Wegener Stephen T, Mackenzie Ellen J, Ephraim Patti, Ehde Dawn, Williams Rhonda
Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
Arch Phys Med Rehabil. 2009 Mar;90(3):373-80. doi: 10.1016/j.apmr.2008.08.222.
To test the acceptance and effectiveness of a community-based self-management (SM) intervention designed to improve outcomes after limb loss. A priori hypothesis was that an SM intervention will be more effective than standard support group activities in improving outcomes.
Randomized controlled trial.
General community.
Intervention (N=287) and control participants (N=235) with major limb loss.
INTERVENTION(S): Nine, 90-minute SM group sessions delivered by trained volunteer leaders. Retention rates at immediate postintervention and 6-month follow-up were 97% and 91% for the SM group.
MAIN OUTCOME MEASURE(S): Primary outcomes were depression, positive mood, and self-efficacy. Secondary outcomes were improved functional status and quality of life.
By using intent-to-treat analyses, the odds for being depressed are significantly lower for those in SM group, 50% less likely at treatment completion (95% confidence interval [CI]=0.3-0.9) and 40% less likely at the 6-month follow-up (95% CI=.03-1.1). Treatment completers have a 70% reduction in likelihood of being depressed at posttreatment (P<.01) and this persists at six months (P<.05). For those in the SM group, functional limitations were significantly lower at 6 months (P<.05), and general self-efficacy was significantly higher at immediate posttreatment (P<.05) and at 6 months (P<.05). Treatment completers have generally significantly larger effect sizes at all follow-up points. Pain intensity, self-efficacy for pain control, and quality of life were not significantly different between the groups. Subgroup analyses indicated the impact of the intervention was greater for participants who were less than 3 years postamputation, participants who were less than 65 years of age, or participants who showed at least 1 secondary condition at baseline.
The study provides evidence that SM interventions can improve the outcomes of persons with limb loss beyond benefits offered by support groups.
测试一种旨在改善肢体缺失后结局的社区自我管理（SM）干预措施的接受度和有效性。先验假设是，在改善结局方面，SM干预措施比标准支持小组活动更有效。
随机对照试验。
普通社区。
干预组（N = 287）和对照组参与者（N = 235），均为严重肢体缺失者。
由经过培训的志愿者负责人开展9次时长90分钟的SM小组课程。SM组在干预结束后即刻和6个月随访时的保留率分别为97%和91%。
主要结局为抑郁、积极情绪和自我效能感。次要结局为功能状态改善和生活质量提高。
采用意向性分析，SM组抑郁的几率显著更低，治疗结束时抑郁的可能性降低50%（95%置信区间[CI]=0.3 - 0.9），6个月随访时降低40%（95% CI = 0.03 - 1.1）。治疗完成者在治疗后抑郁的可能性降低70%（P <.01），且在6个月时仍持续存在（P <.05）。对于SM组的参与者，6个月时功能受限显著更低（P <.05），干预结束后即刻和6个月时一般自我效能感显著更高（P <.05）。治疗完成者在所有随访点的效应量通常显著更大。两组之间疼痛强度、疼痛控制自我效能感和生活质量无显著差异。亚组分析表明，对于截肢后不到3年的参与者、年龄小于65岁的参与者或基线时至少有一种次要疾病的参与者，干预的影响更大。
该研究提供了证据，表明SM干预措施可改善肢体缺失者的结局，其效果优于支持小组。
