No abstract

The current COVID-19 pandemic will place enormous pressure on healthcare systems around the world. Large numbers of people are predicted to become critically ill with acute respiratory distress syndrome and will require management in intensive care units. High levels of physical, cognitive, and psychosocial impairments can be anticipated. Rehabilitation providers will serve as an important link in the continuum of care, helping move patients on from acute sites to eventual discharge to the community. Likely impairment patterns, considerations for healthcare practitioner resilience, and organization of services to meet demand are discussed. Innovative approaches to care, such as virtual rehabilitation, are likely to become common in this environment.

No abstract

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.

No abstract

Biopsychosocial models of chronic pain hypothesize a role for psychological and environmental factors in adjustment to chronic pain. To test the utility of such models for understanding phantom limb pain, 61 persons with recent amputations were administered measures of average phantom limb pain intensity, pain interference, depression, pain coping use, pain cognitions and appraisals, and social environmental variables 1 month post-amputation, and the measures of pain intensity, pain interference, and depression again 5 months later. Multiple regression analyses showed that the psychosocial predictors made a statistically significant contribution to the concurrent prediction of average phantom limb pain, pain interference, and depression at the initial assessment, and a significant contribution to the prediction of subsequent change in pain interference and depression over the course of 5 months. The results support the utility of studying phantom limb pain from a biopsychosocial perspective, and identify specific biopsychosocial factors (e.g., catastrophizing cognitions, social support, solicitous responses from family members, and resting as a coping response) that may play an important role in adjustment to phantom limb pain.

No abstract

Objective-To describe the prevalence, intensity, and functional impact of the following types of pain associated with upper-limb loss: phantom limb, residual limb, back, neck, and nonamputatedlimb pain.Design-Cross-sectional survey; 104 respondents with upper-limb loss at least 6 months postamputation completed measures of pain intensity, interference, disability, and health-related quality-of-life.Results-Nearly all (90%) of the respondents reported pain, with 76% reporting more than one pain type. Phantom-limb pain and residual-limb pain were the most prevalent (79% and 71%, respectively), followed by back (52%), neck (43%), and nonamputated-limb pain (33%). Although nonamputated-limb pain was least prevalent, it was reported to cause the highest levels of interference and pain-related disability days. Self-reported quality-of-life was significantly lower for individuals with each type of pain compared with those without any pain. Age, time since amputation, and cause of amputation were not associated with pain.Conclusions-In addition to pain in the phantom and residual limb, back, neck, and nonamputated-limb pain are also common after upper-limb loss. All of these pain types are associated with significant disability and activity interference for some individuals, suggesting that assessment of multiple pain types in persons with upper-limb amputation may be important. KeywordsUpper Limb; Limb Loss; Amputation; Pain; Disability; Phantom Limb; Phantom-Limb Pain Chronic pain is a common secondary condition affecting many individuals with limb loss. In addition to other challenges posed by amputation, pain can have serious consequences for health and functioning, including reduced likelihood of employment and participation in social activities 1,2 and interference in prosthetic training. 3 Chronic pain associated with amputation has been associated with higher affective distress 4 and disability 5 as well as lower health-related quality-of-life 6 when compared with persons with amputation who do not report pain.The majority of the amputation literature has focused on lower-limb loss, possibly because of the greater incidence of lower-limb amputation. However, the number of individuals with Correspondence: All correspondence and requests for reprints should be addressed to Marisol Hanley, PhD, 5837 221st Place SE, Issaquah, WA 98027. Disclosures: The work was supported by grant P01HD/NS33988 from the National Institutes of Health, the National Institute of Child Health and Human Development, the National Institute of Neurological Disorders and Stroke, and the National Center for Rehabilitation Research. upper-limb loss in the community may be greater than suggested by incidence data, given the younger average age of upper-limb loss and the higher mortality rate of individuals with lower-limb loss. 7 Individuals with upper-limb loss tend to live and work with an amputation for more of their lifespan than those with lower-limb loss. Therefore, the impact of pain on functioning may be especially important for...