Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 3 , Pages 373-380, March 2009

Self-Management Improves Outcomes in Persons With Limb Loss

  • Stephen T. Wegener, PhD, ABPP

      Affiliations

    • Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
    • Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • Corresponding Author InformationCorrespondence to Stephen T. Wegener, PhD, ABPP, Johns Hopkins University, Dept of Physical Medicine and Rehabilitation, 600 N Wolfe St, Phipps, Room 174, Baltimore, MD 21287
    • ,
  • Ellen J. Mackenzie, PhD

      Affiliations

    • Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
    • Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • ,
  • Patti Ephraim, MPH

      Affiliations

    • Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
    • ,
  • Dawn Ehde, PhD

      Affiliations

    • Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
    • ,
  • Rhonda Williams, PhD

      Affiliations

    • Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA

Abstract 

Wegener ST, Mackenzie EJ, Ephraim P, Ehde D, Williams R. Self-management improves outcomes in persons with limb loss.

Objective

To test the acceptance and effectiveness of a community-based self-management (SM) intervention designed to improve outcomes after limb loss. A priori hypothesis was that an SM intervention will be more effective than standard support group activities in improving outcomes.

Design

Randomized controlled trial.

Setting

General community.

Participants

Intervention (N=287) and control participants (N=235) with major limb loss.

Intervention(s)

Nine, 90-minute SM group sessions delivered by trained volunteer leaders. Retention rates at immediate postintervention and 6-month follow-up were 97% and 91% for the SM group.

Main Outcome Measure(s)

Primary outcomes were depression, positive mood, and self-efficacy. Secondary outcomes were improved functional status and quality of life.

Results

By using intent-to-treat analyses, the odds for being depressed are significantly lower for those in SM group, 50% less likely at treatment completion (95% confidence interval [CI]=0.3–0.9) and 40% less likely at the 6-month follow-up (95% CI=.03–1.1). Treatment completers have a 70% reduction in likelihood of being depressed at posttreatment (P<.01) and this persists at six months (P<.05). For those in the SM group, functional limitations were significantly lower at 6 months (P<.05), and general self-efficacy was significantly higher at immediate posttreatment (P<.05) and at 6 months (P<.05). Treatment completers have generally significantly larger effect sizes at all follow-up points. Pain intensity, self-efficacy for pain control, and quality of life were not significantly different between the groups. Subgroup analyses indicated the impact of the intervention was greater for participants who were less than 3 years postamputation, participants who were less than 65 years of age, or participants who showed at least 1 secondary condition at baseline.

Conclusions

The study provides evidence that SM interventions can improve the outcomes of persons with limb loss beyond benefits offered by support groups.

Key Words: Amputation, Depression, Rehabilitation, Self-care, Self-efficacy

List of Abbreviations: ACA, Amputee Coalition of America, CBT, cognitive-behavioral theory, CESD, Center for Epidemiologic Studies Depression Scale, CI, confidence interval, MFA, Musculoskeletal Function Assessment, PALS, Promoting Amputee Life Skills, SM, self-management, SWLS, Satisfaction with Life Scale

 

 Supported by the Centers for Disease Control and Prevention (grant no. R04/CCU322981).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(08)01700-0

doi:10.1016/j.apmr.2008.08.222

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 3 , Pages 373-380, March 2009

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