An holistic and interdisciplinary approach to Amputation and

Prosthetic Rehabilitation

Dr Maggie Donovan-Hall

RI World Conference, Edinburgh

Presentation outline

• Brief overview of cause, incidence and demographics of limb loss

• Taking a holistic perspective and adopting a Biopsychosocial approach to understand the complexities of limb loss

• Examples of areas where an holistic biopsychosocial approach has applied in education and research

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Causes of Limb Loss

• Multiple causes of limb loss

– Amputation and congenital limb deficiency

• Main cause in the UK is to Peripheral vascular disease and diabetes

– National Amputee Statistical Database (NASDAB, 2008) state dysvacularityaccounted for 67% of amputations

– Other factors include trauma, tumour, infection and congenital limb deficiency

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Peripheral Arterial

disease (PAD)

Diabetes Mellitus (DM)

TraumaTumour

CongentitalLimb

deficiency

Infection

Incidence and prevalence of Limb Loss

• Incidence and prevalence of limb loss is difficult to calculate due to a lack of data on National Amputation Rates

– Current literature on the dysvascular related amputation and suggest major amputation rate of 3.9-7.2 per 100,000 people (Moxey et al. 2010)

– Suggested that there are 60,000 to 65,000 people with limb loss in England (Moxey et al. 2010) with approximately 5,000 new referrals each year (NASDAB, 2008)

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Demographic consideration

• National Amputee Statistical Database (NASDAB, 2008) demographic shows that:

– 70% of new referrals are for men

– 50% of these new referrals are for people over the age of 65 years and additional 25% are over 75 years

– 95% for lower limb loss

– 5% are for upper limb loss

– 3% for congenital limb loss

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Readjustment following an amputation

• Individuals following limb loss are confronted with a large number of different factors. For example:

– Physical and functional factors

– Changes to appearance and body image

– Coping and adjustment

– Changes to social situation and roles

– Changes to identity and roles

– Impact on quality of life

– Environmental factors and enabling technologies

• Limb loss is an individual experience and all of these different factors will impact on the individual's adjustment (Gallagher et al, 2007)

The Biopsychosocial Model

• The Biopsychosocial model was developed by Engel (1980) to illustrate the interactions between biological, psychological and social factors

– Argues not one factor is sufficient in understanding complexity of health and illness

– Focuses on the individual within the complex healthcare system

• The Biopsychosocial Approach has been linked to the concept of 'Person Centred Care’, which has many different definitions (Olsson, 2012).

Biological

Sociological Psychological

Understanding Limb Loss

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Biological• Level and cause of

limb loss• Presence of co-

morbidities • Pain/phantom limb

pain• General health

Psychological• Coping strategies

• Adjustment • Affective distress

• Appearance and body-image

• Self-identity and construction of new self • Expectations and

motivation

Sociological• Living situation• Social support• Cultural factors

• Environment factors (enabling technology)• Social roles

• Social economic factors

Different Dimension of Limb Loss

Holistic view of patient

experience

Interdisciplinary approach

Patient Centred

approach

Links to guidelines and service

delivery

Working together in interdisciplinary teams

• Working with clinical partners, professional special interest groups, industry and charities organisation to establish key clinical questions and areas for development. For example:

– New educational opportunities in Amputation Rehabilitation and Prosthetic Use

– Interdisciplinary research using a wide range of flexible approaches

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Interdisciplinary Educational Opportunities

• Working with external stakeholders to develop:

– Flexible and innovative multidisciplinary learning opportunities

– Providing an in-depth understanding of the entire patient journey within a holistic framework

– Research-led teaching delivered from researchers, educators and clinicians across University Faculties

– Strong links to external partners within clinical practice, industry and enterprise and research at a UK, European and International level

Interdisciplinary holistic research

• A growing number of interdisciplinary research projects embracing a holistic framework. For example:

– Involving the users of paediatric upper limb prostheses in the design of new devices

– Understanding the views of people with multiple limb loss following Meningococcal Septicaemia

– Using flexible approaches (ethnography) to explore the potential of new technologies in developing Countries

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Summary

• Importance of a holistic frame working to understand all aspects of limb loss from the patient’s perspective

• Close integration of education, research and clinical practice

• Importance of interdisciplinary collaboration and understanding

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