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- Lindner, Helen, 1967-, et al.
(författare)
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Risk of depression following traumatic limb amputation : a general population-based cohort study
- 2018
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Ingår i: Book of Abstracts. - Ljubjana, Slovenia : ISPO Slovena. - 9789612887346 ; , s. 9-9
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: Traumatic limb amputation (TLA) is a sudden event that accompanies life changes in physical functioning, body image and challenges in daily lives. Amputees may experience significant levels of distress and be at risk of depression may be at risk of depression. However, evidence for depression risk after TLA has been limited because of the use of cross-sectional study design of a small or selected sample and the lack of a comparison with non-amputees. Confounding from pre-amputated occupational and individual characteristics was possible but no study has controlled for these. AIMS: We aimed to examine whether amputation may be associated with an increased risk of depression required inpatient and outpatient hospital treatment. METHODS: Our study population was drawn from a cohort of men (n=284,257) who underwent a compulsory conscription assessment for between 1969 and 1976. Complete data were available for 189,220 men. We followed these men from 1st January 1985, when these men were between age 29 and 34 years until the date of depression. We used the ICD codes in Swedish patient register to identify TLA (primary and secondary diagnosis) and depression after TLA (primary diagnosis). Cox regression was used to calculate hazard ratios and 95% confidence intervals [CI] for the association of amputation with depression. Age was used as the underlying time scale, and the diagnosis of amputation was included as a time-dependent exposure status, with the value zero before amputation and one after the date of amputation. Birth year, region, occupation, cognitive and physical function and stress resilience in adolescence were considered as potential confounding factors and adjusted for in the analysis. RESULTS: In total 401 men experienced amputation between 1985 and 2009, with the mean age of amputation was age 42.5 years (SD 7.4). Those who experience amputation were more likely to have low stress resilience and cognitive function in adolescence and engaged in farming and manual work in 1985. Cox regression produced unadjusted hazard ratio 2.61 (CI 1.62-4.21, p<0.001), i.e. 2.61 times risk of subsequent depression diagnosis for risk of subsequent depression compared with amputation-free individuals. Moderate and low cognitive function, physical fitness and stress resilience were associated with elevated risk of depression. Working for farms and manual work was also associated with higher depression risk. When the analysis was adjusted for these factors, the risk of depression after amputation changed little, 2.53 (CI 1.57-4.08, p <0.001) times risk of depression remained compared with amputation-free individuals.CONCLUSIONS: As we hypothesized, TLA was associated with an increased risk of depression over more than two decades of follow-up of men from age 29 to 57 years. Higher levels of depressive symptoms were noted among working age amputees and our study group also comprised of working age amputees. Future research may benefit from investigating potential influence of different amputation sites, degree, and prosthesis use involved in order to set intervention target.
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- Widehammar, Cathrine, 1969-, et al.
(författare)
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Designing a new training method for advanced hand prostheses
- 2018
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Ingår i: Book of Abstracts. - Ljubljana, Slovenia : ISPO Slovenia. - 9789612887346 ; , s. 66-66
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Konferensbidrag (refereegranskat)abstract
- INTRODUCTION: New prosthetic hands with advanced technology making it possible to perform many different grasps and positions are now available on the market. This new advanced technology is also difficult for users to control, and studies have shown that the new hand functions are not used to the extent expected (1).The Örebro Centre for Limb Deficiency and Arm Prostheses has a long experience of prosthetic fitting for both children and adults. About 80% of the adults report daily prosthesis use (2). Today, many prosthesis users find the advanced prosthetic hands interesting and wish to have one. However, when introducing a new prosthetic hand with questionable merits, the reasons for these results need to be considered. In light of our experience from fittings in Örebro, we decided that the training programs for the new hand models were not comprehensive enough, and there was a need for the development of a new method for training.AIMS: To design a training method for advanced hand prosthetic hands.METHODS: We performed a review of existing training programs for advanced myoelectric prosthetic hands and combined this with a structured training program, and a treatment philosophy with early fitting and regular follow up used in Örebro.RESULTS AND CONCLUSIONS: The training method comprises control training and performance of ADL’s. It follows a structured program based on the 14 steps described in the Skills Index Ranking Scale. The control training focuses on control of all different grasps available with the body in different positions: sitting, standing; with and without support of the arm. The ADL’s are chosen individually through a Canadian Occupational Performance Measure interview. The capacity to use different grasps and integrating the new prosthesis when performing ADL’s is evaluated through the Assessment of Capacity for Myoelectric Control. The method is based on regular support and feedback from an occupational therapist, with follow-ups weekly the first month and then monthly the following 3-6 months. The method has been used on patients with good results.CONCLUSION: A new method is designed to fit the new multifunctional prosthetic hands. The method can be applied upon prescription of advanced multifunctional prosthetic hands to enhance the functional use of the hands.
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