Article

Clinicians commonly believe that lower extremity amputations are
potentially preventable with coordinated care and motivated patient
self-management. We used in-depth interviews with recent amputees to assess how
patients viewed their initial amputation risk and causes. METHOD: We interviewed
22 patients at a rehabilitation hospital 2-6 weeks after an incident amputation.
We focused on patients' representations of amputation cause and methods of coping
with prior foot and leg symptoms. RESULTS: Patients reported unexpected onset and
rapid progression of ulceration, infection, progressive vascular disease, foot
trauma and complications of comorbid illness as precipitating events. Fateful
delays of care were common. Many had long histories of painful prior treatments.
A fatalistic approach to self-management, difficulties with access and
communication with providers and poor understanding of medical conditions were
common themes. Few patients seemed aware of the role of smoking as an amputation risk factor.
CONCLUSIONS: Most patients felt out of control and had a poor
understanding of the events leading to their initial amputations. Prevention of
subsequent amputations will require rehabilitation programs to address low health
literacy and psychosocial obstacles to self-management.

Langue : ANGLAIS