Abstract
The nature of, indications for, and aims of amputation and prosthetic rehabilitation are described. The influence of those procedures on patients' physical, psychological and social states are examined over time. Psychological theories of the coping techniques of surgical patients are used to develop an understanding of the influence of patients' pre-surgical characteristics on their post-operative rehabilitation. The Roehampton Functional Assessment Scale has been developed and validated on three separate samples of primary lower-limb amputees. The developmental sample consisted of 121 patients, the reliability sample of 50 amputees and the validity sample of 25 patients. The 10-point Body Barrier Test, Family Environment Scale, General Health Questionnaire, Multidimensional Health Locus of Control, Minnesota Multiphasic Personality Inventory, State-Trait Anxiety Inventory and the Roehampton Functional Assessment Scale were used to assess patients' pre- and post-operative physical, psychological and social parameters. 109 patients were assessed before their amputation, whom were re-assessed six months after amputation, and 27 followed-up at eighteen months or more after their operation. The results indicated that patients' psychological profiles differed at each assessment stage, and the changes observed were not always in the same direction. Patients appeared to suffer from worse physical symptoms, sleep disturbances, State Anxiety and body-image before their amputation than after, while still functioning independently from their family environment. At the first post-operative assessment, amputees wore found to fare better than at any other assessment stage. Nevertheless, inter-personal difficulties, indicated by reduced Individuality scores, became evident at this stage. At the final stage, amputees appeared to continue physically and psychologically functioning on levels similar to the previous stage, except for significantly increased Trait Anxiety scores. The three pre-operative variables accounting for most of the variance in the first post-operative assessment variables were Trait Anxiety, Anxiety and Dysphoria and Sleep Disturbances [the later two are subscales of the General Health Questionnaire (GHQ)]; while for the second post-operative assessment the variables were State Anxiety, Somatic Symptoms (a subscale of the GHQ) and Chance Locus of Control. Male and non-vascular patients and those with below-the-knee amputations achieved the best physical rehabilitation and lowest levels of psychopathological disturbances at both re-assessment stages. Additionally, younger patients were found to do better that older amputees at the first post-operative assessment. This clear age difference was not maintained at their second post-operative assessment. Explanations of the possible relationships of the results obtained and a comparison with the results of previous research studies are provided. Clinical applications and recommendations for future research are also included.