Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot‐related behaviours, yet many individuals with diabetes do not adhere to foot care recommendations. The aim of this paper was to synthesise the findings of qualitative papers exploring diabetic people's perceptions and experiences of DFU in order to identify how they could be better supported to prevent ulceration or manage its impact. Five databases (MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science) were searched in May 2016 to identify eligible articles. Findings were synthesised using a meta‐ethnographic approach. Forty‐two articles were eligible for inclusion. Synthesis resulted in the development of five overarching themes: personal understandings of diabetic foot ulceration; preventing diabetic foot ulceration: knowledge, attitudes, and behaviours; views on health care experiences; development of diabetic foot ulceration and actions taken; and wide‐ranging impacts of diabetic foot ulceration. The findings highlight various barriers and facilitators of foot care experienced by people with diabetes and demonstrate the significant consequences of ulcers for their physical, social, and psychological well‐being. The insights provided could inform the development of interventions to promote foot care effectively and provide appropriate support to those living with ulceration.

Several psychological factors predict QoL among HNC survivors who have completed treatment. Routine screening and early interventions that target distress could improve HNC survivors' QoL following treatment. Longitudinal and population-based studies incorporating more systematic and standardised measurement approaches are needed to better understand relationships between psychological factors and QoL and to inform the development of intervention and supportive care strategies.Copyright © 2016 John Wiley & Sons, Ltd.

Disability and RehabilitationResults. Thirty papers were found that met the inclusion criteria. The studies were characterised by heterogeneity of design, methodological quality, sample characteristics, assessment of cognitive functioning, and outcomes examined. The research published to date suggests that cognitive impairment is more prevalent among persons with lower limb amputations than in the general population, and is linked with a number of important outcomes in this patient group, including mobility, prosthesis use, and maintenance of independence following amputation.Conclusions. These findings highlight the importance of assessing the cognitive abilities of persons with lower limb amputations. An understanding of the cognitive profile of these patients could assist rehabilitation teams in determining their suitability for prosthetic or wheelchair rehabilitation, ascertaining appropriate and realistic goals for rehabilitation, and tailoring rehabilitation programmes to patients' strengths so that maximal mobility and independence is achieved. Individuals with lower limb amputations may be particularly susceptible to impairments in cognitive function for a number of reasons. Firstly, there has been a significant increase in the average age at which amputation occurs in recent years, due to improvements in the medical management of associated conditions such as diabetes and peripheral vascular disease [14]. Over half of all individuals referred to prosthetic centres in the U.K. every year are older than 65 years of age, and more than a quarter are aged over 75 years [15]. The rising age at which lower limb amputation is performed brings with it a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 [5,9,12,19]. These shared characteristics may leave individuals with dysvascular amputations susceptible to vascular cognitive impairment [20,21],which affects approximately five percent of all persons aged over 65 years [22] and is characterised by deficits in attentional and executive functioning (the ability to organise cognitive processes e.g. planning and sequencing of actions) in addition to slowing of motor performance and information processing, with episodic memory remaining relatively intact [8,20,23].Diabetes mellitus, which is present in almost half of all cases of lower limb amputation [24], is associated with increased incidence of dementia and accelerated decline in cognitive functioning [25][26][27].

Aim To examine psychosocial adjustment in persons with lower limb amputations related to diabetes.Methods Thirty-eight participants with diabetes-related lower limb amputations, recruited from two limb-fitting centres, completed three psychological self-report assessments: the Trinity Amputation and Prosthesis Experience Scales (TAPES); the Hospital Anxiety and Depression Scale (HADS); and the Amputation Body Image Scale-Revised (ABIS-R).Results Over 18% of participants scored above the normal range (> 8) for depression on the HADS and 18.5% scored above the normal range for anxiety. Both depression (q = 0.75, P < 0.01) and anxiety (q = 0.62, P < 0.01) scores were significantly associated with body image disturbance, as measured using the ABIS-R. Significant relationships were also observed between body image disturbance and three TAPES subscales measuring psychosocial adjustment [general adjustment (q = )0.48, P < 0.01), social adjustment (q = )0.51, P < 0.01), adjustment to limitations (q = )0.45, P < 0.05)].Conclusions Individuals with diabetes-related amputations may be at elevated risk for psychological distress as a result of their co-morbid medical condition. Regular screening for anxiety and depression and the provision of appropriate follow-up care may therefore be advisable in this population.

Objective: (1) To identify significant changes in disability and quality of life (QoL) across three time points (T1 = admission to rehabilitation, T2 = six weeks post-discharge, T3 = six months post-discharge) in individuals with lower limb amputation, and (2) to examine whether goal pursuit and goal adjustment at T1 were predictive of these outcomes at T3.Design: Prospective cohort study. Setting: Inpatient rehabilitation.Participants: Consecutive sample of 64 persons aged 18 years and over with major lower limb amputation.Interventions: Not applicable. Main Outcome Measures: World Health Organisation Disability Assessment ScheduleVersion 2.0 (WHODAS 2.0); World Health Organisation Quality of Life Questionnaire-Brief Version (WHOQOL-BREF).Results: Mean WHODAS 2.0 scores were in the 95 th percentile at each time point. Scores on the WHODAS 2.0 and the physical, psychological and social relationships domains of the WHOQOL-BREF remained stable across the study period. Environmental QoL scores decreased from T1 to T2, but returned to near-baseline levels between T2 and T3. Having a greater tendency towards goal pursuit at T1 was predictive of higher physical and psychological QoL at T3, while having a stronger disposition towards goal adjustment at T1 predicted lower disability and higher environmental QoL at T3. Conclusions:High levels of disability were experienced from admission to rehabilitation up to six months post-discharge. QoL in the physical, psychological and social relationships domains remained stable over the study period. Stronger goal pursuit and goal adjustment 3 tendencies on admission predicted lower disability and higher QoL six months postdischarge. and health classification system that offers a generic framework for describing the consequences of illness and disability and the dynamic interplay of personal and environmental factors (5), and has been applied to a number of conditions, including LLA (5, 6). The ICF classifies functioning and disability into two components: (1) body functions and structures (at the level of the body or body part), which are interpreted through changes in physiological systems or anatomical structures; and (2) activities (at the level of the whole person) and participation (at the level of the whole person in a social context), which are interpreted through capacity and performance.The primary goal of rehabilitation is to achieve optimal functioning (as appropriate to the individual) at each of these levels (7). Recent reviews indicate that most rehabilitation outcomes research among persons with LLA has been at the level of body functions and structures (2) or specific activities such as mobility (6) Theories of self-regulation may help to increase understanding of adjustment to LLA (17, 18). According to this perspective, human behaviour is organised around the pursuit of goals, which energise activities and give structure and meaning to people's lives and are thus closely linked with their subjective well-being (19-21). Indeed, negative associations hav...