title: Self-management improves outcomes in persons with limb loss.
abstract: OBJECTIVE
  To test the acceptance and effectiveness of a community-based self-management (SM) intervention designed to improve outcomes after limb loss. A priori hypothesis was that an SM intervention will be more effective than standard support group activities in improving outcomes.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  General community.
  
  
  METHODS
  Intervention (N=287) and control participants (N=235) with major limb loss.
  
  
  METHODS
  Nine, 90-minute SM group sessions delivered by trained volunteer leaders. Retention rates at immediate postintervention and 6-month follow-up were 97% and 91% for the SM group.
  
  
  METHODS
  Primary outcomes were depression, positive mood, and self-efficacy. Secondary outcomes were improved functional status and quality of life.
  
  
  RESULTS
  By using intent-to-treat analyses, the odds for being depressed are significantly lower for those in SM group, 50% less likely at treatment completion (95% confidence interval [CI]=0.3-0.9) and 40% less likely at the 6-month follow-up (95% CI=.03-1.1). Treatment completers have a 70% reduction in likelihood of being depressed at posttreatment (P<.01) and this persists at six months (P<.05). For those in the SM group, functional limitations were significantly lower at 6 months (P<.05), and general self-efficacy was significantly higher at immediate posttreatment (P<.05) and at 6 months (P<.05). Treatment completers have generally significantly larger effect sizes at all follow-up points. Pain intensity, self-efficacy for pain control, and quality of life were not significantly different between the groups. Subgroup analyses indicated the impact of the intervention was greater for participants who were less than 3 years postamputation, participants who were less than 65 years of age, or participants who showed at least 1 secondary condition at baseline.
  
  
  CONCLUSIONS
  The study provides evidence that SM interventions can improve the outcomes of persons with limb loss beyond benefits offered by support groups.
authors.affiliation: Department of Physical Medicine & Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Mackenzie
authors.forename: Patti
authors.initials: P
authors.lastname: Ephraim
authors.forename: Dawn
authors.initials: D
authors.lastname: Ehde
authors.forename: Rhonda
authors.initials: R
authors.lastname: Williams
mesh_terms: D000203:Activities of Daily Living; D000674:Amputees / Q000534:rehabilitation* / Q000706:statistics & numerical data; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D015999:Multivariate Analysis; D010349:Patient Compliance; D017060:Patient Satisfaction; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D012944:Social Support; D016896:Treatment Outcome