Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain
Abstract
PURPOSE: To evaluate the utility of a biopsychosocial model to predict long-term adjustment to lower-limb amputation and phantom limb pain (PLP). METHOD: One month after lower-limb amputation, 70 participants completed measures of PLP intensity, cognitions (catastrophizing, perceived control over pain), coping (pain-contingent rest), social environment (social support, solicitous responding), and functioning (pain interference, depressive symptoms). The measures of functioning were administered again at 1- and 2-years post-amputation. Multiple regression analyses were used to examine the ability of the psychosocial variables at 1-month post-amputation to predict changes in the functioning measures over time. RESULTS: The psychosocial variables at 1-month post-amputation, controlling for initial PLP intensity, accounted for 21% of the variance in change in depressive symptoms at 1-year (p < 0.05), and 27% and 22% (p's < 0.01 and 0.05, respectively) of the variance in change in pain interference and depressive symptoms, respectively, at 2-years post-amputation. Catastrophizing and social support were associated with decreases (improvement) in both criterion measures, while solicitous responding was associated with increases (worsening) in both measures. DISCUSSION: The findings support a biopsychosocial model of long-term adjustment to amputation and PLP. In addition, results suggest that some psychosocial variables are more important than others for predicting adjustment, providing important implications for early interventions after amputation.
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A handful of studies suggest that the working alliance statistically mediates the positive effects of rehabilitative treatments in people with musculoskeletal pain.
“A handful of studies suggest that an index of the therapeutic relationship (i.e., the working alliance) statistically mediates the positive effects of rehabilitative treatments among people with musculoskeletal pain 141–145.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [144]
Creating and sustaining an effective therapeutic alliance appears to be a necessary and sufficient condition for the pain-improving effects of diverse interventions.
“creating and sustaining an effective therapeutic alliance appears to be a necessary and sufficient condition for promoting the pain-improving effects of diverse interventions 144–145.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [144]
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Self-citation
- Authors
- Hanley, M. A., Jensen, M. P., Ehde, D. M., Hoffman, A. J., Patterson, D. R., & Robinson, L. R.
- Affiliations
- University of Washington (US)
- Corresponding author
- Hanley, Marisol A
- Venue
- Disability and Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2004-07-22
- Volume
- 26
- Issue
- 14-15
- Pages
- 882-893
- ISSN
- 0963-8288 (ISSN-L)
- 1464-5165
- OpenAlex
- W2108244230
- Cited by
- 263
- References
- 65
- Citations by year
- 2026: 13 · 2025: 4 · 2024: 6 · 2023: 46 · 2022: 9 · 2021: 5 · 2020: 8 · 2019: 5 · 2018: 12 · 2017: 11 · 2016: 10 · 2015: 8 · 2014: 14 · 2013: 19 · 2012: 14
- FWCI
- 8.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Disability and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01 HD/NS33988)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- lower limb amputation, phantom limb pain, long-term adjustment, biopsychosocial model, pain catastrophizing, social support, pain interference, depressive symptoms, coping
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Adolescent, Adult, Aged, Aged, 80 and over, Amputation, Surgical, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pain Measurement, Phantom Limb, Predictive Value of Tests, Probability, Regression Analysis, Severity of Illness Index, Social Adjustment, Socioeconomic Factors, Time Factors, Cohort Studies, Multivariate Analysis, Sickness Impact Profile, Risk Assessment, Lower Extremity
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