Objectives. To explore the coping strategies used following a lower limb amputation and their relationship to adjustment in the hospital, rehabilitation, and home setting. Method. Sixteen individuals who had a lower limb amputation due to vascular disease completed questionnaires, including the Ways of Coping Questionnaire (WCQ), during hospitalization (T1), at the end of rehabilitation (T2), and 2-3 months after discharge from rehabilitation (T3). A subsample ( ) also participated in three semistructured interviews analyzed using the approach of Miles and Huberman. Results. Self-controlling was the coping strategy used most, followed by seeking social support and positive reappraisal. Three additional coping strategies not found in the WCQ were identified in the qualitative data: noticing progress, learning new things, and using humor. Confrontive coping (T1) and escape-avoidance (T1, T2, and T3) were related to adjustment problems while positive reappraisal (T1 and T3), seeking social support (T1 and T3), and planful problem solving (T3) were associated with positive adjustment. Conclusion. Coping strategies used to deal with the amputation seem to vary across settings, thus signifying the complexity of the coping process following a lower limb amputation due to vascular disease. 1. Introduction Following a lower limb amputation, many individuals face stressful situations such as phantom pain [1], loss of functional independence [2], and body image issues [3]. The coping abilities of individuals who had an amputation are greatly utilized and some may be overwhelmed by the task at hand. In fact, 15 to 42% of them develop depressive symptoms [4–9]. When facing a stressful situation, people react by using coping strategies, that is, they engage in multiple behavioral and cognitive efforts to regain or maintain their well-being [10]. Adjustment is the result of using various coping strategies to deal with the different stressful aspects of a situation, in this case, an amputation. Coping strategies targeting emotions caused by a stressful event (emotion-focused strategies) have been found to be related to psychosocial and functional adjustment following a lower limb amputation. A study by Hill et al. [11] revealed that the combination of three coping strategies, namely, catastrophizing, increase in behavioral activities and hoping/praying, accounted for a statistically significant proportion of functional ( ; ) and psychosocial ( ; ) adjustmentproblems even after controlling for demographic and amputation-related variables. Catastrophizing alone was a
References
[1]
M. A. Hanley, M. P. Jensen, D. M. Ehde, A. J. Hoffman, D. R. Patterson, and L. R. Robinson, “Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain,” Disability and Rehabilitation, vol. 26, no. 14-15, pp. 882–893, 2004.
[2]
R. Ham, J. De Trafford, and C. Van De Ven, “Patterns of recovery for lower limb amputation,” Clinical Rehabilitation, vol. 8, no. 4, pp. 320–328, 1994.
[3]
C. D. Murray and J. Fox, “Body image and prosthesis satisfaction in the lower limb amputee,” Disability and Rehabilitation, vol. 24, no. 17, pp. 925–931, 2002.
[4]
J. M. Behel, B. Rybarczyk, T. R. Elliott, J. J. Nicholas, and D. Nyenhuis, “The role of perceived vulnerability in adjustment to lower extremity amputation: a preliminary investigation,” Rehabilitation Psychology, vol. 47, no. 1, pp. 92–105, 2002.
[5]
C. Bodenheimer, A. J. Kerrigan, S. L. Garber, and T. N. Monga, “Sexuality in persons with lower extremity amputations,” Disability and Rehabilitation, vol. 22, no. 9, pp. 409–415, 2000.
[6]
O. Uzun, C. Yildiz, A. Ates, A. Cansever, and A. S. Atesalp, “Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation,” Military Medicine, vol. 168, no. 2, pp. 106–109, 2003.
[7]
L. Coffey, P. Gallagher, O. Horgan, D. Desmond, and M. MacLachlan, “Psychosocial adjustment to diabetes-related lower limb amputation,” Diabetic Medicine, vol. 26, no. 10, pp. 1063–1067, 2009.
[8]
L. F. Phelps, R. M. Williams, K. A. Raichle, A. P. Turner, and D. M. Ehde, “The importance of cognitive processing to adjustment in the 1st year following amputation,” Rehabilitation Psychology, vol. 53, no. 1, pp. 28–38, 2008.
[9]
G. M. Williamson, R. Schulz, M. W. Bridges, and A. M. Behan, “Social and psychological factors in adjustment to limb amputation,” Journal of Social Behavior and Personality, vol. 9, no. 5, pp. 249–268, 1994.
[10]
M. S. Pinzur, F. Littooy, J. Daniels et al., “Multidisciplinary preoperative assessment and late function in dysvascular amputees,” Clinical Orthopaedics and Related Research, no. 281, pp. 239–243, 1992.
[11]
A. Hill, C. A. Niven, and C. Knussen, “The role of coping in adjustment to phantom limb pain,” Pain, vol. 62, no. 1, pp. 79–86, 1995.
[12]
A. Whyte and L. J. Carroll, “The relationship between catastrophizing and disability in amputees experiencing phantom pain,” Disability and Rehabilitation, vol. 26, no. 11, pp. 649–654, 2004.
[13]
H. Livneh, R. F. Antonak, and J. Gerhardt, “Psychosocial adaptation to amputation: the role of sociodemographic variables, disability-related factors and coping strategies,” International Journal of Rehabilitation Research, vol. 22, no. 1, pp. 21–31, 1999.
[14]
P. Gallagher and M. MacLachlan, “Psychological adjustment and coping in adults with prosthetic limbs,” Behavioral Medicine, vol. 25, no. 3, pp. 117–124, 1999.
[15]
D. M. Desmond and M. MacLachlan, “Coping strategies as predictors of psychosocial adaptation in a sample of elderly veterans with acquired lower limb amputations,” Social Science and Medicine, vol. 62, no. 1, pp. 208–216, 2006.
[16]
R. S. Lazarus, “Coping theory and research: past, present, and future,” Psychosomatic Medicine, vol. 55, no. 3, pp. 234–247, 1993.
[17]
E. L. Teng and H. C. Chui, “The Modified Mini-Mental State (MMS) examination,” Journal of Clinical Psychiatry, vol. 48, no. 8, pp. 314–318, 1987.
[18]
G. Bravo and R. Hébert, “Age- and education-specific reference values for the mini-mental and modified mini-mental state examinations derived from a non-demented elderly population,” International Journal of Geriatric Psychiatry, vol. 12, no. 10, pp. 1008–1018, 1997.
[19]
S. Folkman and R. S. Lazarus, Ways of Coping Questionnaire, Consulting Psychologist Press, Palo Alto, Ca, USA, 1988.
[20]
P. P. Vitaliano, R. D. Maiuro, J. Russo, and J. Becker, “Raw versus relative scores in the assessment of coping strategies,” Journal of Behavioral Medicine, vol. 10, no. 1, pp. 1–18, 1987.
[21]
A. T. Beck, C. H. Ward, M. Mendelson, J. Mock, and J. Erbraugh, “An inventory for measuring depression,” Archives of general psychiatry, vol. 4, pp. 561–571, 1961.
[22]
D. Gallagher, G. Nies, and L. W. Thompson, “Reliability of the Beck Depression Inventory with older adults,” Journal of Consulting and Clinical Psychology, vol. 50, no. 1, pp. 152–153, 1982.
[23]
M. Bruchon-Schweitzer, “Dimensionality of the body-image: the body-image questionnaire,” Perceptual and Motor Skills, vol. 65, pp. 887–892, 1987.
[24]
M. Koleck, M. Bruchon-Schweitzer, F. Cousson-Gélie, J. Gilliard, and B. Quintard, “The body-image questionnaire: an extension,” Perceptual and Motor Skills, vol. 94, no. 1, pp. 189–196, 2002.
[25]
R. Hébert, R. Carrier, and A. Bilodeau, “Le système de mesure de l'autonomie fonctionnelle (SMAF),” La Revue de Gériatrie, vol. 13, pp. 161–167, 1988.
[26]
J. Desrosiers, G. Bravo, R. Hebert, and N. Dubuc, “Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research,” Age and Ageing, vol. 24, no. 5, pp. 402–406, 1995.
[27]
M. B. Miles and M. A. Huberman, Qualitative Data Analysis: An Expanded Sourcebook, Sage, London, UK, 1994.
[28]
R. S. Lazarus and S. Folkman, Stress, Appraisal and Coping, Springer, New York, NY, USA, 1984.
[29]
C. Sj？dahl, G. Gard, and G. B. Jarnlo, “Coping after trans-femoral amputation due to trauma or tumour—a phenomenological approach,” Disability and Rehabilitation, vol. 26, no. 14-15, pp. 851–861, 2004.
[30]
K. Oaksford, N. Frude, and R. Cuddihy, “Positive coping and stress-related psychological growth following lower limb amputation,” Rehabilitation Psychology, vol. 50, no. 3, pp. 266–277, 2005.
[31]
B. Rybarczyk, J. J. Nicholas, and D. L. Nyenhuis, “Coping with a leg amputation: integrating research and clinical practice,” Rehabilitation Psychology, vol. 42, no. 3, pp. 241–255, 1997.
[32]
D. Zidarov, B. Swaine, and C. Gauthier-Gagnon, “Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up,” Archives of Physical Medicine and Rehabilitation, vol. 90, no. 4, pp. 634–645, 2009.
