Using a novel psychosocial group intervention to improve adaption, coping and mental health outcomes following dysvascular limb amputations: A feasibility study.

BACKGROUND

Individuals with lower extremity amputations (LEA) often face high rates of depression and anxiety that hinder their rehabilitation and post-discharge coping. Group therapy is a clinically and cost-effective way to address these mental health challenges, but evidence for its use with LEA inpatients is limited.

OBJECTIVE

To determine the feasibility of a psychosocial group therapy intervention for individuals with dysvascular LEA undergoing inpatient rehabilitation.

METHODOLOGY

This randomized controlled trial randomly assigned dysvascular LEA rehabilitation inpatients into a supportive-expressive group therapy (SEGT) or a treatment as usual (TAU) group. The SEGT intervention, a form of group therapy adapted from outpatient medical settings, consisted of six one-hour sessions held twice weekly over a three-week period. Participants completed baseline, exit and three-month surveys assessing the study's secondary outcomes of SEGT effectiveness on depression, anxiety, coping, body image, health, and community participation. The main outcomes assessed recruitment, survey completion, treatment adherence, and participant retention rates. Interviews and a focus group were completed to obtain feedback on the intervention.

FINDINGS

Twenty-five participants were recruited, with 12 randomly assigned to the SEGT group, and 13 to the TAU group. The average number of sessions attended by SEGT participants was 3.9 (SD = 2.1). The survey completion rates for all participants were 84% (21/25) for the baseline assessment, 64% (18/25) for discharge, and 44% (11/25) for the three-month follow-up. The SEGT group showed a significant improvement in anxiety and depression scores (p = 0.02). SEGT was well-received by participants and staff.

CONCLUSION

The findings suggest a larger pragmatic SEGT trial is feasible, despite a small sample size and implementation challenges during the COVID-19 pandemic, given this study achieved moderate rates of recruitment, retention, and survey completion. Several critical insights were gained on how to optimize an inpatient group therapy intervention for dysvascular LEA populations in rehabilitative settings.