Abstract
Study Design
Descriptive cross-sectional survey study.
Introduction
Limb salvage spares an extremity at risk for amputation after a major traumatic injury.
Psychosocial recovery for individuals with lower extremity limb salvage has been discussed
in the literature. However, to date, psychosocial reactions for individuals with upper
extremity (UE) limb salvage have not been examined.
Purpose of the Study
To determine which factors may influence psychosocial adaptation to UE limb salvage.
Methods
Participants (n = 30; 28 males) were adults (mean, 30.13; range, 18-61) who sustained an UE limb
salvage from a traumatic event. Adaptation was measured using a modified version of
the Reactions to Impairment and Disability Inventory.
Results
A linear mixed-effects regression found that worse psychosocial adaptation was associated
with having less than a college degree, being less than 6 months post-injury, being
older than 23 years, and having more pain. Dominant hand injuries were found to influence
poor adaptation on the denial Reactions to Impairment and Disability Inventory subscale
only.
Discussion
The results of this study indicate that there is potential for nonadaptive reactions
and psychological distress with certain variables in UE limb salvage. Therapists may
use these results to anticipate which clients may be at risk for poor psychosocial
outcomes.
Conclusions
This study indicates the need for early consideration to factors that affect psychological
prognosis for the UE limb salvage population. However, future research is indicated
to better understand the unique psychosocial challenges and needs of these individuals.
Level of Evidence
4.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An analysis of outcomes of reconstruction or amputation of leg-threatening injuries.N Engl J Med. 2002; 347: 1924-1931
- Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies.J Orthop Trauma. 2007; 21: 70-76
- Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long term retrospective comparison.Eur J Orthop Surg Traumatol. 2014; 24: 621-626
- Complications following limb-threatening lower extremity trauma.J Orthop Trauma. 2009; 23: 1-6
- Late amputation may not reduce complications or improve mental health in combat-related, lower extremity limb salvage patients.Injury. 2015; 46: 1527-1532
- A comparison of health outcomes for combat amputee and salvage patients injured in Iraq and Afghanistan.J Trauma Acute Care Surg. 2013; 75: S247-S254
- Comparison of quality of life and functionality in patients with traumatic unilateral below knee amputation and salvage surgery.Prosthet Orthot Int. 2009; 33: 17-24
- The mangled extremity and attempt for limb salvage.J Orthop Surg Res. 2009; 4: 1-6
- Short-term physical and mental health outcomes for combat amputee and nonamputee extremity injury patients.J Orthop Trauma. 2013; 27: e31-e37
- Early versus delayed amputation in the setting of severe lower extremity trauma.Am Surg. 2015; 81: 564-568
- A meta-analysis of amputation versus limb salvage in mangled lower limb injuries—the patient perspective.Injury. 2011; 42: 1194-1197
- The Military Extremity Trauma Amputation/Limb Salvage (METALS) study.J Bone Joint Surg [Am]. 2013; 95: 138-145
- Long-term persistence of disability following severe low-limb trauma. Results of a seven-year follow-up.J Bone Joint Surg [Am]. 2005; 87: 1801-1809
- Common factors and outcome in late upper extremity amputations after military injury.J Orthop Trauma. 2014; 28: 227-231
- Risk factors for and results of late or delayed amputation following combat-related extremity injuries.Orthopedics. 2010; 33: 669
- A qualitative study of factors influencing the decision to have an elective amputation.J Bone Joint Surg [Am]. 2011; 93: 2087-2092
- Conversion from limb salvage to late amputation: lessons learned from recent battlefields with application to civilian trauma.J Surg Orthop Adv. 2015; 24: 170-173
- Upper extremity injuries in the U.S. military during peacetime years and wartime years.J Hand Ther. 2008; 21: 115-122
- Problems experienced during the first year of an acute traumatic hand injury—a prospective study.J Clin Nurs. 2004; 13: 986-995
- Managing the upper extremity amputee: a protocol for success.J Hand Ther. 2008; 21: 160-175
- Psychological aspects of mutilating hand injuries.Hand Clin. 2003; 19: 41-49
- Psychosocial issues after a traumatic hand injury: facilitating adjustment.J Hand Ther. 2011; 24: 95-103
- Treating the war casualty: case reports of polytrauma.J Hand Ther. 2008; 21: 177-187
- Reactions to disability: an empirical investigation of their nature and structure.J Appl Rehabil Counsel. 1990; 21: 13-21
- A hierarchy of reactions to disability.Int J Rehabil Res. 1991; 14: 13-24
Livneh H, Antonak R. Reactions to impairment and disability inventory: users' manual. 2008.
- Fitting linear mixed-effects models using lme4.J Stat Softw. 2015; 67: 1-48
- Traumatic and trauma-related amputations. Part II: upper extremity and future directions.J Bone Joint Surg [Am]. 2010; 92: 2934-2945
- Early delayed amputation: a paradigm shift in the limb-salvage time line for patients with major upper-limb injury.J Rehabil Res Dev. 2009; 46: 385-394
- Current management of the mangled upper extremity.Int Orthop. 2012; 36: 2189-2195
- Patient-based outcomes and quality of life after salvageable wartime extremity vascular injury.J Vasc Surg. 2014; 59: 173-179
- A qualitative study of stress factors in the early stage of acute hand trauma.J Adv Nurs. 2000; 32: 1333-1340
- Psychological and social consequences after reconstruction of upper extremity trauma: methods of detection and management.J Reconstr Microsurg. 2014; 30: 193-206
- Psychosocial adjustment among cancer survivors: findings from a national survey of health and well-being.Health Psychol. 2009; 28: 147-156
- Psychological resilience in young and older adults.Int J Geriatr Psychiatry. 2011; 27: 262-270
- A comparison of health-related quality of life of elderly and younger insulin-treated adults with diabetes.Age Ageing. 2003; 32: 613-618
- Coping strategies associated with participation and quality of life in older adults.Can J Occup Ther. 2015; 82: 44-53
- The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis.J Pain. 2013; 14: 3-13
- Systematic review of effectiveness of mirror therapy in upper extremity function.Disabil Rehabil. 2009; 31: 2145-2149
- The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature.Int J Rehab Res. 2011; 34: 1-13
- Psychological perspective on hand injury and pain.J Hand Ther. 2010; 23: 199-210
- Correlates of pain symptoms among Iraq and Afghanistan military personnel following combat-related blast exposure.J Rehabil Res Dev. 2012; 51: 1189-1202
- Psychosocial factors predict pain and physical health after lower extremity trauma.Clin Orthop Relat Res. 2015; 473: 3519-3526
- Chronic pain and cognitive behavioral therapy: an integrative review.West J Nurs Res. 2016; 38: 596-628
- Cognitive-behavioral therapy for hand and arm pain.J Hand Ther. 2011; 24: 124-131
- Ten years follow-up of trauma-related psychological distress in a cohort of patients with acute traumatic hand injury.Int J Orthop Trauma Nurs. 2012; 16: 129-135
- Reconstruction of blast injuries of the hand and upper limb.Injury. 2013; 44: 305-312
- Injury-induced hand dominance transfer.([dissertation]) University of Kentucky, Lexington, KY2010
- Management of dominant upper extremity injuries: a survey of practice patterns.J Hand Ther. 2012; 25: 79-88
- The effect of upper extremity trauma on handedness.Am J Occup Ther. 1993; 47: 787-795
- The assessment and analysis of handedness: the Edinburg Inventory.Neuropsycholgia. 1971; 9: 97-113
JHT Read for Credit
Quiz: #573
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- #1.The purpose was to identify _____________ following upper limb salvage
- a.functional levels
- b.best practices in hand therapy
- c.the incidence of such injuries in the US and Canada vs. the EU
- d.factors impacting psychosocial adaptation
- a.
- #2.Adaptation was assessed using a modified
- a.DASH
- b.Mayo Hand Function Survey
- c.RIDI
- d.Gilbert and Sullivan Upper Limb Assessment Tool
- a.
- #3.The following did NOT adversely affect adaptation
- a.gender
- b.pain
- c.having less than a college degree
- d.being greater than 23 years old
- a.
- #4.The following has/have been identified as one of numerous non-adaptive reactions
- a.internalized delusions
- b.externalized hostility
- c.bipolar behavior
- d.recurrent micro aggressions
- a.
- #5.The findings may assist clinicians anticipate potential adaptation problems
- a.false
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: August 09, 2017
Accepted:
May 25,
2017
Received in revised form:
May 18,
2017
Received:
July 9,
2016
Footnotes
Disclaimer: The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army and Department of Defense, or the US government.
Identification
Copyright
© 2017 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
