Psychosocial adjustment to lower-limb amputation: a review.

PURPOSE To review the existing literature on the social and psychological challenges faced by people with an amputation and to provide a detailed analysis of the literature examining psychological adjustment to these challenges across time. METHOD Existing papers on psychological adjustment to amputation were analysed according to their results, methodology, and conclusions. RESULTS Although depression and anxiety are relatively high up to 2 years post-amputation, they appear to decline thereafter to general population norms. However, social discomfort and body-image anxiety have also been found among some people with amputations, and these have been associated with increased activity restriction, depression, and anxiety. Factors associated with positive adjustment to limb loss include greater time since amputation, more social support, greater satisfaction with the prosthesis, active coping attempts, an optimistic personality disposition, a lower level of amputation in the case of lower limbs, and lower levels of phantom limb pain and stump pain. CONCLUSION The majority of studies on adjustment to amputation are cross-sectional in design and have used noncomparable measures. Furthermore, they have neglected to study many important areas of rehabilitation, including immediate reaction to amputation, adjustment during and shortly after the rehabilitation period, and development of a changed sense of self and identity. In order to address these concerns, more longitudinal and qualitative research is called for. We end by outlining the components of a descriptive phased model of the rehabilitation process.