“If I can do it I will do it,if I can’t,I can’t”: a study of adaptive self-regulatory strategies following lower limb amputation

Abstract

Purpose: To explore the goal-related strategies employed by people following lower limb amputation using a framework based on the dual-process model of adaptive self-regulation. Methods: Semi-structured interviews were conducted with 30 individuals with a lower limb amputation. Results: Theoretical thematic analysis identified four broad assimilative/goal pursuit strategies; internal resource use, planning, technology use and help use. The most common strategies were maintaining a specific leisure activity (n?=?20), seeking instrumental help (n?=?15) and determination (n?=?15). Three broad categories of accommodative/goal adjustment strategies were also identified; interpersonal accommodation, managing limitations and meaning-making. The most common were accepting limitations (n?=?18), emotional support from friends and family (n?=?17) and adjusting goals to constraints (n?=?16). There was also evidence of strategies that combined the use of accommodative and assimilative strategies, and the use of avoidant strategies. Conclusions: The findings point towards key assimilative/goal pursuit and accommodative/goal adjustment strategies that may be adaptive following lower limb amputation. The study highlights the potential usefulness of the dual-process model in understanding how individuals adapt to functional disability, while bringing to light issues warranting further explication within this framework.

• Implications for Rehabilitation

• People adopt specific adaptive goal pursuit and goal adjustment strategies in response to goal disruptions following limb loss.

• Being aware of the processes involved in regulating goals in response to challenges is useful for understanding adjustment to limb loss.

• Greater understanding of adaptive and maladaptive goal strategies may help the rehabilitation team to foster positive outcomes in people with lower limb amputation.

     

‘I can’t see any reason for stopping doing anything,but I might have to do it differently’ – restoring hope to patients with persistent non-specific low back pain – a qualitative study

Purpose: To explore the differences in narrative between patients with persistent non-specific low back pain (PLBP) who benefited from a pain management programme, and those who did not benefit. Method: We conducted interviews with 20 patients attending a pain management programme; prior to attending the programme, immediately following the programme and at one year. Our analysis focused on a theoretical sample of patients who either described dramatic life improvements at one year, and who described themselves as much worse. We used the methods of grounded theory. Results: We found that finding hope was central to good outcome. Patients restored hope by making certain changes; (a) deconstructing specific fears, (b) constructing an acceptable explanatory model (c) reconstructing self identity by making acceptable changes. Those who had not restored hope retained fears of loss of self, remained committed to the biomedical model and were unable to make acceptable changes. Conclusions: Our findings may help to operationalise the restoration of hope in patients with PLBP. Firstly, health care professionals need to identify and resolve any specific fears of movement. Secondly, patients need an acceptable explanatory model that fits their experience and personal narrative. Finally our study confirms the centrality of self concept to recovery.

Implications for Rehabilitation

• Explanatory models are likely to have an impact on recovery following pain rehabilitation.

• Adherence to a biomedical model may have a negative impact on recovery.

• Patients need an acceptable explanatory model that fits their experience.

• Defining an acceptable self concept is integral to recovery.