riwc_para_a170 modern prosthetics – an interdisciplinary approach incorporating a biopsychosocial...
TRANSCRIPT
An holistic and interdisciplinary approach to Amputation and
Prosthetic Rehabilitation
Dr Maggie Donovan-Hall
RI World Conference, Edinburgh
Presentation outline
• Brief overview of cause, incidence and demographics of limb loss
• Taking a holistic perspective and adopting a Biopsychosocial approach to understand the complexities of limb loss
• Examples of areas where an holistic biopsychosocial approach has applied in education and research
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Causes of Limb Loss
• Multiple causes of limb loss
– Amputation and congenital limb deficiency
• Main cause in the UK is to Peripheral vascular disease and diabetes
– National Amputee Statistical Database (NASDAB, 2008) state dysvacularityaccounted for 67% of amputations
– Other factors include trauma, tumour, infection and congenital limb deficiency
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Peripheral Arterial
disease (PAD)
Diabetes Mellitus (DM)
TraumaTumour
CongentitalLimb
deficiency
Infection
Incidence and prevalence of Limb Loss
• Incidence and prevalence of limb loss is difficult to calculate due to a lack of data on National Amputation Rates
– Current literature on the dysvascular related amputation and suggest major amputation rate of 3.9-7.2 per 100,000 people (Moxey et al. 2010)
– Suggested that there are 60,000 to 65,000 people with limb loss in England (Moxey et al. 2010) with approximately 5,000 new referrals each year (NASDAB, 2008)
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Demographic consideration
• National Amputee Statistical Database (NASDAB, 2008) demographic shows that:
– 70% of new referrals are for men
– 50% of these new referrals are for people over the age of 65 years and additional 25% are over 75 years
– 95% for lower limb loss
– 5% are for upper limb loss
– 3% for congenital limb loss
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Readjustment following an amputation
• Individuals following limb loss are confronted with a large number of different factors. For example:
– Physical and functional factors
– Changes to appearance and body image
– Coping and adjustment
– Changes to social situation and roles
– Changes to identity and roles
– Impact on quality of life
– Environmental factors and enabling technologies
• Limb loss is an individual experience and all of these different factors will impact on the individual's adjustment (Gallagher et al, 2007)
The Biopsychosocial Model
• The Biopsychosocial model was developed by Engel (1980) to illustrate the interactions between biological, psychological and social factors
– Argues not one factor is sufficient in understanding complexity of health and illness
– Focuses on the individual within the complex healthcare system
• The Biopsychosocial Approach has been linked to the concept of 'Person Centred Care’, which has many different definitions (Olsson, 2012).
Biological
Sociological Psychological
Understanding Limb Loss
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Biological• Level and cause of
limb loss• Presence of co-
morbidities • Pain/phantom limb
pain• General health
Psychological• Coping strategies
• Adjustment • Affective distress
• Appearance and body-image
• Self-identity and construction of new self • Expectations and
motivation
Sociological• Living situation• Social support• Cultural factors
• Environment factors (enabling technology)• Social roles
• Social economic factors
Different Dimension of Limb Loss
Holistic view of patient
experience
Interdisciplinary approach
Patient Centred
approach
Links to guidelines and service
delivery
Working together in interdisciplinary teams
• Working with clinical partners, professional special interest groups, industry and charities organisation to establish key clinical questions and areas for development. For example:
– New educational opportunities in Amputation Rehabilitation and Prosthetic Use
– Interdisciplinary research using a wide range of flexible approaches
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Interdisciplinary Educational Opportunities
• Working with external stakeholders to develop:
– Flexible and innovative multidisciplinary learning opportunities
– Providing an in-depth understanding of the entire patient journey within a holistic framework
– Research-led teaching delivered from researchers, educators and clinicians across University Faculties
– Strong links to external partners within clinical practice, industry and enterprise and research at a UK, European and International level
Interdisciplinary holistic research
• A growing number of interdisciplinary research projects embracing a holistic framework. For example:
– Involving the users of paediatric upper limb prostheses in the design of new devices
– Understanding the views of people with multiple limb loss following Meningococcal Septicaemia
– Using flexible approaches (ethnography) to explore the potential of new technologies in developing Countries
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