Dr. Donovan-Hall discusses the importance of taking a holistic biopsychosocial approach to understanding limb loss. This approach considers the biological, psychological, and social factors that impact individuals experiencing amputation. It is important for rehabilitation to be interdisciplinary, involving professionals from different fields working together. Examples of applying this approach include developing new educational opportunities on amputation rehabilitation through interdisciplinary collaboration and research that embraces users' perspectives through flexible methodologies.

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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