title: Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain.
abstract: OBJECTIVE
  To evaluate the utility of a biopsychosocial model to predict long-term adjustment to lower-limb amputation and phantom limb pain (PLP).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195-6490, USA. hanleym@u.washington.edu
authors.forename: Marisol A
authors.initials: MA
authors.lastname: Hanley
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Hoffman
authors.forename: David R
authors.initials: DR
authors.lastname: Patterson
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Robinson
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods* / Q000523:psychology* / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010591:Phantom Limb / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D011336:Probability; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012917:Social Adjustment; D012959:Socioeconomic Factors; D013997:Time Factors