Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

Messinger, Seth D.; Bozorghadad, Sayeh; Pasquina, Paul F.

doi:10.2340/16501977-2274

Cited by 18 publications

(20 citation statements)

References 33 publications

(41 reference statements)

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“…A second observation of note is that peers were frequently mentioned when participants spoke of their positive clinic experiences. The role of peers in gaining physical skills has had limited exploration within the amputation and prosthetics literature; 18,19 however, our findings are consistent with research with a wider ‘disability’ lens, 9,10 in which peers are seen to have knowledge beyond that of health staff. The findings of positive responses to informal peer education should be studied within other programmes and explored in a wider population with limb loss.…”

Section: Discussionsupporting

confidence: 80%

“…20 However, rarely is mobility seen as a skill that can be taught; instead, it is viewed as an outcome measure that is influenced by gait ability. 18,20 The clinic appears to meet a key aspect of rehabilitation that is currently missing from the participants’ health experience which influences peoples’ ability to participate. Higher levels of physical participation have been shown to positively impact quality of life along with other key outcomes, such as greater community participation.…”

Section: Discussionmentioning

confidence: 99%

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‘It’s . . . forward-focused’

Anderson

Chaffey

Dillon

2019

Prosthetics &Amp; Orthotics International

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Background: Mobility clinics are designed to extend gait and mobility training beyond rehabilitation programmes. No research has been undertaken into participants’ experiences of attending these multidisciplinary, experience-based clinics. Research in this area is needed to ensure clinics meet intended goals, including understanding the motivation and experience of attendees. Insights may improve mobility clinics and inform strategies to encourage greater participation. Objectives: To explore the motivation of people with limb loss to attend a mobility clinic, the experience of participation and their perception of the clinic’s benefits. Study design: Qualitative methodology, naturalistic enquiry. Methods: Semi-structured interviews were conducted with nine clinic attendees during the clinic. Interviews were transcribed verbatim, data thematically analysed and emergent themes underwent member checking. Results: Three themes emerged from the data: facing the challenge captured how participants’ have adapted to amputation, valuing peers highlights the important role of peers in learning and support and improving mobility described the ongoing quest to improve mobility. Conclusion: The mobility clinic was attractive to those who liked challenges and was an invaluable source of learning for those wishing to improve their mobility. Future clinics should ensure that peer education is supported, and activities cater for a range of skills and fitness levels. Clinical relevance Findings of this study indicate that those who attended the mobility clinic liked to challenge themselves. Participation with peers was an important source of learning and support. Those participants who had previously attended a mobility clinic reported improvements in their overall daily function.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

‘It’s . . . forward-focused’

Anderson

Chaffey

Dillon

2019

Prosthetics &Amp; Orthotics International

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“…Our multidisciplinary approach was informed by lessons from the military community where recent conflicts have necessitated medical advance. Programs such as the US Armed Forces Amputee Patient Care Program at Walter Reed National Military Medical Center, the Center for the Intrepid at Brooke Army Medical Center, and Veterans Administration Regional Amputation Centers provide a comprehensive medical home for the rehabilitation of combat‐related amputees and have been shown to have a positive impact on their patients’ recovery by providing durable provider‐patient relationships, open communication, easy accessibility, and peer support . The application of military medical practices in civilian medical institutions, specifically those caring for oncology populations, requires acknowledgment of their similarities and differences.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a strong peer support network for major limb amputees is known to be associated with improved outcomes. 76,77 In the cancer population, this sense of community from a peer support network is associated with improved quality of life for many participants. 78 The plight of the oncologic amputee is truly unique with patients battling a cancer diagnosis during ongoing treatment, as well as the pain, change in body image, and loss of function associated with a major limb amputation.…”

Section: Peer Supportmentioning

confidence: 99%

“…The emotional and physical strain endured by an oncology patient necessitates a supportive cast of caregivers, family, friends, healthcare providers, and peers. Furthermore, a strong peer support network for major limb amputees is known to be associated with improved outcomes . In the cancer population, this sense of community from a peer support network is associated with improved quality of life for many participants .…”

Section: Introductionmentioning

confidence: 99%

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Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

Alexander

Jordan

West

et al. 2019

Journal of Surgical Oncology

124

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Background We describe a multidisciplinary approach for comprehensive care of amputees with concurrent targeted muscle reinnervation (TMR) at the time of amputation. Methods Our TMR cohort was compared to a cross‐sectional sample of unselected oncologic amputees not treated at our institution (N = 58). Patient‐Reported Outcomes Measurement Information System (NRS, PROMIS) were used to assess postamputation pain. Results Thirty‐one patients underwent amputation with concurrent TMR during the study; 27 patients completed pain surveys; 15 had greater than 1 year follow‐up (mean follow‐up 14.7 months). Neuroma symptoms occurred significantly less frequently and with less intensity among the TMR cohort. Mean differences for PROMIS pain intensity, behavior, and interference for phantom limb pain (PLP) were 5.855 (95%CI 1.159‐10.55; P = .015), 5.896 (95%CI 0.492‐11.30; P = .033), and 7.435 (95%CI 1.797‐13.07; P = .011) respectively, with lower scores for TMR cohort. For residual limb pain, PROMIS pain intensity, behavior, and interference mean differences were 5.477 (95%CI 0.528‐10.42; P = .031), 6.195 (95%CI 0.705‐11.69; P = .028), and 6.816 (95%CI 1.438‐12.2; P = .014), respectively. Fifty‐six percent took opioids before amputation compared to 22% at 1 year postoperatively. Conclusions Multidisciplinary care of amputees including concurrent amputation and TMR, multimodal postoperative pain management, amputee‐centered rehabilitation, and peer support demonstrates reduced incidence and severity of neuroma and PLP.

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COVID‐19: A catalyst for change in virtual health care utilization for persons with limb loss

Hewitt

Smith

Heckman

et al. 2021

PM&R

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The dramatic uptake of virtual care, or telehealth, utilization because of COVID-19 restrictions for persons with limb loss has led to a much greater understanding of this health care delivery method for this complex patient population. However, much is still unknown. Therefore, the authors provide a comprehensive literature review of existing evidence for virtual care delivery across the phases of amputation rehabilitation, as well as anecdotal evidence, to provide a platform for further discussion and development of research and innovative opportunities. Evidence reveals that virtual care serves as a complement to in-person health care for individuals with limb loss because it allows for increased accessibility to these services. The authors conclude that continued use of telehealth beyond the COVID-19 restrictions to optimize outcomes across the continuum of care for persons with limb loss is warranted.

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Social relationships in rehabilitation and their impact on positive outcomes among amputees with lower limb loss at Walter Reed National Military Medical Center

Abstract: The social component of service delivery influences patients' outcomes from clinical care. These results could be translated across healthcare settings to improve patient outcomes.

Cited by 18 publications

References 33 publications

‘It’s . . . forward-focused’

‘It’s . . . forward-focused’

Targeted muscle reinnervation in oncologic amputees: Early experience of a novel institutional protocol

COVID‐19: A catalyst for change in virtual health care utilization for persons with limb loss

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