A170 modern prosthetics – an interdisciplinary approach incorporating a biopsychosocial approach

1. An holistic and interdisciplinary
approach to Amputation and
Prosthetic Rehabilitation
Dr Maggie Donovan-Hall
RI World Conference, Edinburgh

2. 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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3. 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 dysvacularity
accounted for 67% of amputations
– Other factors include trauma, tumour,
infection and congenital limb deficiency 3
Peripheral
Arterial
disease (PAD)
Diabetes
Mellitus (DM)
TraumaTumour
Congentital
Limb
deficiency
Infection

4. 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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5. 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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6. 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)

7. 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
SociologicalPsychological

8. 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

9. 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 9

10. 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

11. 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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12. Summary
• Importance of a holistic frame
working to understand all aspects of
limb loss from the patient’s
perspective
• Close integration of education,
research and clinical practice
• Importance of interdisciplinary
collaboration and understanding
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