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Archives of Business Research – Vol. 9, No. 11
Publication Date: November 25, 2021
DOI:10.14738/abr.911.11226. Castelli, I. (2021). Patients Profile of Traumatic Amputation: An Analysis of Factors That Can Help or Prevent the Treatment
Adherence. Archives of Business Research, 9(11). 15-20.
Services for Science and Education – United Kingdom
Patients Profile of Traumatic Amputation: An Analysis of Factors
That Can Help or Prevent the Treatment Adherence
Isabela Castelli
Researcher in Universidade de Brasília, Brazil
Psychologist in Hospital de Base do Distrito Federal
ABSTRACT
Amputee surgeries refer to the removal of totally or partial part of an organ. There
are few illnesses that can lead to an amputation: cancer, diabetes, infections and
traumas. We should stand out about the traumatic amputees’ patient’s profile:
young, on working age and with no previously known disease. In the United States
of America, are estimated 185.000 amputations per year which 45% are provoked
for traumatic accidents. It’s estimated that by the year of 2050 the total number of
amputees will reach about 3.6 million people. That makes the attendance and
follow-up of amputees a public health issue. It is essential that an amputee patient
be evaluated and monitored by a psychological professional. These study analysis
11 traumatic amputees and the factors that influenced adherence. The results show
that social factors, type of amputation and use of drugs are the principal factors to
be considered.
Key-Words: traumatic amputation; healthcare adherence; rehabilitation; psychological
treatment
INTRODUCTION
Amputation: an overview
Amputee surgeries refer to the removal of totally or partial part of an organ. Currently, this type
of surgery is considered reconstructive surgery because the final objective is to restore the
organ [1; 2].
There are few illnesses that can lead to an amputation: cancer, diabetes, infections and traumas.
About this last type of amputation, it’s necessary to highlight the sudden break with the
“normal” life before the trauma and the need to quickly adapt to a completely new form of living
[3]. In other words, the patients usually distinct their lives on “before and after” the traumatic
amputation [3].
We should stand out about the traumatic amputees’ patient’s profile: young, on working age
and with no previously known disease [4; 5].
In the United States of America, are estimated 185.000 amputations per year which 45% are
provoked for traumatic accidents [6; 7]. It’s estimated that by the year of 2050 the total number
of amputees will reach about 3.6 million people [8]. That makes the attendance and follow-up
of amputees a public health issue.
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Psychological reaction in amputation
The experience of amputation brings physical and psychological changes [9]. It’s important to
highlight that these changes are called “adjustment reactions” and they are not considered
pathological reactions. These adjustment reactions involve feelings like anger, fear of the future,
sadness, self-esteem change and anxiety.
Therefore, it’s important that the patient receive psychological treatment as soon as possible
(10; 11; 9]. Despite the vast report of these symptoms the number of studies publications is still
very low [12; 6; 5].
It’s possible to didactically divide two moments post amputation: (a) acute phase, immediately
after the surgery, when the principal mission of the patient is to survive with the necessary
adaptations; (b) chronic phase, the moment when the patient must lead with the characteristic
of its new physical limitation, the pain, the meaning of loss, quality of life and, eventually, the
fitting on a prosthetic.
In both phases – acute or chronic – the limitation imposed by the absence of a member result
in serious daily life changes; impacting social, work and sexual life [13; 14; 15].
Psychological interventions are recommended in both phases in order to avoid aggravation os
psychological changes [16; 10; 17; 9].
Authors defend that follow-up of psychological intervention in medium and long term (to six
months to a year) it’s important to follow the evolution of the adaptation of the adjustment
reaction [6; 4]. According to these authors, the first year after an amputation brings emotional
symptoms, being the most frequent depressive and anxiety symptoms’. This important to
discuss that negative symptoms are not necessarily negative reactions – they can be the
adjustment reaction. These reactions can lead the patient to treatment motivation. Some
patients understand the amputation as a chance to “live a new, health life” (9, p. 326).
Given the above, it is essential that an amputee patient be evaluated and monitored by a
psychological professional [12].
Just to explain to the reader, a systematic literature review was carried out by this author to
screen the number of studies that address psychological aspects of amputees. Descriptors used
were “traumatic amputation” and “psychological trauma”.
Were found a total of 143 articles. Of these, 14 were duplicated. 30 articles did not approach
amputation issues. Another three articles were excluded because approach only technical
questions about amputation’s surgery (two of them discuss what the medication were to be
used on the immediately post operatory and the other one discusses exclusively the surgical
techniques for an amputation).
Eight articles were excluded because treat about pediatric context (the reader can suppose that
pediatric and adult context of amputation are different). 21 articles were excluded for treating
revascularization surgeries (where, we can understand, that the patient was not amputated).
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Castelli, I. (2021). Patients Profile of Traumatic Amputation: An Analysis of Factors That Can Help or Prevent the Treatment Adherence. Archives of
Business Research, 9(11). 15-20.
URL: http://dx.doi.org/10.14738/abr.911.11226
25 articles were excluded because they discuss penile amputations (which, for this review
would bring low contribution). Seven articles were excluded for treat about complications of
non-traumatic amputation. Three articles were excluded because they did not mention
psychological aspects.
On this survey, 110 articles were excluded; being considered only 31 articles. Based on the
survey above descript, we can note that studies about traumatic amputation are rare. Just in
front of that fact, we need to develop studies with traumatic.
PROFILE OF TRAUMATIC AMPUTATION
This study was conducted in a tertiary hospital located in Brasília. This hospital is a reference
in attendance of polytraumatized patients. We considered the time gap of one year (from august
2020 to august 2021) and proposed to follow up the patients victims of traumatic amputation.
It’s important to say that other type of amputation triggered by chronic illness was not
considered in this analysis.
Were considered eligible for these analysis 11 patients: 9 men and only 2 women. The average
age was about 34.83years and eight patients were inserted in the labor market. This can be
explained by the social reinforcement for men to engage in dangerous situations. This is
according to recent literature [18; 19; 20; 21].
The same health treatment was offered to all patients: early psychological intervention,
physiotherapeutic and orthopedic follow up along the first year after the accident.
Between the 11 patients, one died due to clinical complications.
About the other 10 patients, three patients lived on the streets and used different kind of drugs
(like alcohol, crack, cocaine, tobacco etc); making treatment adherence unfeasible. Despite of
have been forwarded to healthcare follow up, none of these three patients were followed up.
One patient worked as bricklayer, was formal working at the time of the accident and he
followed up the treatment. Nevertheless, he also used different types of drugs and that was a
barrier to his treatment.
One of the patients’ was minor and lived in rural area which made hospital access very difficult.
This patient chose to not maintain the healthcare treatment. He and his parents were aware of
the losses of discontinue the treatment.
Another patient suffers from a very advanced type of anxiety with serious damage to social
relations. The healthcare team was never able to obtain telephone contact with this patient and
he totally abandoned the treatment. Until now, it is unknown how the case evolved. Similar to
this case, another patient also abandoned the treatment (he even had some psychotherapy
sessions), however one day he no longer met the investments of the healthcare team. This case
is also unknown about the outcome.
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Three of the patients’ adhered to the treatment: (a) one was a woman, 18 year-old, with both
breast and arm amputation. She was a victim of a trampling and was dragged to 2.5 miles on
the hood of the car. She is still in psychological treatment and medical treatment, waiting for
the breast reconstruction (this treatment is paid for the Brazilian HealthCare System – also
known as Sistema Único de Saúde (SUS). About the arm prosthesis, it cost average U$ 24.000,00
and it is not distributed by SUS. As to be expected, this prosthesis cost too much for her family
to pay for.
It’s important to frizz that the SUS pays for some types of prostheses like prostheses above and
below the knee ; some type of insoles adapted for amputee toes; none functional (only
aesthetics) above elbow prostheses. However, prostheses below elbow and hand prostheses
are not commonly provided for SUS and when provided, they are not functional.
(b) The second success case of patient was a man, 34 year-old, who lost his arm in a crushing
by concrete mixer when he was working. He maintained psychological treatment for one year
over the accident and evolves satisfactorily, being discharged from follow-up. The company he
worked for bore the cost of the prostheses and he managed to acquire a functional prosthesis.
Now, he is well adapted to the prosthetization process and has resumed retake his work
activities (obviously in an adapted way).
(c) The third case, also considered successful, was a 19 year-old man who had an amputation
of three fingers with chainsaw. At the beginning of his psychological treatment he was very shy,
having difficulties of expressing his emotions. He was in treatment for nine months, when he
decided to leave the follow up because he had managed to reframe his loss. Although he was
not prosthetized he was clearly pleased with its physical limitations and satisfied with his life.
DISCUSSION
What psychologist could do in those situations? Help of prevent the treatment adherence. The
first conclusion about these case reports is to bring to discussion is the lack of studies and
publication on the traumatic amputee area. This reinforces the importance of offering
conditions for researchers to develop innovate studies. Also, in this study we could observe the
difficulty to do a follow up research. Despite of this, it’s very necessary that others researchers
seek answers about the change of treatment adherence behavior over time after the accident.
We show, in this study, that simple factors influence on the good or bad rehabilitation process.
We can quote: the type of amputation, the use of drugs, the presence of support network, and
the ability to face and reframe the problems.
Another conclusion on these case reports is the importance of psychological intervention on
both phases: acute and chronic phases; therefore, which one has their specificities. More than
“patients” the psychological professional should stare to the amputee as a person who need all
the effort on the healthcare team.
An amputee will need help to relearn the simplest things and activities in their live and, this,
should motivate the healthcare team.
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Castelli, I. (2021). Patients Profile of Traumatic Amputation: An Analysis of Factors That Can Help or Prevent the Treatment Adherence. Archives of
Business Research, 9(11). 15-20.
URL: http://dx.doi.org/10.14738/abr.911.11226
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