Out-of-pocket costs and affordability of upper limb prostheses.

BACKGROUND: Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians. OBJECTIVES: Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse. STUDY DESIGN: Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans. METHODS: Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated. RESULTS: Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment. CONCLUSIONS: Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.

Depression and Anxiety Symptoms Among Lebanese Lower Limb Traumatic Amputees: Association with Education, Employment, Adjustment to Amputation and Prosthesis Satisfaction.

ObjectiveTo examine and compare the association between the presence of depression and anxiety symptoms and different sociodemographic and clinical factors including the adjustment to amputation and prosthesis satisfaction among Lebanese individuals with lower limb amputation (LLA). Method: This cross-sectional study was conducted between December 2022 and May 2023 among 72 participants with LLA. Participants completed a questionnaire that included sociodemographic and clinical variables, the revised Trinity Amputation and Prosthesis Experience Scale (TAPES-R), and the Hopkins Symptom Checklist (HSCL-25). Result: Using the HSCL depression and anxiety cut-off, 25% of participants were categorized as having depression symptoms, with unemployment being significantly associated (p-value < .05) with depression. Similarly, 25% were classified as having anxiety symptoms, with both lower education and unemployment (p-value < .05) significantly linked to anxiety. TAPES-R subscales scores exhibited significant differences between non-depressed and depressed, as well as non-anxious and anxious participants (p-value < .05). Correlation analysis demonstrated significant relationship between HSCL scales and TAPES-R subscales; lower scores in adjustment to amputation and prosthesis satisfaction were moderately associated with increased rates of depression (r ranging between -0.331 and -0.500, p-values < .005) and increased rates of anxiety symptoms (r ranging between -0.362 and -0.441, p-values < .002). In addition, higher scores in activity limitation were moderately correlated to increased rates of depression and anxiety (r = 0.438 for anxiety and 0.490 for depression; p < .001). Conclusion: Mental health symptoms are associated with educational level, employment status, and adjustment to amputation and prosthesis satisfaction in Lebanese individuals with LLA. These findings should be considered to achieve optimal prosthetic rehabilitation.

What do users and their aiding professionals want from future devices in upper limb prosthetics? A focus group study.

BACKGROUND: High rejection rates of upper limb prosthetics indicate that current prosthetic devices only partially meet user demands. This study therefore investigated the benefits and challenges with current prostheses, associated services and potential areas for improvement from the perspective of upper limb prosthesis users and various professionals working in the field of upper limb and hand prosthetics. METHODS AND FINDINGS: Seven different focus group discussions were conducted with 32 participants. Participants were grouped by prosthesis type, if they were prosthesis users, or professionals. All focus group discussions were transcribed verbatim, and a summarizing content analysis was performed. Three main topic areas to be addressed emerged from the interviews: 1. a properly functioning prosthesis, 2. the infrastructure, and 3. users' psychological and physical prerequisites. The interaction between a well-functioning prosthesis and a well-developed infrastructure was shown to be important for successful use. CONCLUSIONS: Our study raises many of the same issues that have been reported in previous qualitative studies, dating back over several decades. This study underlines the need to include users and professionals in the future development of prosthetic devices.

Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation?

Mirror therapy is a widely used treatment for phantom limb pain (PLP) relief in patients with limb loss. Less common is progressive muscle relaxation (PMR), used mostly in other medical conditions (psychological, terminal cancer pain, etc). The purpose of this study is to evaluate the efficacy of a mirror therapy preceded by PMR intervention compared to mirror therapy preceded by unguided generic relaxation-mirror therapy in patients with lower limb amputation suffering from PLP. This pilot study was a single-blind, controlled, randomized trial. Thirty lower limb amputees suffering from PLP were recruited and randomly assigned to three groups respectively undergoing a PMR-mirror therapy rehabilitative intervention, generic relaxation-mirror therapy, and conventional physiotherapy (ConvPT). Selected items from Prosthesis Evaluation Questionnaire (PEQ) and the Brief Pain Inventory (BPI) were used to test the pain features at the beginning and 1 week after 3 weeks of intervention. A decrease of about 65% was found in the rate and duration of PLP at the PEQ in PMR-mirror therapy with respect to generic relaxation-mirror therapy (about 30%) and ConvPT (about 6%). A decrease of about 90% in intensity (worst and average) of PLP in PMR-mirror therapy when compared to generic relaxation-mirror therapy (about 45%) and ConvPT (about 20%) was found at the BPI. We preliminary concluded, albeit with limitations due to the small sample of patients, that mirror therapy can improve PLP when associated with PMR. Further studies are required to confirm that PMR could be an effective technique for more successful PLP management.

Amputation Acceptance: A Survey of Factors Influencing the Decision to Undergo Lower Extremity Amputation.

Accepting to undergo amputation is an arduous process often fraught with confusion, fear, and uncertainty. To assess how to best facilitate discussions with at-risk patients, we surveyed lower extremity amputees about their experiences surrounding this decision-making process. Patients who underwent lower extremity amputation at our institution from October 2020 to October 2021 were asked to complete a 5-item telephone survey assessing their decision to undergo amputation and postoperative satisfaction. Retrospective chart review of respondent demographics, comorbidities, operative details, and complications was conducted. Of 89 lower extremity amputees identified, 41 (46.07%) responded to the survey, with the majority undergoing below-knee amputations (n = 34, 82.93%). At a mean follow-up of 5.90 ± 3.45 months, 20 patients (48.78%) were ambulatory. Surveys were completed at a mean of 7.74 ± 4.03 months since amputation. Factors that helped patients decide to undergo amputation included discussions with doctors (n = 32, 78.05%) and concern for worsening health (n = 19, 46.34%). Deteriorating ability to walk (n = 18, 45.00%) was the most common concern prior to surgery. Recommendations by survey respondents to ease the decision-making process included speaking with amputees (n = 9. 22.50%), more discussions with doctors (n = 8, 20.00%), and access to mental health and social services (n = 2, 5.00%); however, many had no recommendations (n = 19, 47.50%), and most were pleased with their decision to undergo amputation (n = 38, 92.68%). Despite most patients primarily citing satisfaction with their decision to undergo lower extremity amputation, it is critical to consider factors that affect patient decisions and recommendations to improve this decision-making process.

Relationship between phantom limb pain, function, and psychosocial health in individuals with lower-limb loss.

INTRODUCTION: The adverse influence of chronic pain on function and psychological health in the general population is well understood. However, the relationship between phantom limb pain (PLP) after limb loss with function and psychological health is less clear. The study purpose was to assess the influences of PLP presence and intensity on function and psychosocial health in individuals with lower-limb loss (LLL). METHODS: One hundred two individuals with major LLL completed a study-specific questionnaire on the presence and intensity of their PLP. The Patient-Reported Outcomes Measurement Information System -29 questionnaire was also administered. RESULTS: Of 102 participants, 64% reported PLP, with a mean intensity of 4.8 ± 2.3 out of 10. Individuals with vs. without PLP demonstrated significantly greater sleep disturbances ( p = 0.03), whereas the differences in function, fatigue, pain interference, depressive symptoms, anxiety, or ability to participate in social roles and activities were not statistically different between groups ( p > 0.05). Of note, mean scores for many of the Patient-Reported Outcomes Measurement Information System-29 short forms among the current sample were similar to the mean of the general population, minimizing the potential clinical impact of PLP on these domains. CONCLUSIONS: Our findings indicate a lack of meaningful associations between PLP presence or intensity with function, and psychosocial health among individuals with LLL. These findings conflict with previous research suggesting an adverse relationship between PLP, function, and psychosocial health after limb loss.

Effect of mirror therapy in the treatment of phantom limb pain in amputees: A systematic review of randomized placebo-controlled trials does not find any evidence of efficacy.

BACKGROUND AND OBJECTIVE: Phantom limb pain (PLP) concerns >50% of amputees and has a negative impact on their rehabilitation, mental health and quality of life. Mirror therapy (MT) is a promising strategy, but its effectiveness remains controversial. We performed a systematic review to: (i) evaluate the effectiveness of MT versus placebo in reducing PLP, and (ii) determine MT effect on disability and quality of life. DATABASES AND DATA TREATMENT: We selected randomized-controlled trials in five databases (Medline, Cochrane Library, CINAHL, PEDro and Embase) that included patients with unilateral lower or upper limb amputation and PLP and that compared the effects on PLP of MT versus a placebo technique. The primary outcome was PLP intensity changes and the secondary outcomes were PLP duration, frequency, patients' disability and quality of life. RESULTS: Among the five studies included, only one reported a significant difference between the MT group and control group, with a positive MT effect at week 4. Only one study assessed MT effect on disability and found a significant improvement in the MT group at week 10 and month 6. CONCLUSIONS: Our systematic review did not allow concluding that MT reduces PLP and disability in amputees. This lack of strong evidence is probably due to (i) the low methodological quality of the included studies, and (ii) the lack of statistical power. Future trials should include a higher number of patients, increase the number and frequency of MT sessions, have a long-term follow-up and improve the methodological quality. SIGNIFICANCE: Recent meta-analyses concluded that MT is effective for reducing phantom limb pain. Conversely, the present systematic review that included only studies with the best level of evidence did not find any evidence about its effectiveness for this condition. We identified many ways to improve future randomized-controlled trials on this topic: increasing the number of participants, reducing the intra-group heterogeneity, using a suitable placebo and intensifying the MT sessions and frequency.

Long-term physical and psychological outcome following traumatic hemipelvectomy.

PURPOSE: First time examination of the physical and psychological long-term outcome following traumatic hemipelvectomy. METHODOLOGY: In this study, all patients suffering from traumatic hemipelvectomy that were treated in a level-A trauma center since 1988 were retrospectively evaluated. The authors aimed to compare the physical and psychological outcome following primary amputation (A) vs. limb-preservation (LP) procedures. The patients were examined with a focus on pain, function, mobility and general health. As part of this examination, various scores were recorded, i.e., Majeed Score, Time up & Go or SF-36. RESULTS: The following work showed 13 patients who had suffered a traumatic hemipelvectomy, 8 of whom survived. Five of these were available for subsequent clinical re-examination; of these, three patients underwent an amputation, while limb preservation was performed on two patients. Mean follow-up of the amputee group was after 12 years compared to 6.5 years following limb preservation. After limb preservation, both patients reported phantom limb pain at the affected leg, despite pain medication. The general state of health was assessed as 82/100 (A) and 45/100 (LP). The Majeed score was 61 (A) vs. 45 (LP). In the clinical examination, three out of five patients (2 LP, 1 A) showed peroneal palsy (PP). In the quality-of-life analysis based on the SF12/36 and the NHP, amputees scored higher than the patients who underwent limb preservation surgery. CONCLUSION: In our small patient cohort, satisfaction, pain and mobility tend to be better following primary amputation compared to limb preserving surgery.

Vivências do luto na amputação em um hospital de urgência e trauma / Experiences of grief and amputation in an emergency and trauma hospital

A definição de amputação compreende a separação total ou parcial de um membro do resto do corpo, com finalidade de proporcionar alívio à dor ou evitar a morte. Apesar de ser algo ocorrido no corpo físico e de cunho reconstrutor, também pode gerar impactos psíquicos a quem vivencia. Objetivos: A presente pesquisa tem como objetivo realizar um estudo qualitativo sobre como as pessoas que sofreram amputação de membros inferiores (MMII) lidam com o processo de mudança corporal e a vivência do luto. O desenvolvimento deste estudo justifica-se pelo avanço no campo da investigação do processo associado à cirurgia de amputação e seus aspectos psicológicos. Isso possibilita uma possível contribuição para a compreensão de como esses sujeitos vivenciam o processo de luto e a reintegração de sua imagem corporal, uma vez que a amputação pode trazer consequências em diversas áreas da vida do paciente. Metodologia: O estudo foi realizado através de uma amostragem intencional, composta por seis participantes, submetidos à amputação de membros inferiores, internados em um hospital de urgências. Para isso foram realizadas duas entrevistas semiestruturadas, utilizadas em dois momentos: após a indicação clínica de amputação e no pós-operatório, após a retirada do membro. Posteriormente, as entrevistas foram analisadas por meio da técnica de análise de conteúdo. Resultados e Discussão: A partir das entrevistas realizadas, emergiram diversos conteúdos emocionais. Assim, compreendeu-se que a amputação, em grande medida, assumiu um caráter traumático para os sujeitos, sobretudo considerando-se as especificidades de cada situação em particular. Conclusões: Mediante o estudo realizado, concluiu-se que o acompanhamento psicológico nesse cenário visa a manejar o impacto psicológico que a perda do membro pode ocasionar na vida do paciente, auxiliando na construção de uma nova imagem corporal, permitindo, assim, que o sujeito possa lidar com as decorrentes repercussões emocionais

The definition of amputation comprises the complete or partial separation of a limb from the rest of the body, with the purpose of providing pain relief or preventing death. Although it is something that happens in the physical body and has a reconstructive nature, it can also generate psychological impacts on those who experience it. Objectives: The objective of this research is to conduct a qualitative study on how individuals who have undergone lower limb amputations cope with the process of bodily changes and the experience of mourning. The development of this study is justified by the advancements in the field of investigation regarding the amputation surgery process and its psychological aspects. This allows for a potential contribution to the understanding of how these individuals experience the mourning process and the reintegration of their body image, as amputation can have consequences in various areas of the patient's life. Methodology: The study was conducted through intentional sampling, consisting of six participants who had undergone lower limb amputations and were hospitalized in an emergency hospital. Two semi-structured interviews were conducted, used at two moments: after the clinical indication of amputation and post-operative limb removal, and later analyzed using content analysis technique. Results and Discussion: Several emotional contents emerged from the interviews conducted. Thus, it was understood that amputation, to a great extent, assumed a traumatic character for these individuals, especially considering the specificities of each particular situation. Conclusions: Based on the conducted study, it was concluded that psychological support in this scenario aims to manage the psychological impact that limb loss can cause in the patient's life, assisting in the construction of a new body image and enabling the individual to cope with the resulting emotional repercussions

A review of user needs to drive the development of lower limb prostheses.

BACKGROUND: The development of bionic legs has seen substantial improvements in the past years but people with lower-limb amputation still suffer from impairments in mobility (e.g., altered balance and gait control) due to significant limitations of the contemporary prostheses. Approaching the problem from a human-centered perspective by focusing on user-specific needs can allow identifying critical improvements that can increase the quality of life. While there are several reviews of user needs regarding upper limb prostheses, a comprehensive summary of such needs for those affected by lower limb loss does not exist. METHODS: We have conducted a systematic review of the literature to extract important needs of the users of lower-limb prostheses. The review included 56 articles in which a need (desire, wish) was reported explicitly by the recruited people with lower limb amputation (N = 8149). RESULTS: An exhaustive list of user needs was collected and subdivided into functional, psychological, cognitive, ergonomics, and other domain. Where appropriate, we have also briefly discussed the developments in prosthetic devices that are related to or could have an impact on those needs. In summary, the users would like to lead an independent life and reintegrate into society by coming back to work and participating in social and leisure activities. Efficient, versatile, and stable gait, but also support to other activities (e.g., sit to stand), contribute to safety and confidence, while appearance and comfort are important for the body image. However, the relation between specific needs, objective measures of performance, and overall satisfaction and quality of life is still an open question. CONCLUSIONS: Identifying user needs is a critical step for the development of new generation lower limb prostheses that aim to improve the quality of life of their users. However, this is not a simple task, as the needs interact with each other and depend on multiple factors (e.g., mobility level, age, gender), while evolving in time with the use of the device. Hence, novel assessment methods are required that can evaluate the impact of the system from a holistic perspective, capturing objective outcomes but also overall user experience and satisfaction in the relevant environment (daily life).

Phantom limb syndrome: Assessment of psychiatric and medical comorbidities associated with Phantom pain in 44,028 below knee amputees.

INTRODUCTION: Phantom limb syndrome is a debilitating complication after extremity amputation that poses significant challenges to recovery. This study aims to examine the relationship between phantom limb syndrome and mental and physical comorbidities, including a comparison between phantom limb pain and phantom limb syndrome without pain in below knee amputees. METHODS: This is a retrospective cohort study of patients who underwent below knee amputation of the lower extremity in the PearlDiver database, as identified using CPT codes. Analysis was carried out to evaluate the absence or presence of phantom limb syndrome. Matched bivariate analysis accounting for age, sex, Charlson Comorbidity Index score, and region was used to assess whether the presence of pain in phantom limb syndrome patients was associated with increased comorbidity. RESULTS: In total, 44,028 patients with below knee amputation were examined: 95% (42,493 patients) did not develop phantom limb syndrome while 4.8% (1,535 patients) of patients did develop phantom limb syndrome. Phantom limb syndrome was significantly associated with increased odds of coexistent major depressive disorder (OR = 1.86, p <0.0001), generalized anxiety disorder (OR = 2.14, p = 0.04), posttraumatic stress disorder (OR = 1.7, p <0.0001), suicidal ideation (OR = 1.62, p <0.0001), obesity (OR = 1.28, p = 0.0007), osteoarthritis (OR = 1.53, p <0.0001), osteoporosis (OR = 1.64, p <0.0001), and low back pain (OR = 2.31, p <0.0001). Analysis of patient cohorts of phantom limb syndrome with pain and those without pain did not reveal a statistically significant relationship between the presence of pain and any dependent variable. CONCLUSIONS: This investigation of over 44,000 patients with below knee amputation revealed that patients with phantom limb syndrome exhibit significantly higher rate of psychiatric comorbidities compared to those without documented phantom limb pain. Suicidal ideation, major depressive disorder, generalized anxiety disorder, and post-traumatic stress disorder were especially common, and consequently a multi-disciplinary approach to management is essential.

Effectiveness of graded motor imagery protocol in phantom limb pain in amputed patient: Protocol of a randomized clinical trial.

OBJECTIVE: The aim of this study is to analyse the effectiveness of the Graded Motor Imagery (GraMI) protocol in phantom limb pain in amputee patients. MATERIALS AND METHODS: A randomised clinical trial will be conducted, with two parallel groups and simple blinding, and a phenomenological study with semi-structured interviews. People over the age of 18, with amputation of one limb, with a minimum score of 3 on the visual analogue scale of pain, who are pharmacologically stable and have been discharged from hospital, will be recruited. An initial assessment, a post-intervention assessment (9 weeks) and a follow-up assessment (12 weeks post-intervention) will be performed, in which pain, quality of life, functionality and psychological aspects will be assessed. The aim of the qualitative study is to find out about the experience of living with phantom limb pain and to identify the satisfaction with the intervention. A descriptive, univariate and bivariate quantitative statistical analysis will be performed using the SPSS program, with a 95% confidence level and a statistical significance level of p < 0.05. The qualitative analysis will be carried out using the Atlas.ti 8.0 program, where the different interviews will be analysed, coded and categorised. DISCUSSION: The GraMI protocol allows the patient to work on motor learning through brain reorganisation, analytical movements, sensory stimulation, and functional activities. In addition, it can help to standardise the use of graded motor imagery in future studies and in clinical practice with this patient profile. TRIAL REGISTRATION: NCT05083611.

Quality of life in lower limb amputees: a cross-sectional study from a tertiary care center of South India.

BACKGROUND: Various literature have dealt with the physical aspect of amputation and the functional outcome after amputation. There are a few studies that give focused attention to the quality of life (QOL) of amputees. These studies are mostly from the developed countries. This study analyzed amputation as a whole and how it affects an individual physically, psychologically, emotionally, and socially, which would enable the health care providers to help the amputees to attain a better QOL. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: This cross-sectional study was conducted on lower limb amputees. Data were collected using a proforma for demographic details and two pretested questionnaires-the World Health Organization QOL-Bref and prostheses-specific Trinity Amputation and Prosthesis Experience Scales-Revised questionnaires. The data were analyzed using SPSS software, version 20. RESULTS: Amputation significantly affects all domains of the QOL. Age was a significant determinant of QOL of amputees, and it was found that the QOL decreased with an increase in age. 48.1% of the amputees were using a prosthetic device, and they were found to have a significantly better QOL. The prevalence of residual limb pain and phantom limb pain was 52.9% and 37%, respectively. CONCLUSION: Nearly half of the population perceived that their QOL was neither poor nor good. The QOL of the physical domain was better than the other domains. The most important factors that were found to be associated with QOL of amputees were age, duration since amputation, and use of prosthesis.

Acceptance of illness, quality of life and nutritional status of patients after lower limb amputation due to diabetes mellitus.

INTRODUCTION: Diabetes mellitus is one of the most common chronic diseases with a high number of sufferers worldwide. Diabetic neuropathy and diabetic angiopathy lead to serious infectious complications which are very difficult to combat and may finally lead to the amputation of a lower limb. The aim of the study was to evaluate the quality of life, the level of acceptance of the illness and the nutritional status of patients after lower limb amputation due to diabetes. METHODS: Ninety-nine patients (23 men and 76 women) were enrolled into the study. They had all undergone lower limb amputation due to diabetic foot and were treated in the Department of General and Oncological Surgery. The following questionnaires were used: the WHO Quality of Life-BREF (WHOQOL-BREF), the Mini Nutritional Assessment (MNA), the Acceptance of Illness Scale (AIS) and the anonymous specific socio-demographic characteristics questionnaire. RESULTS: The diabetes-related amputees were revealed to have a higher QoL within the social domain (mean score 64.48), an intermediate QoL - within the environmental domain (mean score 63.04) and the mental domain (mean score 59.61), and a lower QoL - within physical (somatic) domain (mean score 54.69). There was no statistical correlation between genders or between all the domains of QoL (P > 0.05). The mean MNA score was 22.66, which means that patients were at risk of malnutrition. There were statistical differences between women and men as regards nutritional status (P = 0.034). The mean AIS score was 27.65 (27.09 women and 29.48 men), which means that the respondents accept their disease. There was no statistical correlation between gender and the acceptance of the disease (P = 0.288). There was not statistical correlation between age and QoL (P > 0.05). There were statistical differences between age and nutritional status (P < 0.05), and between age and acceptance of the illness (P = 0.044). CONCLUSIONS: The better the quality of life was in all the domains, the better the level of acceptance of illness was. The less malnourished the patient was, the better their quality of life was in all the domains.

Aspectos Psicológicos do Fenômeno do Membro Fantasma em Pacientes Oncológicos Submetidos à Cirurgia de Amputação: Revisão Integrativa da Literatura / Psychological Aspects of the Phenomenon of the Phantom Limb in Cancer Patients Undergoing Amputation Surgery: Integrative / Literature Review Aspectos Psicológicos del Fenómeno del Miembro Fantasma en Pacientes con Cáncer Sometidos a Cirugía de Amputación: Revisión Integradora de la Literatura

Introdução: Entre os tipos de câncer existentes, estão os tumores ósseos e de tecidos moles. Muitos pacientes acometidos por essas neoplasias são submetidos à cirurgia de amputação e relatam a ocorrência da sensação e/ou dor do membro fantasma. Objetivo: Identificar, sintetizar e discutir estudos realizados acerca dos aspectos psicológicos do fenômeno do membro fantasma em pacientes oncológicos submetidos à cirurgia de amputação. Método: Revisão integrativa da literatura publicada nos últimos 25 anos. Realizou-se a busca de estudos experimentais, ensaios clínicos e revisões de literatura nas bases de dados MEDLINE, LILACS e Embase. Resultados: Foram selecionados sete artigos para compor esta revisão. Três estudos estabeleceram correlações entre os fatores psicológicos e a ocorrência do fenômeno do membro fantasma após a amputação, quatro abordam aspectos psicológicos e emocionais envolvidos na cirurgia de amputação e aspectos psicológicos envolvidos no fenômeno do membro fantasma, entretanto não estabeleceram relações entre eles. Alguns autores defendem a correlação entre os aspectos psicológicos e a ocorrência do fenômeno do membro fantasma em pacientes amputados. Sua explicação neurofisiológica ainda permanece desconhecida pela comunidade científica. Conclusão: O fenômeno do membro fantasma pode sofrer influências de aspectos psicológicos e emocionais provocados pelo adoecimento e seu tratamento. Ressalta-se a necessidade de mais pesquisas sobre o fenômeno em pacientes oncológicos, principalmente, no que refere aos seus aspectos psicológicos, dada a sua relevância no cuidado oncológico

Introduction: Many patients affected by bone and soft tissue tumors, undergo amputation surgery and report the sensation and/or pain of the phantom limb. Objective: Identify, summarize and discuss studies on the psychological aspects of the phantom limb phenomenon in oncological patients who underwent amputation surgery. Method: Integrative review of the literature published in the last 25 years. Experimental studies, clinical trials and literature review were searched in the databases MEDLINE, LILACS and Embase. Results: Seven articles were selected for this review. Three studies established correlations between psychological factors and the occurrence of the phantom limb phenomenon after amputation, four addressed psychological and emotional aspects involved in the amputation surgery and psychological aspects involved in the phantom limb phenomenon, however, they did not establish relationships among them. Some authors defend the correlation between psychological aspects and the occurrence of the phantom limb phenomenon in amputee patients. Its neurophysiological explanation remains unknown to the scientific community. Conclusion: The phantom limb phenomenon can be influenced by psychological and emotional aspects caused by the illness and its treatment. Further studies about the phenomenon in cancer patients are necessary, especially about the psychological aspects, given its relevance in cancer care

Introducción: Entre los tipos de cáncer existentes se encuentran los tumores de huesos y tejidos blandos. Muchos pacientes afectados por estas enfermedades se someten a una cirugía de amputación y notifican la aparición de sensación y/o dolor en el miembro fantasma. Objetivo: Identificar y analizar estudios realizados sobre aspectos psicológicos del fenómeno del miembro fantasma en pacientes oncológicos sometidos a cirugía de amputación. Método: Revisión integradora de la literatura publicada en los últimos 25 años. La búsqueda de artículos se realizó en las bases de datos MEDLINE, LILACS y Embase. Resultados: Se seleccionaron siete artículos para componer esta revisión. Tres estudios establecen correlaciones entre factores psicológicos y la ocurrencia del fenómeno del miembro fantasma después de la amputación, cuatro abordan aspectos psicológicos y emocionales involucrados en la cirugía de amputación y aspectos psicológicos involucrados en el fenómeno del miembro fantasma, sin embargo, no establecen relaciones entre ellos. Algunos autores defienden la correlación entre los aspectos psicológicos y la ocurrencia del fenómeno del miembro fantasma en pacientes amputados. La explicación neurofisiológica sigue siendo desconocida para la comunidad científica. Conclusión: El fenómeno del miembro fantasma puede verse influido por aspectos psicológicos y emocionales provocados por la enfermedad y su tratamiento. Se destaca la necesidad de profundizar en la investigación del fenómeno en pacientes oncológicos, especialmente en sus aspectos psicológicos, dada su relevancia en la atención oncológica

Structural validity and reliability of the patient experience measure: A new approach to assessing psychosocial experience of upper limb prosthesis users.

Recent advances in upper limb prosthetics include sensory restoration techniques and osseointegration technology that introduce additional risks, higher costs, and longer periods of rehabilitation. To inform regulatory and clinical decision making, validated patient reported outcome measures are required to understand the relative benefits of these interventions. The Patient Experience Measure (PEM) was developed to quantify psychosocial outcomes for research studies on sensory-enabled upper limb prostheses. While the PEM was responsive to changes in prosthesis experience in prior studies, its psychometric properties had not been assessed. Here, the PEM was examined for structural validity and reliability across a large sample of people with upper limb loss (n = 677). The PEM was modified and tested in three phases: initial refinement and cognitive testing, pilot testing, and field testing. Exploratory factor analysis (EFA) was used to discover the underlying factor structure of the PEM items and confirmatory factor analysis (CFA) verified the structure. Rasch partial credit modeling evaluated monotonicity, fit, and magnitude of differential item functioning by age, sex, and prosthesis use for all scales. EFA resulted in a seven-factor solution that was reduced to the following six scales after CFA: social interaction, self-efficacy, embodiment, intuitiveness, wellbeing, and self-consciousness. After removal of two items during Rasch analyses, the overall model fit was acceptable (CFI = 0.973, TLI = 0.979, RMSEA = 0.038). The social interaction, self-efficacy and embodiment scales had strong person reliability (0.81, 0.80 and 0.77), Cronbach's alpha (0.90, 0.80 and 0.71), and intraclass correlation coefficients (0.82, 0.85 and 0.74), respectively. The large sample size and use of contemporary measurement methods enabled identification of unidimensional constructs, differential item functioning by participant characteristics, and the rank ordering of the difficulty of each item in the scales. The PEM enables quantification of critical psychosocial impacts of advanced prosthetic technologies and provides a rigorous foundation for future studies of clinical and prosthetic interventions.

Prosthetic Disuse Leads to Lower Balance Confidence in a Long-Term User of a Transtibial Prosthesis.

Residual limb wounds or ulcers are one of the most frequent skin problems reported by lower extremity prosthesis users. Healing often requires prosthesis disuse, which can logically impair physical functioning. However, there are limited data available to support this idea. We report the impact of prosthesis disuse by presenting assessments of balance, gait, physical activity, and balance confidence obtained on a case subject before experiencing a wound and following reintroduction to a well-fit prosthesis after wound-related prosthesis disuse. The case subject was a 76-year-old male who suffered a unilateral, transtibial amputation due to synovial sarcoma 13 years before. After presenting with a history of pain in the area of a chronic skin plaque, he received a punch biopsy, which resulted in 4 weeks of prosthesis disuse followed by 12 weeks of limited use before a final well-fitting socket was received. The following data were collected 24 weeks before the biopsy and 4 weeks after receiving the final well-fitting socket: Berg Balance Scale, L-test of walking, quantitative gait analysis, Activity-specific Balance Confidence Scale, and 1 week of community-based activity. Balance confidence decreased nearly 19%, walking speed decreased by 12%, and steps/day decreased by 19% following ∼4 months of prosthesis disuse/limited use; functional measures were not impacted. Lower balance confidence is not trivial as it can lead to activity avoidance and increased fall risk. Interventions to target balance confidence changes following prosthesis disuses may be important to minimize the impact of disuse on physical and mental well-being.

Quality of life, body image and self-esteem in patients with unilateral transtibial amputations.

Amputation represents a drastic impact on the patient's body and perception. This cross-sectional study aims to analyse the aesthetic concern represented by body image, self-esteem and quality of life in patients with unilateral transtibial amputations of lower limbs compared to control group. People living with amputations present lower average levels than controls in all subscales of the SF-36 (Short Form 36 Health Survey) quality of life questionnaire, and in both the physical component summary and the mental component summary, although the difference is not statistically significant in the latter. These patients present a significantly lower mean score (p = 0.002) in the MBSRQ (Body-Self Relations Questionnaire) body image questionnaire: 2.64 ± 0.49 opposed to 3.16 ± 0.55 in controls. People living with amputations had a lower mean score on the Rosenberg Self-Esteem scale than controls (34.44 ± 4.61 v 36.04 ± 3.63). The results also show that amputation has a significant influence on the BI (Body image) of patients with unilateral transtibial amputations. SE (Self-Esteem) seems to be an aspect that is not significantly affected by lower limb amputation, although these patients scored a lower mean on the RSE scale compared to the control group. We consider it is highly relevant to assess QoL (Quality of life), BI and SE in patients after a lower limb amputation process.

Changes in Temporal and Spatial Patterns of Intrinsic Brain Activity and Functional Connectivity in Upper-Limb Amputees: An fMRI Study.

Background: Amputation in adults is a serious procedure or traumatic outcome, one that leads to a possible "remapping" of limb representations (somatotopy) in the motor and sensory cortex. The temporal and spatial extent underlying reorganization of somatotopy is unclear. The aim of this study was to better understand how local and global structural plasticity in sensory-motor cortical networks changes temporally and spatially after upper-limb amputation. Methods: We studied 8 healthy nonamputee control subjects and 16 complete upper-limb amputees. Resting-state MRI (rs-fMRI) was used to measure local and large-scale relative differences (compared to controls) in both the amplitude of low-frequency fluctuations (ALFF) and degree of centrality (DC) at 2 months, 6 months, and 12 months after traumatic amputation. Results: In amputees, rs-fMRI scans revealed differences in spatial patterns of ALFF and DC among brain regions over time. Significant relative increases in ALFF and DC were detected not only in the sensory and motor cortex but also in related cortical regions believed to be involved in cognition and motor planning. We observed changes in the magnitude of ALFFs in the pre- and postcentral gyrus and primary sensory cortex, as well as in the anterior cingulate, parahippocampal gyrus, and hippocampus, 2 months after the amputation. The regional distribution of increases/decreases in ALFFs and DC documented at 2-month postamputation was very different from those at 6 and 12-month postamputation. Conclusion: Local and wide-spread changes in ALFFs in the sensorimotor cortex and cognitive-related brain regions after upper-limb amputation may imply dysfunction not only in sensory and motor function but also in areas responsible for sensorimotor integration and motor planning. These results suggest that cortical reorganization after upper extremity deafferentation is temporally and spatially more complicated than previously appreciated, affecting DC in widespread regions.

Telerehabilitation for Amputee Care.

Patients with amputation have unique characteristics and needs that must be considered when services are being provided through a virtual platform. The types of amputation rehabilitation services that can be provided virtually are numerous and vary from a full clinical team evaluation to individual therapy services. Whether services are being provided in person or through a virtual platform, rehabilitation of the person with amputation ideally involves a collaborative interdisciplinary team. The potential benefits of providing amputation rehabilitation care through a virtual platform include enhanced access to specialized services, reduced travel burden, and improved continuity of care.