A PSYCHOSOCIAL ADJUSTMENT MEASURE FOR PERSONS WITH UPPER LIMB AMPUTATION
Authors: Resnik Linda , Ni Pengsheng , Borgia Matthew L. , Clark Melissa A. 
Published: April 2022

BACKGROUND: Measurement of psychosocial adjustment after upper limb amputation (ULA) could be helpful in identifying persons who may benefit from interventions, such as psychotherapy and/or support groups. However, available measures of psychosocial adjustment after limb loss are currently designed for prosthetic users only.
OBJECTIVE: To create a measure of psychosocial adjustment for persons with ULA that could be completed by individuals regardless of whether a prosthesis is use.
METHODOLOGY: We modified items from an existing Trinity Amputation and Prosthesis Experience Survey (TAPES) measure and generated new items pertinent to persons who did not use a prosthesis. Item content was refined through cognitive interviewing and pilot testing. A telephone survey of 727 persons with major ULA (63.6% male, mean age of 54.4) was conducted after pilot-testing. After exploratory and confirmatory factor analyses (EFA and CFA), Rasch analyses were used to evaluate response categories, item fit and differential item functioning (DIF). Item-person maps, score distributions, and person and item reliability were examined. Test-retest reliability was evaluated in a 50-person subsample.
FINDINGS: EFA and CFA indicated a two-factor solution. Rasch analyses resulted in a 7-item Adjustment to Limitation subscale (CFI=0.96, TLI=0.95, RMSEA=0.128) and a 9-item Work and Independence subscale (CFI=0.935, TLI=0.913, RMSEA=0.193). Cronbach alpha and ICC were 0.82 and 0.63 for the Adjustment to Limitation subscale and 0.90 and 0.80 for the Work and Independence subscale, respectively.
CONCLUSIONS: This study developed the Psychosocial Adjustment to Amputation measure, which contains two subscales: 1) Adjustment to Limitation and 2) Work and Independence. The measure has sound structural validity, good person and item reliability, and moderate to good test-retest reliability.
Layman's Abstract
A substantial proportion of persons with upper limb amputation (ULA) experience clinical depression, post-traumatic stress disorder, general anxiety, and/or long term post-traumatic psychological distress after amputation. Levels of depression and anxiety have been reported to be greater and psychosocial adjustment poorer in persons with upper limb amputation as compared to those with lower limb amputation. Between 20-40% of individuals with upper limb amputation (ULA) do not use a prosthesis. Previous measures of psychosocial adjustment after limb loss are designed for prosthesis users, and no measure exists that can be used for individuals who do not use a prosthesis. We developed a measure of psychosocial adjustment for persons with ULA that can be completed by individuals regardless of prosthesis use. Factor analyses led to identification of two subscales: a 7-item Adjustment to Limitation subscale and a 9-item Work and Independence subscale. Our analyses supported validity and reliability of both subscales. Both scales can be used for persons with ULA regardless of whether they use a prosthesis.  
Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37873/29269
How To Cite: Resnik L.J., Ni P., Borgia M.L., Clark M.A. A psychosocial adjustment measure for persons with upper limb amputation. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.8. https://doi.org/10.33137/cpoj.v5i1.37873
Corresponding Author: Linda J. Resnik PT, PhDResearch Department, Providence VA Medical Center, 830 Chalkstone Ave, Building 32, Providence, RI 02908E-Mail: Linda.Resnik@va.govORCID ID: https://orcid.org/0000-0002-0168-6759