Psychological adjustment and coping in adults with prosthetic limbs

The potential mediating effects of different coping strategies on the adjustment to living with a prosthetic limb were investigated in 44 adult amputees. Participants completed a questionnaire inquiring about coping, pain, emotional well-being, demographics, and disability-related variables. The coping strategy adopted and the extent of the adjustment to the prosthetic limb varied with age, site of limb loss, and cause of amputation. Furthermore, coping style mediated the adjustment to wearing a prosthetic limb. The results are discussed in terms of future applications and research.     

Informing abortion counseling: An examination of evidence-based practices used in emotional care for other stigmatized and sensitive health issues

ObjectiveEmotional care is an important component of abortion services. Evidence-based counseling for other stigmatized and sensitive health issues may be informative for the improvement of abortion counseling.MethodsWe searched the literature for practices used in emotional care for stigmatized and sensitive health issues. We made analytic choices for the selection of articles using the “constant comparative method,” a grounded theory technique. We selected practices that were effective in supporting coping and improving psychosocial adjustment. Findings were synthesized and analyzed to draw evidence-based implications for abortion counseling.ResultsWe uncovered nine practices used in emotional care for stigmatized and sensitive health issues that have been shown to support coping or improve psychological adjustment. The techniques and interventions identified were: self-awareness assessments, peer counseling, decision aids, encouraging active client participation, supporting decision satisfaction, support groups, Internet-based support, ongoing telephone counseling, and public artistic expression.ConclusionA variety of patient-centered, evidence-based interventions used for other health issues are applicable in emotional care for abortion. Evaluation of these practices in the abortion counseling setting can determine their appropriateness and effectiveness.Practice implicationsAbortion care providers may be able to integrate additional patient-centered practices to support coping or improve psychological adjustment after abortion.     

‘More than a box of puzzles’: Understanding the parental experience of having a child with a rare genetic condition"

BackgroundChromosomal microarray (CMA) testing has been adopted as the first-tier diagnostic test for developmental disabilities. However, determining the clinical significance of the results is often complex. This qualitative study seeks to explore parental interpretation, adaption and coping in the context of ambiguous rare genetic findings in order to support parental adjustment and wellbeing.MethodsIn-depth interviews were conducted with parents (n = 30) of children identified with a rare genetic chromosomal abnormality.ResultsThree major themes were identified following a thematic analysis: ‘Learning of the Genetic Diagnosis', “The Reality of the Rarity’ and ‘Beyond Genetics: The Child Takes Centre Stage’. Findings demonstrated that parental adjustment to their child's genetic results are mediated by several factors including child difficulties and stage of development, clinician communication, perception of genetics, intrinsic coping strategies, access to practical and emotional support as well as broader contextual experiences.ConclusionThis study highlights the importance of considering the parental perspective in the context of genetic testing in clinical practice.     

Key Factors in Smoking Cessation Intervention Among 15–16-Year-Olds

Abstract

This empirical study assessed the psychosocial adjustment of the Palestinians who sustained serious bodily injuries during the intifada. Research dealt with the personal and interpersonal forces that impede or facilitate adjustment, with the mediating effect of social support and with the special services provided by local institutions. Findings suggested that a lapse of time did not improve adjustment. The level of education and marital status had an apparent effect on adjustment. An individual's adjustment correlated positively with situational variables, whereas it was negatively affected by trauma-related variables. Implications for future research, coping strategies, and rehabilitation plans are discussed.     

Psychological Adaptation and Adjustment of Mothers of Children With Congenital Heart Disease: Stress, Coping, and Family Functioning

Objective: Investigate support for the transactional stressand coping model for mothers of children with congenital heartdefects, in accounting for the variance in maternal adjustment. Methods: Participants were 52 mothers of children recruitedfrom a university medical center. Measures included illnessvariables, cognitive processes (i.e., appraisals of stress,expectations, methods of coping, family functioning, and maternalpsychological adjustment). Results: Maternal adjustment was associated with high levelsof daily stress and palliative coping techniques and was notsignificantly associated with severity of the cardiac defect.Together, the variables of the model accounted for approximately38% of the variance in maternal adjustment. Conclusions: The findings are in accord with previous researchamong other chronically ill populations in suggesting an associationbetween stress, coping, and maternal adjustment. Within thelimitations of the study, the data were interpreted to supportthe utility of theoretical models in identifying areas in needof intervention across chronic illness groups.     

Coping with cancer: A qualitative study of adolescent and young adult perspectives

ObjectivesCancer can have long-term biopsychological impacts for young people that persist for years. To promote adjustment, it is essential to understand how young people cope, yet this is relatively understudied.MethodsThis study explored the coping strategies using semi-structured interviews with 16 young people with cancer aged 15–24 years. Eligible participants were diagnosed within the previous 24 months and recruited through Australian Youth Cancer Services. Transcribed interviews were analysed using content analysis.ResultsCoping strategies included: seeking support; controlling the focus; avoiding negatives and staying positive; meaning making and; changes with time. During treatment, seeking support, focussing on the present, distraction and avoidance were commonly applied. Following treatment, planning for the future, avoidance of re-traumatising situations and meaning making were used.ConclusionFindings support the concept of coping as a dynamic process where different strategies are used depending on the stressor, available resources and previous experiences.Practice ImplicationsComprehensive, developmentally appropriate psychosocial assessments, open communication, education and information provision, as well as appropriate referral for support are essential, particularly for young cancer survivors identified at risk.     

How to manage treatment failure in prosthetic joint infection

BackgroundManagement for prosthetic joint infections remains a challenging area for both infectious diseases and orthopaedic surgery, particularly in the setting of treatment failure. This is compounded by a lack of level 1 evidence to guide approaches. The optimal management of prosthetic joint infections requires a multi-disciplinary approach combined with shared decision making with the patient.AimsThis article describes the approach to prosthetic joint infections in the setting of treatment failure.SourcesNarrative review based on literature review from PubMed. There was no time limit on the studies included. In addition, the reference list for included studies were reviewed for literature saturation with manual searching of clinical guidelines. Management approaches described incorporate evidence- and eminence-based recommendations from expert guidelines and clinical studies, where applicable.ContentThe surgical and antimicrobial approaches for prosthetic joint infections are described for first-line treatment of prosthetic joint infections and approaches in the event of treatment failure. Management approaches are based on an understanding of the role the biofilm plays in the pathogenesis of prosthetic joint infections. The management of these infections aims to fulfil two key goals: to eradicate the biofilm-associated microorganisms and, to maintain a functional joint and quality of life. In treatment failure, these goals are not always feasible, and the role of the multi-disciplinary team and shared-decision making are prominent.ImplicationsProsthetic joint surgery is a high-volume surgery, and the demand for this surgery is continually increasing. With this, the number of infections requiring expert care will also increase. Eminence-based management approaches have been established to guide treatment failure until knowledge gaps in optimal management are addressed by well-designed, clinical trials.     

The strategies to regulate and to modulate the propulsive forces during gait initiation in lower limb amputees

We used the framework of motor program adaptability to examine how unilateral above-knee (AK) or below-knee (BK) amputee subjects organize the global and local biomechanical processes of generation of the propulsive forces during gait initiation to overcome the segmental and neuro-muscular asymmetry. The organization of the global biomechanical process refers to the kinematics behavior of the couple center of foot pressure (CoP) and center of mass (CoM); the organization of the local biomechanical process refers to the propulsive forces generated by the prosthetic or intact limb during the anticipatory postural adjustment phase and the step execution phase. Specifically, we examined: i) the strategy to regulate the progression velocity, i.e., to maintain it comparably when the leading limb changed from the prosthetic limb to the intact limb; and ii) the strategy to modulate the progression velocity, i.e., to increase it when gait was initiated with the prosthetic limb vs. intact limb. The kinematics of the CoM and CoP in the amputees showed the same global biomechanical organization that is typically observed in able-bodied subjects, i.e., the production of the forward disequilibrium torque was obtained by a backward shift of the CoP, followed by a forward acceleration of the CoM. However, gait initiation was achieved by using a different local strategy depending on which limb was used to initiate the step. For the regulation of the CoM progression velocity, when the gait was initiated with the intact limb, the slope of the progression velocity during the anticipatory postural adjustment phase (APA) was steeper and lasted longer, the step execution duration was shorter, and the variation of the CoM speed was lower. In other words, to regulate the speed of progression, the amputee subjects controlled the spatial and temporal parameters of the propulsive forces. In the modulation of the CoM progression velocity, when the gait was initiated with the intact limb, the amputees controlled only the intensity of the propulsive forces during both the APA and step execution phases. In contrast, when the gait was initiated with the prosthetic limb, the modulation resulted mainly from the propulsive forces generated during the step execution phase. These different strategies are discussed in terms of the subjects capacity to adapt the motor program for gait initiation to new constraints.An erratum to this article can be found at     

Association of Coping Styles with Quality of Life in Cancer Patients

Methods:The study was performed on 150 cancer patients (71 females and 79 males) admitted to the hospitals affiliated with Kermanshah University of Medical Sciences. Endler and Parker Coping Inventory for Stressful Situations, and World Health Organization''s Quality of Life Questionnaire were used to evaluate their coping style and QOL, respectively.Results:The Present study showed in cancer patients being male, single, having higher salary and education, and lower age are related to higher QOL. Furthermore, in general, QOL of cancer patients was positively correlated with avoidant coping style (P < 0.05, r : 0.170) and negatively associated with emotion-focused coping styles (P < 0.01, r : −0.378).Conclusion:The results suggested that focusing on a patient''s coping style, predominantly on an emotion-focused coping style, is essential to improve patient''s QOL, and that patients possibly to employ a more emotion-oriented coping style should receive enough notice, particularly before discharge.     

Dyadic Adjustment, Family Coping, Body Image, Quality of Life and Psychological Morbidity in Patients with Psoriasis and Their Partners

Background

Psoriasis is an incurable and chronic disease that includes unpredictable periods of remission and relapse requiring long-term therapy.

Purpose

This paper focuses on the relationship among family coping, psychological morbidity, body image, dyadic adjustment and quality of life in psoriatic patients and their partners.

Method

One hundred and one patients with psoriasis and 78 partners comprised the sample. They were regular users of the Dermatology Service of a Central Northern hospital in Portugal and a private dermatology clinic. Patients with psoriasis were assessed on anxiety, depression, body image, quality of life, dyadic adjustment and family coping. Partners were assessed on the same measures except body image and quality of life.

Results

A positive relationship among dyadic adjustment, psychological morbidity and family coping in patients and their partners was found. Also, patients with lower levels of quality of life had partners with higher levels of depressive and anxious symptoms. Better dyadic adjustment predicted family coping in the psoriatic patient. High levels of dyadic adjustment in patients and low partners?? trait anxiety predicted better dyadic adjustment in partners.

Conclusion

The results highlight the importance of incorporating family variables in psychological interventions in psoriasis?? care, particularly family coping and dyadic adjustment as well as the need for psychological intervention to focus both on patients and partners.     

A physiotherapist-delivered,combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: A pilot study

BackgroundOsteoarthritis (OA) of the knee is associated with a number of physical and psychological impairments. Unfortunately, very few treatment strategies are capable of addressing both types of impairments concurrently. We performed a pilot, randomized controlled, proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training (PCST).MethodsTwenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were randomized to receive either 10 weeks of physiotherapist supervised exercises (lower limb strengthening and walking) combined with non-directive counseling (NDC) or the same exercise program delivered concurrently with PCST. Primary outcomes included self-reported pain and pain coping, while secondary outcomes included self efficacy and self-reported physical function.ResultsTen participants were randomized to each group and both groups exhibited significant improvements in isometric knee strength, self-reported knee pain and physical function, self efficacy for control of pain management and other arthritis symptoms. Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking. No between-group differences existed in any outcome (0.07 < p < 0.98). Based on our findings, 63 participants per group would be needed for future large-scale studies using similar outcome measures and design.ConclusionsOur study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA.Level of evidenceLevel IIClinical Trials Registry number: ACTRN12609000623291     

Mycobacterium fortuitum prosthetic valve endocarditis: a case for the pathogenetic role of biofilms

BackgroundProsthetic valve endocarditis presents unique challenges for both diagnosis and treatment. A potential role of biofilm has been hypothesized in the pathogenesis of these infections.MethodsA patient with infective endocarditis involving a stentless (Freestyle) porcine prosthetic aortic valve with annular abscess and paravalvular leak 8 months after implantation is reported.ResultsThe infected valve did not show vegetations or perforations, but histiocytic inflammation was seen along the endocardial surfaces of the valve. Auramine–rhodamine staining revealed many acid-fast organisms associated with the inflammation. There was also an acellular matrix material with ultrastructural features of biofilm. Blood cultures grew Mycobacterium fortuitum, a biofilm-associated microbe.ConclusionsThe role of biofilm in prosthetic valve endocarditis is discussed. The importance of microscopy for prosthetic valves, even when no vegetations are present, is highlighted along with correlation of pathologic findings with culture results.     

Adjustment to an artificial limb: a qualitative perspective

The purpose of this study was to identify factors considered to be important in the adjustment to amputation and the wearing of a prosthetic limb from the perspective of the person who has had a lower limb amputation. Hence, focus group methodology was employed as a means of acquiring perspectives within a population of young adults who had a lower limb amputation. Preliminary thematic analysis revealed that factors such as self-image, social, physical and practical concerns, the meaning attributed to and the acceptance of the amputation and support among others were important in the adjustment process. These findings have substantial implications for directing future research.     

Staying in dynamic balance on a prosthetic limb: A leg to stand on?

With the loss of a lower limb, amputees lack the active muscle empowered control of the ankle that is important for balance control. We examined single-leg stance on prosthesis vs. sound limb balancing on narrow ridges in transtibial amputees. When balancing on the prosthetic limb, the lateral displacement of the center of pressure was reduced and was compensated by an increase in counter-rotation. We show that single-leg stance on a prosthetic limb can be compared to balancing on a narrow ridge. Standing on a prosthetic limb involves the same balance mechanisms as balancing on narrow ridges of 40-mm to 20-mm width. Yet, the ability to balance on a narrow ridge with the sound limb was only a weak predictor for an amputee's ability to stand on the prosthetic limb. Balancing in single-leg stance on a prosthetic limb is not a common activity. The ability to compensate with the sound limb may therefore be functionally more important than the ability to stay in dynamic balance on the prosthetic limb.     

Associations between coping strategies and insomnia: a longitudinal study of Japanese workers

Study ObjectivesCoping with stress is important because stress disturbs sleep. However, only a few longitudinal studies have investigated the association between coping and insomnia. We examined whether individuals with insomnia symptoms used more maladaptive coping strategies than individuals without insomnia symptoms, and evaluated the association between insomnia symptoms and coping strategies.MethodsIn this prospective cohort study, Japanese workers were enrolled and observed over a 2-year period. During both years, self-administered questionnaires on coping and insomnia symptoms were administered. Coping was assessed using the Brief-Coping Orientation to Problems Experienced, and insomnia symptoms were examined using the Athens Insomnia Scale. Generalized estimating equation modeling identified the effects of coping strategies on insomnia severity.ResultsIn total, 1358 of 1855 workers at baseline were followed up. Individuals with insomnia symptoms showed a higher use of maladaptive coping strategies and less use of humor and instrumental support than individuals without insomnia symptoms. Active coping, humor, emotional support, and instrumental support were negatively associated with insomnia severity. In contrast, venting, substance use, behavioral disengagement, and self-blame were positively associated with insomnia severity.ConclusionsThis study showed that individuals with insomnia symptoms use both adaptive and maladaptive coping strategies and are more likely to use maladaptive strategies than individuals without insomnia symptoms. In the future, interventions focused on educating people about adaptive coping strategies should be conducted to determine whether coping strategies may prevent insomnia symptoms.     

Coping with Prostate Cancer: A Meta-Analytic Review

The present meta-analytic review assessed the relations between coping categories and indices of adjustment in men with prostate cancer. Relevant methodological and statistical information was extracted from 33 target studies (n = 3,133 men with prostate cancer). Men with prostate cancer who used approach, problem-focused, and emotion-focused coping were healthier both psychologically and physically, although the effect sizes for problem-focused coping and emotion-focused coping were more modest. For approach coping these effect sizes were particularly strong for measures of self-esteem, positive affect, depression, and anxiety. Conversely, men with prostate cancer who used avoidance coping experienced heightened negative psychological adjustment and physical health, and particularly for measures of positive mood and physical functioning. The findings of this study suggest that active approaches to coping with prostate cancer are beneficial psychologically, physically, and are positively associated with a return to pre-cancer activities.     

Relationship between religiosity,religious coping and socio-demographic variables among out-patients with depression or diabetes mellitus in Enugu,Nigeria

BackgroundReligion is a powerful coping strategy. Diabetes and depression are common conditions in our environment that induce psychological distress, thus requiring coping for better outcome. Studies indicate that increased religiosity is associated with better outcome in clinical and general populations. Therefore, studies of the distribution of religiosity and religious coping among these populations are essential to improve outcome.ObjectivesTo assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected sociodemographic variables (age, gender and occupational status).MethodsUsing simple random sampling we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using religious orientation scale (revised), religious coping with brief religious coping scale and socio-demographic variables with a socio-demographic questionnaire.ResultsIntrinsic religiosity was greater among older people with depression than among older people with diabetes(t=5.02,p<0.001); no significant difference among young people with depression and diabetes(t=1.47,p=0.15).Positive religious coping was greater among older people with depression than among older people with diabetes(t=2.31,p=0.02); no difference among young people with depression and diabetes(t=0.80,p=0.43). Females with depression had higher intrinsic religiosity scores than males with depression(t=3.85,p<0.001); no difference in intrinsic religiosity between females and males with diabetes(t=0.99,p=0.32).Positive religious coping was greater among participants with diabetes in the low occupational status(t=2.96,p<0.001) than those in the high occupational status.ConclusionReligion is indeed a reliable coping method, most commonly used by the elderly and females with depression. Positive religious coping is more common among diabetic patients who are in the low occupational status.     

Controlling horizontal deceleration during gait termination in transfemoral amputees: Measurements and simulations

In this study we investigated how leading limb angles combined with active ankle moments of a sound ankle or passive stiffness of a prosthetic ankle, influence the center of mass (CoM) velocity during the single limb support phase in gait termination. Also, we studied how the trailing limb velocity influences the CoM velocity during this phase. We analyzed force plate data from a group of experienced transfermoral (TF) amputee subjects using a prosthetic limb, and the outcome from a two-dimensional mathematical forward dynamics model. We found that when leading with the sound limb, the subjects came almost to a full stop in the single limb support phase, without the use of the prosthetic limb. When leading with the prosthetic limb, the CoM deceleration was less in a relatively short single limb support phase, with a fast forward swing of the trailing sound limb. Slowing down the heavier trailing sound limb, compared to the prosthetic limb, results in a relatively larger braking force at the end of the swing phase. The simulations showed that only narrow ranges of leading limb angle and ankle moments could be used to achieve the same CoM velocities with the mathematical model as the average start and end velocities of the prosthetic limb user. We conclude that users of prosthetic limbs have a narrow range of options for the dynamics variables to achieve a target CoM velocity. The lack of active control in the passive prosthetic ankle prevents the TF amputee subjects from producing sufficient braking force when terminating gait with the prosthetic limb leading, forcing the subjects to use both limbs as a functional unit, in which the sound limb is mostly responsible for the gait termination.     

Effects of couple based coping intervention on self-efficacy and quality of life in patients with resected lung cancer

ObjectiveWe aimed to assess the couple based coping intervention (CBCI) for self-efficacy and quality of life in patients with resected lung cancer, compared with individual coping intervention (ICI).MethodsFrom October to December 2015, 132 consecutive patients with resected lung cancer who were married/lived in a stable relationship were randomly assigned to the ICI group and the CBCI group.ResultsThe CBCI group had higher GSES compared with the ICI group at 2 month after operation, and at 6 month after operation (P < 0.05). The CBCI group had higher VT, SF, RE, and MH score of SF-36 compared with the ICI group at 2 month after operation, and at 6 month after operation (P < 0.05), but no significant differences were found in RP, PF, BP, and GH score of SF-36 compared between two groups (P > 0.05) in these 2 time points.ConclusionCouple based coping intervention is more effective than individual coping intervention for improving the self-efficacy and the quality of life in patients with resected lung cancer.Practice implicationsPractitioners might like to consider using couple based coping intervention strategy to improve self-efficacy and quality of life in patients with resected lung cancer.