Resnik L J, Ni P, Borgia M L, Clark M A
Research Department, Providence VA Medical Center, Providence, USA.
Department of Health Services, Policy and Practice, Brown University, Providence, USA.
Can Prosthet Orthot J. 2022 Apr 5;5(1):37873. doi: 10.33137/cpoj.v5i1.37873. eCollection 2022.
Measurement of psychosocial adjustment after upper limb amputation (ULA) could be helpful in identifying persons who may benefit from interventions, such as psychotherapy and/or support groups. However, available measures of psychosocial adjustment after limb loss are currently designed for prosthetic users only.
To create a measure of psychosocial adjustment for persons with ULA that could be completed by individuals regardless of whether a prosthesis is use.
We modified items from an existing Trinity Amputation and Prosthesis Experience Survey (TAPES) measure and generated new items pertinent to persons who did not use a prosthesis. Item content was refined through cognitive interviewing and pilot testing. A telephone survey of 727 persons with major ULA (63.6% male, mean age of 54.4) was conducted after pilot-testing. After exploratory and confirmatory factor analyses (EFA and CFA), Rasch analyses were used to evaluate response categories, item fit and differential item functioning (DIF). Item-person maps, score distributions, and person and item reliability were examined. Test-retest reliability was evaluated in a 50-person subsample.
EFA and CFA indicated a two-factor solution. Rasch analyses resulted in a 7-item Adjustment to Limitation subscale (CFI=0.96, TLI=0.95, RMSEA=0.128) and a 9-item Work and Independence subscale (CFI=0.935, TLI=0.913, RMSEA=0.193). Cronbach alpha and ICC were 0.82 and 0.63 for the Adjustment to Limitation subscale and 0.90 and 0.80 for the Work and Independence subscale, respectively.
This study developed the Psychosocial Adjustment to Amputation measure, which contains two subscales: 1) Adjustment to Limitation and 2) Work and Independence. The measure has sound structural validity, good person and item reliability, and moderate to good test-retest reliability.
测量上肢截肢（ULA）后的心理社会适应情况有助于识别可能从心理治疗和/或支持小组等干预措施中受益的人群。然而，目前现有的肢体缺失后心理社会适应情况的测量方法仅针对假肢使用者设计。
创建一种适用于ULA患者的心理社会适应情况测量方法，无论个体是否使用假肢均可完成。
我们对现有的《三一截肢与假肢体验调查》（TAPES）测量方法中的项目进行了修改，并生成了与未使用假肢的人群相关的新项目。通过认知访谈和预试验对项目内容进行了完善。在预试验后，对727名主要ULA患者（63.6%为男性，平均年龄54.4岁）进行了电话调查。在探索性和验证性因素分析（EFA和CFA）之后，使用拉施分析来评估反应类别、项目拟合和项目功能差异（DIF）。检查了项目-人员映射、分数分布以及人员和项目的可靠性。在一个50人的子样本中评估了重测信度。
EFA和CFA表明为两因素解决方案。拉施分析得出了一个7项的“适应限制”子量表（CFI = 0.96，TLI = 0.95，RMSEA = 0.128）和一个9项的“工作与独立性”子量表（CFI = 0.935，TLI = 0.913，RMSEA = 0.193）。“适应限制”子量表的克朗巴赫α系数和组内相关系数（ICC）分别为0.82和0.63，“工作与独立性”子量表的分别为0.90和0.80。
本研究开发了截肢心理社会适应情况测量方法，该方法包含两个子量表：1）适应限制；2）工作与独立性。该测量方法具有良好的结构效度、人员和项目可靠性，以及中等至良好的重测信度。
