Beyond the body image: a qualitative study on how adults experience lower limb amputation

Objective: To explore adults’ experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. Setting: A rehabilitation medicine service from a general public hospital. Participants: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. Results: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. Conclusions: The self-identity changes after a lower limb amputation appear beyond the patient’s body image and functioning, affecting the patient’s awareness of the impairment, biographical self and any future projections.

[1]  John W. Creswell,et al.  Research Design: Qualitative, Quantitative, and Mixed Methods Approaches , 2010 .

[2]  C. M. Parkes,et al.  Psycho-social Transitions: Comparison between Reactions to Loss of a Limb and Loss of a Spouse , 1975, British Journal of Psychiatry.

[3]  Richard Schulz,et al.  Social and psychological factors in adjustment to limb amputation. , 1994 .

[4]  James W. Breakey,et al.  Body Image: The Lower‐Limb Amputee , 1997 .

[5]  Robert G. Frank,et al.  Handbook of rehabilitation psychology. , 2000 .

[6]  M Maclachlan,et al.  Adjustment to an Artificial Limb: A Qualitative Perspective , 2001, Journal of health psychology.

[7]  M. Maclachlan,et al.  Phantom limb pain and residual limb pain following lower limb amputation: a descriptive analysis. , 2001, Disability and rehabilitation.

[8]  C. Murray,et al.  Body image and prosthesis satisfaction in the lower limb amputee , 2002, Disability and rehabilitation.

[9]  D. Braile,et al.  Quality of life after amputation , 2002 .

[10]  Francis Guillemin,et al.  Health related quality of life and related factors in 539 persons with amputation of upper and lower limb , 2003, Disability and rehabilitation.

[11]  A. Esquenazi Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration , 2004, Disability and rehabilitation.

[12]  J. Czerniecki,et al.  A two-year longitudinal study of social support following amputation , 2004, Disability and rehabilitation.

[13]  B. Rybarczyk,et al.  Diversity in adjustment to a leg amputation: Case illustrations of common themes , 2004, Disability and rehabilitation.

[14]  G. Gard,et al.  Coping after trans-femoral amputation due to trauma or tumour—a phenomenological approach , 2004, Disability and rehabilitation.

[15]  M. Hanley,et al.  Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain , 2004, Disability and rehabilitation.

[16]  C. Murray,et al.  An interpretative phenomenological analysis of the embodiment of artificial limbs , 2004, Disability and rehabilitation.

[17]  O. Horgan,et al.  Psychosocial adjustment to lower-limb amputation: A review , 2004, Disability and rehabilitation.

[18]  J. Geertzen,et al.  Phantom pain: A sensitivity analysis , 2004, Disability and rehabilitation.

[19]  N. Frude,et al.  Positive Coping and Stress-Related Psychological Growth Following Lower Limb Amputation. , 2005 .

[20]  Stephen T Wegener,et al.  Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. , 2005, Archives of physical medicine and rehabilitation.

[21]  M. Maclachlan,et al.  Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations. , 2006, Social science & medicine.

[22]  Noelle Robertson,et al.  Psychological adjustment to lower limb amputation amongst prosthesis users , 2006, Disability and rehabilitation.

[23]  Klaas Postema,et al.  From satisfaction to expectation: The patient's perspective in lower limb prosthetic care , 2007, Disability and rehabilitation.

[24]  P. Dijkstra,et al.  Amputation, phantom pain and subjective well-being: a qualitative study , 2007, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[25]  Á. Mayer,et al.  Body schema and body awareness of amputees , 2008, Prosthetics and orthotics international.

[26]  D. Datta,et al.  The experience of men using an upper limb prosthesis following amputation: Positive coping and minimizing feeling different , 2008, Disability and rehabilitation.

[27]  Helvi Kyngäs,et al.  The qualitative content analysis process. , 2008, Journal of advanced nursing.

[28]  O. Horgan,et al.  Psychosocial adjustment to diabetes‐related lower limb amputation , 2009, Diabetic medicine : a journal of the British Diabetic Association.

[29]  J. Unwin,et al.  A prospective study of positive adjustment to lower limb amputation , 2009, Clinical rehabilitation.

[30]  Pre prosthetic mobility: The amputees' perspectives , 2009, Disability and rehabilitation.

[31]  C. Murray,et al.  Being like everybody else: the personal meanings of being a prosthesis user , 2009, Disability and rehabilitation.

[32]  B. Pentland,et al.  Depression and anxiety symptoms after lower limb amputation: the rise and fall , 2009, Clinical rehabilitation.

[33]  M. Dorahy,et al.  Experiences of psychosocial adjustment within 18 months of amputation: an interpretative phenomenological analysis , 2010, Disability and rehabilitation.

[34]  Matthew J. Thompson,et al.  Epidemiological study of lower limb amputation in England between 2003 and 2008 , 2010, The British journal of surgery.

[35]  J. Desrosiers,et al.  Cognitive appraisal and perceived benefits of dysvascular lower limb amputation: a longitudinal study. , 2011, Archives of gerontology and geriatrics.

[36]  Michael R. Harwell,et al.  Research design: Qualitative, quantitative, and mixed methods: Pursuing ideas as the keystone of exemplary inquir , 2011 .

[37]  Handbook of Rehabilitation Psychology, second edition. Edited by Robert G. Frank, Mitchell Rosenthal, and Bruce Caplan; American Psychological Association, Washington, DC; 2010; 504; $99.95; ISBN 13: 978-1-4338-0444-1, ISBN 10: 1-4338-0444-1 , 2011 .