripheral arterial disease amputees (aged: 50+ yrs). The illness perception questionnaire-revised (IPQ-R) assessed psychological variables at 3–4 weeks post-operatively. Items from the functional measure for amputees (FMA) assessed prosthetic use and the locomotor capabilities index (LCI) evaluated activity limitations at 1-month and 6-months post-discharge. Outcome variables were entered into multiple regression equations with predictor variables.
Results: Significant CS-SRM regression models emerged for predicting prosthetic use, with timeline cyclical (perceptions of symptoms fluctuating) and treatment control (beliefs about treatment efficacy) being the most influential variables. Their effects were stronger at 6-months than at 1-month. The same variables were influential for predicting activity limitations at both 1-month and 6-months. Emotional representations (distressing thoughts) were also influential at 1-month.
Conclusions: Knowledge of how psychological variables determined prosthetic use and activity limitations is valuable because it raises the prospect of being able to identify patients whose psychological profiles render them more at risk of not rehabilitating successfully with a prosthesis, in this case those who perceived symptoms as fluctuating and treatment to be ineffective. Such information could also inform the formulation of elements of psychological care aimed at increasing the number of patients making effective use of their prosthesis and achieving improved activity post-discharge from hospital.