Date Presented 4/20/2018
Forty-six users of unilateral multiarticulating prosthetic hands completed the validated QuickDASH and TAPES-R self-report instruments. Users who received occupational therapy reported improved work-related self-efficacy and psychosocial adjustment and reduced discomfort.
Primary Author and Speaker: Mandi Laurie
Additional Authors and Speakers: Steve Mandacina
Contributing Authors: Joyce Tyler, Phil Stevens
BACKGROUND AND PURPOSE: Occupational therapy offers individualized, patient-centered training for users of upper limb prostheses. Treatment objectives include aiding in the personalized recovery process and advancing the goals of independent living, increased feelings of self-efficacy, and acceptance of the prosthesis. Prosthetic training has been linked to significantly better employment outcomes and less arm pain in people with upper limb loss. With continued technological advances in upper limb prosthetics, training is required for wearers to gain proficiency with their new prosthesis. The present study sought to consider the role of occupational therapy in addressing the psychosocial, occupational, and physical needs of people with upper limb loss using multiarticulating prosthetic hands through an analysis of validated patient-reported outcomes.
METHOD: This descriptive study used survey methodology to examine the effect of occupational therapy on the psychosocial, functional, and work experiences of upper limb prosthesis users. Patients of a single national provider of limb prostheses who had been provided with multiarticulating prosthetic hands, including the bebionic (Ottobock, Leeds, England), iLimb (Touch Bionics, Mansfield, MA), and Michelangelo (Ottobock, Leeds, England) hands, were included in a targeted patient survey mailed to recipients as part of their clinical follow-up care. The questionnaire contained questions regarding residual limb pain, perceived self-efficacy, work habits, social acceptance, acclimation to the prosthesis, and amount of time spent wearing the limb. Participation was voluntary, and no compensation was provided.
Paper questionnaires and self-addressed stamped envelopes were mailed to prospective participants along with an explanatory cover letter and a web URL to facilitate digital participation in the survey. The 60-item questionnaire consisted of demographic items, the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH; Kennedy, 2011), and the Trinity Amputation and Prosthesis Experience Scales–Revised (TAPES–R; Gallagher et al., 2010). The QuickDASH is a patient-report instrument that assesses activities of daily living, comfort, social, and work activities, as well as perceptions of pain and sleep disturbance. The TAPES–R is a patient-report instrument that assesses general adjustment to limb loss and use of a prosthetic device, dependence on others, self-perceptions of employment potential, and satisfaction with specific dimensions of the prosthesis. Independent samples t tests were conducted to assess differences across group means.
RESULTS: Forty-six patients with unilateral upper limb loss completed the questionnaire. Respondents were divided into two groups, those who received occupational therapy (n = 26) and those who did not (n = 20). Respondents who received occupational therapy reported more time spent working (p < .001) and perceived their prosthesis as interfering less with their ability to do their work (p < .001) than did those who did not receive occupational therapy. Respondents who received occupational therapy also had better total psychosocial adjustment (p < .001) and found it easier to talk about their limb loss (p < .001) than those who did not receive occupational therapy. Respondents receiving occupational therapy reported less arm, shoulder, and hand pain in their residual limb (p < .001) and perceived their prosthesis as more comfortable (p < .001) than those who did not receive occupational therapy.
CONCLUSION: This study found that interaction with an occupational therapist led to increases in self-efficacy related to both the ability to do work and the length of time spent working. Desmond and MacLachlan (2002) similarly contended that continuing paid employment is instrumental in overcoming perceptions of functional limitations. Prosthetic training also improved acceptance of the amputation and prosthesis. Biddiss and Chau (2007) reported that people with upper limb loss who failed to use the health care system had twice the rate of prosthesis abandonment and worse overall outcomes than those who had regular visits with clinicians. The observed reductions in reported limb pain and improvements in socket comfort may reflect therapeutic management of overuse strain and facilitation of required socket adjustments.
Collectively, respondents who participated in occupational therapy also had lower than average rates of prosthesis rejection and abandonment. Research suggests that the average upper limb prosthesis abandonment rate is approximately 30%, whereas the present study had only two cases (4%) of prosthesis abandonment.
IMPACT STATEMENT: Occupational therapy appeared to enhance self-efficacy and psychosocial adjustment and to reduce discomfort among users of multiarticulating prosthetic hands.
References
Biddiss, E. A., & Chau, T. T. (2007). Upper limb prosthesis use and abandonment: A survey of the last 25 years. Prosthetics and Orthotics International, 31, 236–257. https://doi.org/10.1080/03093640600994581
Desmond, D., & MacLachlan, M. (2002). Psychosocial issues in the field of prosthetics and orthotics. Journal of Prosthetics and Orthotics, 14, 19–22. https://doi.org/10.1097/00008526-200203000-00006
Gallagher, P., Franchignon, F., Giordano, A., & MacLachlan, M. (2010). Trinity Amputation and Prosthesis Experience Scales: A psychometric assessment using classical test theory and Rasch analysis (TAPES). American Journal of Physical Medicine and Rehabilitation, 89, 487–496. https://doi.org/10.1097/phm.0b013e3181dd8cf1
Kennedy, C. A. (2011). The DASH and QuickDASH outcome measure user’s manual. Toronto: Institute for Work & Health.
