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RIWC_PARA_A170 modern prosthetics – an interdisciplinary approach incorporating a biopsychosocial approach


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A170 modern prosthetics – an interdisciplinary approach incorporating a biopsychosocial approach

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RIWC_PARA_A170 modern prosthetics – an interdisciplinary approach incorporating a biopsychosocial approach

  1. 1. An holistic and interdisciplinary approach to Amputation and Prosthetic Rehabilitation Dr Maggie Donovan-Hall RI World Conference, Edinburgh
  2. 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 2
  3. 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. 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) 4
  5. 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 5
  6. 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. 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. 8. Understanding Limb Loss 8 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. 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. 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. 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 11
  12. 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 12