Self‐Efficacy and Social Support are Associated with Disability for Ambulatory Prosthesis Users After Lower‐Limb Amputation

Abstract

Background Interventions targeting psychosocial factors may improve rehabilitation outcomes for prosthesis users after lower‐limb amputation (LLA), but there is a need to identify targeted factors for minimizing disability. Objective To identify psychosocial factors related to disability for prosthesis users after LLA in middle age or later. Design Cross‐sectional study. Setting General community. Participants Participants with LLA (N = 122) were included in this cross‐sectional study if their most recent LLA was at least 1 year prior, they were ambulating independently with a prosthesis, and they were between 45 and 88 years old. Interventions Not applicable. Main Outcome Measures Disability, the primary outcome, was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). Candidate psychosocial variables included self‐efficacy, social support, and motivation, measured using the Self‐Efficacy of Managing Chronic Disease questionnaire (SEMCD), Multidimensional Scale of Perceived Social Support questionnaire (MSPSS), and modified contemplation ladder (mCL), respectively. The hypothesis was that greater self‐efficacy, social support, and motivation would be associated with lower disability when controlling for covariates. Results The covariate model, including etiology, age, sex, U.S. military veteran status, LLA characteristics, time since LLA, medical complexity, and perceived functional capacity, explained 66.1% of disability variability (WHODAS 2.0). Backward elimination of candidate psychosocial variables stopped after removal of motivation (P = .10), with self‐efficacy (P < .001) and social support (P = .002) variables remaining in the final model. The final model fit was statistically improved (P < .001) and explained an additional 6.1% of disability variability when compared to the covariate model. Conclusions Greater self‐efficacy and social support are related to lower disability after LLA. Findings suggest there may be a role for interventions targeting increased physical function, self‐efficacy, and social support for ambulatory prosthesis users after LLA in middle age or later, especially when complicated by multiple chronic conditions.

Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision

“…Job positions requiring more craft skills than managerial-professional skills are strongly related to back pain ( 56 ). Prospective evidence shows that pain symptom severity and disability are worse over time among non-white, less-educated individuals ( 26 , 56 , 57 ) and those with less social support ( 24 ). Neighborhood location and resources may influence effectiveness of long-term care for people in different geographical areas.…”

“…Furthermore, specific SDH can contribute to disparities in outcomes among patient subgroups ( 3 , 4 ). For example, SDH, including educational attainment, housing and living environment, and social support, influence rehabilitation outcomes with various post-acute conditions such as stroke ( 5 – 14 ), spinal cord injury (SCI) ( 15 , 16 ), traumatic brain injury (TBI) ( 17 – 21 ), amputation ( 22 – 24 ), and chronic conditions such as osteoarthritis ( 25 ), chronic pain ( 26 ), and cardiopulmonary disease ( 27 ).…”

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“…Job positions requiring more craft skills than managerial-professional skills are strongly related to back pain (56). Prospective evidence shows that pain symptom severity and disability are worse over time among non-white, less-educated individuals (26, 56, 57) and those with less social support (24). Neighborhood location and resources may influence effectiveness of longterm care for people in different geographical areas.…”

“…Inclusion of measures of perception of physical function and self-efficacy would inform how much functional limitation is modified by thoughts and feelings. Higher self-efficacy (82) directly relates to better community reintegration (83), functionality (24,82), and independence in conditions such as amputation and osteoarthritis. Patient-perceived function and self-efficacy could be measured through traditional methods such as survey.…”

“…Furthermore, specific SDH can contribute to disparities in outcomes among patient subgroups (3,4). For example, SDH, including educational attainment, housing and living environment, and social support, influence rehabilitation outcomes with various post-acute conditions such as stroke (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), spinal cord injury (SCI) (15,16), traumatic brain injury (TBI) (17)(18)(19)(20)(21), amputation (22)(23)(24), and chronic conditions such as osteoarthritis (25), chronic pain (26), and cardiopulmonary disease (27).…”