USING A NOVEL PSYCHOSOCIAL GROUP INTERVENTION TO IMPROVE ADAPTION, COPING AND MENTAL HEALTH OUTCOMES FOLLOWING DYSVASCULAR LIMB AMPUTATIONS: A FEASIBILITY STUDY

Abstract

BACKGROUND: Individuals with lower extremity amputations (LEA) often face high rates of depression and anxiety that hinder their rehabilitation and post-discharge coping. Group therapy is a clinically and cost-effective way to address these mental health challenges, but evidence for its use with LEA inpatients is limited. OBJECTIVE: To determine the feasibility of a psychosocial group therapy intervention for individuals with dysvascular LEA undergoing inpatient rehabilitation. METHODOLOGY: This randomized controlled trial randomly assigned dysvascular LEA rehabilitation inpatients into a supportive-expressive group therapy (SEGT) or a treatment as usual (TAU) group. The SEGT intervention, a form of group therapy adapted from outpatient medical settings, consisted of six one-hour sessions held twice weekly over a three-week period. Participants completed baseline, exit and three-month surveys assessing the study’s secondary outcomes of SEGT effectiveness on depression, anxiety, coping, body image, health, and community participation. The main outcomes assessed recruitment, survey completion, treatment adherence, and participant retention rates. Interviews and a focus group were completed to obtain feedback on the intervention. FINDINGS: Twenty-five participants were recruited, with 12 randomly assigned to the SEGT group, and 13 to the TAU group. The average number of sessions attended by SEGT participants was 3.9 (SD = 2.1). The survey completion rates for all participants were 84% (21/25) for the baseline assessment, 64% (18/25) for discharge, and 44% (11/25) for the three-month follow-up. The SEGT group showed a significant improvement in anxiety and depression scores (p = 0.02). SEGT was well-received by participants and staff. CONCLUSION: The findings suggest a larger pragmatic SEGT trial is feasible, despite a small sample size and implementation challenges during the COVID-19 pandemic, given this study achieved moderate rates of recruitment, retention, and survey completion. Several critical insights were gained on how to optimize an inpatient group therapy intervention for dysvascular LEA populations in rehabilitative settings. Layman's Abstract People who have undergone lower limb amputations often experience high rates of anxiety and depression, making it harder for them to recover from surgery and transition back home. Group therapy has been shown to improve the mental health of many patient populations, but it has not been widely studied in persons with lower limb loss in hospital settings. This project tested whether a group therapy program would be feasible for persons with lower limb loss who are undergoing hospital based rehabilitation. The therapy program consisted of six sessions over a three week period. Participants were either randomly assigned to the group therapy sessions or to a treatment as usual condition (no group therapy). We recruited 25 participants: 12 assigned to the group therapy sessions and 13 to the treatment as usual group. The average number of group therapy sessions attended by participants was 3.9 sessions, and individuals that attended the group sessions showed improvements in anxiety and depression scores. The survey completion rates for all participants were 84% for the baseline assessment, 64% for discharge, and 44% for the three-month follow-up. Follow-up interviews with patients who took part in the group therapy revealed they found it to be helpful for the mental well-being, and hospital staff shared some suggestions on how to optimize its’ delivery. Overall this study found that running an in-hospital group therapy program for individuals with limb loss is feasible. The project also provided valuable insights on how to improve any future group therapy studies for people with limb loss. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/45122/33962 How To Cite: Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. Https://doi.org/10.33137/cpoj.v8i1.45122 Corresponding Author: Dr. Rosalie J. Steinberg, MSc, MD, FRCPC Affiliation: St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. E-Mail: [email protected] ORCID ID: Https://orcid.org/0000-0002-5042-1378 Telephone: [phone]

Keywords

• Psychotherapy
• Amputation
• Group
• Amputees
• Feasibility Studies
• Mental Health