Saini Uttam Chand, Bu Shubhankar, Bhayana Himanshu, Dhillon Mandeep Singh, Mehra Aseem
Department of Orthopaedics, PGIMER, Chandigarh, India.
Department of Psychiatry, PGIMER, Chandigarh, India.
Indian J Orthop. 2023 Nov 7;57(12):2040-2049. doi: 10.1007/s43465-023-01007-0. eCollection 2023 Dec.
Amputation of a limb is equivalent to loss of a person's life. Psychological aspects are essential factors in dealing with the disability and functional outcome is a significant concern. Longitudinal studies have not examined the experience and determinants of common mental health problems and functional outcome in lower limb amputees.
A total of 103 lower limb amputees were recruited and followed up for 6 months. Patients were assessed on Hospital Anxiety and Depression Scale (HADS) and Social Functioning (SF-36) Quality of life, semi-structured clinical interview for psychiatric disorders and phantom limb at baseline (in hospital), at 2 weeks, 3 months and 6 months, respectively after discharge. Holistic care was provided through psychological counselling, supportive sessions, medications if required, rehabilitation counselling, prosthesis implantation, and treatment as usual.
Holistic care resulted in a statistically significant reduction in anxiety, depression and overall psychiatric morbidity as measured on HADS ( < 0.001). There was a significant improvement in all the domains of SF-36 ( -< 0.001) except the role of limitation due to physical activity. The intervention also resulted in a statistically significant reduction in the presence of phantom limbs.
Amputees should be provided holistic care under one roof, which was found to be very useful in treating psychiatric morbidity, social functioning and quality of life.
肢体截肢等同于一个人生命的丧失。心理因素是应对残疾的关键因素，功能结局是一个重要关注点。纵向研究尚未考察下肢截肢者常见心理健康问题的经历和决定因素以及功能结局。
共招募了103名下肢截肢者并随访6个月。分别在基线（住院时）、出院后2周、3个月和6个月，使用医院焦虑抑郁量表（HADS）和社会功能（SF - 36）生活质量量表对患者进行评估，针对精神障碍和幻肢进行半结构化临床访谈。通过心理咨询、支持性治疗、必要时用药、康复咨询、假肢植入以及常规治疗提供整体护理。
整体护理使HADS测量的焦虑、抑郁和总体精神疾病发病率在统计学上显著降低（<0.001）。除因身体活动导致的角色受限外，SF - 36的所有领域均有显著改善（<0.001）。该干预还使幻肢的出现率在统计学上显著降低。
截肢者应在一个机构内接受整体护理，事实证明这对治疗精神疾病、社会功能和生活质量非常有用。
