Common psychological challenges for patients with newly acquired disability.

A patient's attitude to a newly acquired disability can often be the determining factor in successful rehabilitation. This attitude is determined by his or her perceived ability to manage symptoms, deal with hospital procedures, form and maintain relationships and manage his or her feelings about the disability. Because of this complexity, psychological aspects of patient rehabilitation are often regarded as vague and difficult to negotiate. This article describes seven common psychological challenges that patients experience with a newly acquired disability or during recovery from major illness (Moos and Schaefer 1984). Strategies are outlined to assist patients to come to terms with their disability and to cope more effectively during rehabilitation.

Do psychological measures predict the ability of lower limb amputees to learn to use a prosthesis?

OBJECTIVE: Can psychological tests predict whether, on admission to a rehabilitation ward post amputation, a lower limb amputee will learn to use a prosthesis during the ensuing inpatient rehabilitation programme? DESIGN: A one-sample design in which psychological variables, and transfemoral/transtibial amputation site were tested as predictors of outcome. SETTING: An inpatient rehabilitation unit in the UK offering prosthetic provision. SUBJECTS: Forty-three consecutive patients with peripheral vascular disease (mean age 66.35 years, standard deviation 14.99) who had received an amputation on average 19 days previously on a surgical ward and were transferred to the unit for rehabilitation including assessment for prosthetic provision. MAIN OUTCOME MEASURE: Whether the patient learnt to use a prosthesis independently during the stay on the rehabilitation unit. RESULTS: During their stay in the rehabilitation unit (mean length of stay = 42 days), 31 patients learnt to use a prosthesis and 12 did not. A forward stepwise logistic regression revealed that the Kendrick Object Learning Test score on admission correctly predicted outcome in 70% of cases. The predictive power rose to 81% correct when the amputation site (transfemoral or transtibial) was included amongst the predictors. Anxiety, depression and recovery locus of control scores were not significant predictors of functional prosthetic use in this study. CONCLUSION: A simple test of learning ability and the amputation site can help to predict the patient's ability to learn to use a prosthesis following amputation and is recommended as part of the assessment process.