Self-Management Improves Outcomes in Persons With Limb Loss
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.
aDepartment of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
bHealth Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
cDepartment of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, WA
Correspondence 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
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.
ABSTRACT