STRENGTH OF EVIDENCE: Moderate
O’toole (JBJS-AM; 2008) determined that the presence of anxiety or depression at 2 years after injury decreased patient satisfaction. MacKenzie (JBJSn-AM; 2005) found that patients with low self-efficacy had worse Sickness Impact Profile (SIP) scores. Melcer (JOT; 2013) showed that lower extremity trauma amputees had greater odds of mood disorders. Furthermore, PTSD risk was lower in amputees versus non-amputees. Bosse (N Engl J Med; 2002) concluded that amputees and non-amputees had higher SIP scores if they had poor self-efficacy and a poor social support network.
BENEFITS & HARMS:
Screening and treatment of psychosocial risk factors can increase patient satisfaction after amputation or limb salvage. Failure to address these risk factors have been shown to result in poor SIP scores, functional outcome, and patient satisfaction.
Identification and proper referral for psychosocial risk factors can help improve outcomes in all lower extremity trauma patients regardless of whether they receive amputation or limb salvage.
COST EFFECTIVENESS/RESOURCE UTILIZATION:
Bhatnagar (J Rehabil Res Dev; 2015) demonstrated presence of PTSD resulted in higher prosthetic costs as well as cost associated with psychiatric treatment in amputees.
This recommendation is acceptable to all civilian and military lower extremity trauma patients undergoing amputation or limb salvage
This recommendation is feasible in trauma centers with proper referral services. The application of these services to provide psychosocial support will not affect surgical decision making and operative treatment.
Current literature has shown that negative psychosocial factors results in poorer outcomes and satisfaction in both amputation and limb salvage. Long term studies are necessary to determine which factors are most important to address and what specific interventions are most effective.
* Strength of recommendation upgraded. Evidence from two or more “High” quality studies with consistent findings for recommending for or against the intervention. Also requires no reasons to downgrade from the EtD framework.
- Bosse, M. J., MacKenzie, E. J., Kellam, J. F., Burgess, A. R., Webb, L. X., Swiontkowski, M. F., Sanders, R. W., Jones, A. L., McAndrew, M. P., Patterson, B. M., McCarthy, M. L., Travison, T. G., Castillo, R. C. An analysis of outcomes of reconstruction or amputation of leg-threatening injuries. New England Journal of Medicine 2002; 24: 1924-1931
- MacKenzie, E. J., Bosse, M. J., Pollak, A. N., Webb, L. X., Swiontkowski, M. F., Kellam, J. F., Smith, D. G., Sanders, R. W., Jones, A. L., Starr, A. J., McAndrew, M. P., Patterson, B. M., Burgess, A. R., Castillo, R. C. Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am 2005; 8: 1801-9
- Melcer, T., Sechriest, V. F., Walker, J., Galarneau, M. A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars. J Trauma Acute Care Surg 2013; 2: S247-54
- O'Toole, R. V., Castillo, R. C., Pollak, A. N., MacKenzie, E. J., Bosse, M. J. Determinants of patient satisfaction after severe lower-extremity injuries. J Bone Joint Surg Am 2008; 6: 1206-11
- Bhatnagar, V., Richard, E., Melcer, T. Walker, J. Galarneau, M. Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends J Rehabil Res Dev 2015; 7:827-38