Self-Management in Persons With Limb Loss: A Systematic Review

Abstract

BACKGROUND: Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports.
 OBJECTIVE(S): The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use.
 METHODOLOGY: A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens’ LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades.
 FINDINGS: Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues.
 CONCLUSION: Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications.
 Layman's Abstract
 Self-management is an integral component of managing long-term conditions and diseases. Self-management for a person with limb loss involves performing proper hygiene of the residual limb, caring for the prosthesis, and problem-solving the fit between the prosthetic socket and the residual limb. If a person with limb loss fails to correctly self-manage, they may be exposing themselves to the risk of skin breakdown or injury. Other medical diagnoses like diabetes emphasize self-management in the care of persons with the condition and have established a large body of knowledge surrounding this element of lifestyle adaption. However, in the case of limb loss, there is very little evidence to support how self-management is taught or performed. Therefore, the purpose of this study was to explore the body of literature surrounding self-management in persons with limb loss. The results indicate that there is very little evidence supporting self-management related interventions and that further research is required in this area. With the addition of further research, clinical practice can be improved and self-management interventions can become standardized across the spectrum of care, much like in diabetes care.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35098/27909
 How To Cite: Lee DJ, Repole T, Taussig E, Edwards S, Misegades J, Guerra J, Lisle A. Self-management in persons with limb loss: A systematic review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.5. https://doi.org/10.33137/cpoj.v4i1.35098
 Corresponding Author: Daniel J. Lee, PT, PhD, DPT, GCS, COMTTouro College, Department of Physical Therapy, Bayshore, NY USA.Email:Daniel.lee29@touro.edu ORCID: https://orcid.org/0000-0003-1805-2936

Patterns of inpatient acute care and emergency department utilization within one year post-initial amputation among individuals with dysvascular major lower extremity amputation in Ontario, Canada: A population-based retrospective cohort study

“…Given the complex medical profile of persons with LEA, a focus on self-management support within a team-based model of care, may assist with overall physical, emotional, and social functioning of persons with LEA [ 64 ]. Self-management refers to the tasks, skills and behaviours associated with an individual’s ability to navigate the physical, social, and cognitive lifestyle factors, changes, and consequences of living with a chronic condition [ 65 ].…”

“…Previous qualitative research identified the need for more self-management education and training opportunities within rehabilitation to assist in the transition from hospital to community for persons with LEA [ 71 ]. To date, there is limited research on self-management and LEA [ 64 ]. In a recent systematic review, only 7 articles were identified on self-management among persons with LEA [ 64 ].…”

Development and validation of the Self-Management Assessment for the Residuum and prosThesis system designed for persons with limb loss (SMART)

“…[2][3][4][5][6][7][8] This process of self-managing is crucial in the prevention of SMRC's related to limb loss, including integumentary, musculoskeletal, and functional impairments. [9][10][11] Because the importance of self-management in PwLLL is established and teaching this essential information is considered part of the standard care, [12][13][14] it is reasonable that there should be a way to objectively evaluate self-management. Self-management knowledge assessment with resultant intervention is standard care in many other health disciplines.…”

“…Because the importance of self-management in PwLLL is established and teaching this essential information is considered part of the standard care, 12-14 it is reasonable that there should be a way to objectively evaluate self-management. Self-management knowledge assessment with resultant intervention is standard care in many other health disciplines.…”

The Ideal Physical Therapist From the Perspective of Individuals With Limb Loss

“…With approximately two million individuals living with limb loss in the United States, it is paramount that individuals with limb loss receive appropriate treatment following this life altering event. 1 , 2 Limb loss can impact an individual's quality of life and function by limiting participation in valued activities. However, a comprehensive individualized rehabilitation program can help build a functional foundation for a safe transition back to society and daily life for individuals with limb loss.…”