The Role of Interprofessional Teams in the Biopsychosocial Management of Limb Loss
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AMPUTATION REHABILITATION (J HECKMAN, SECTION EDITOR)
The Role of Interprofessional Teams in the Biopsychosocial Management of Limb Loss Larissa B. Del Piero 1,2 & Rhonda M. Williams 1,2 & Kyle Mamiya 1 & Aaron P. Turner 1,2 Accepted: 22 September 2020 # This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract Purpose of Review Individuals undergoing amputations typically present with comorbid conditions that may adversely impact mortality, mobility, residual limb healing, mood, function, and participation. Understanding how to manage these individuals holistically is essential to optimize function and reduce complications. Recent Findings A review of recent literature suggests that a biopsychosocial, interprofessional approach remains the recommended approach to limb loss rehabilitation. This can include the following: (1) optimizing health behaviors and fostering selfmanagement skills; (2) assessing cognitive functioning and training use of assistive technology and compensatory strategies to facilitate learning and activities of daily living specific to limb loss (e.g., prosthetic use, novel self-care routines); (3) using empirically supported treatments for mood disorders to enhance motivation and participation in rehabilitation; and (4) managing pain and pain interference by fostering realistic expectations, teaching skills (e.g., cognitive-behavioral and mindfulness meditation), and enhancing behavioral activation. Summary An interprofessional rehabilitation team employing a biopsychosocial approach can reduce mortality and improve quality of life, mobility, health, function, mood, and participation. Keywords Limb loss . Depression . Anxiety . Pain . Cognition . Health behavior
Introduction Limb loss is a prevalent condition in the USA; in 2005 approximately 1.6 million individuals had limb loss, and prediction models estimate that 3.6 million individuals will be living with limb loss by 2050 [1]. Limb loss can occur at any age, be caused by a range of etiologies, and impact upper and lower limbs at varying anatomic levels. Adults with lower extremity amputation (LEA) due to dysvascular disease and/or diabetes mellitus comprise the majority of individuals with limb loss, are at high risk for adverse outcomes following amputation,
This article belongs to the Topical Collection on Amputation Rehabilitation * Aaron P. Turner [email protected] 1
Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 S. Columbian Way. S-117-RCS, Seattle, WA 98108, USA
2
Department of Rehabilitation Medicine, University of Washington, Seattle, USA
and have high rates of comorbid conditions, including obesity, mood symptoms, and cognitive impairment [1, 2]. Though amputations due to dysvascular disease and diabetes are declining overall due to improvements in early detection and prevention measures in the past decade [2], this improvement is uneven demographically, and chronic disease remains by far the most common cause of major amputa
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