Psychosocial adjustment to a lower limb amputation ten months after surgery

Objective: This longitudinal multisite study examined the influence of demographic characteristics psychological reactions, functionality coping strategies, and social support on psychosocial adjustment to lower limb amputation 10 months after suigery. Method: Of an initial referral of 206 Portuguese patients, a sample of 86 patients who underwent a lower limb amputation due to Diabetes Mellitus Type II were evaluated during the hospitalization that preceded surgery (t0) and at inpatient follow-up consultations, 1 (tl) 6 (t2), and 10 months (t3) after surgery. Results: Higher levels of anxiety symptoms and functionality at presurgery were associated with lower social adjustment to amputation and with higher adjustment to the limitations (t3) respectively. Traumatic stress symptoms (tl) were negatively associated with general and social adjustment, and with the adjustment to the limitations (t3). Perceived social support (t2) mediated the relationship between traumatic stress symptoms (tl) and adjustment to the limitations (t3). Male gender was associated with a higher anxiety and depression symptoms (t0) and with a higher level of functionality (tl). Male gender was associated with functionality at presurgery and postsurgery, and with anxiety and depression symptoms of presurgery. Implications: Results support the need to improve psychological screening and early treatment of anxiety symptoms before the surgery, as well a.s depression and traumatic stress symptoms after a lower limb amputation, and the promotion of social support over time, in order to promote psychosocial adjustment to amputation. This set of psychosocial variables should be included when planning postamputation rehabilitation and psychosocial intervention programs for this target population.
- This study was conducted at the Psychology Research Center (PSI/01662), University of Minho, and supported by the Portuguese Ministry of Science, Technology and Higher Education through national funds and cofinanced by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) and by a grant (SFRH/BD/87704/2012) from the Portuguese Foundation for Science and Technology. The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of the following hospitals: CHP, CHSJ, CHVNG/E, CHTS, ULSAM, and the Vascular Surgery Departments in Braga and CHSJ Hospitals. The authors also wish to thank all patients who agreed to participate in this study.