Wellness

The Wellness Inventory

The Wellness Inventory is an Arm Dynamics patient screening tool. It’s presented in a question and answer format by a clinical therapy specialist at one of our seven Centers of Excellence. The screening was developed as an extension of our holistic care model, which addresses the physical, psychological, social and occupational concerns of people with upper limb loss or congenital limb difference

The Challenge

People who’ve experienced limb loss/difference present with obvious physical challenges. What’s not so clear is how they’re affected by psychosocial factors like anxiety, depression, pain and substance abuse.

Whether the loss is congenital, a traumatic injury or a disease-related amputation, these patients are subject to intense feelings of stress and loss.1  They experience psychosocial challenges at higher rates than the general population.2  When these issues are not acknowledged, they can limit a patient’s full recovery. This possibility is magnified in cases of traumatic injury, which is the leading cause of upper limb loss.3

Addressing the emotional impact of limb loss might seem like it would be a standard part of patient care, but it’s uncommon to screen upper limb prosthetic patients for psychosocial issues. The lack of screening means that for some, there are hidden obstacles that interfere with successful prosthetic rehabilitation.

The Solution

The Wellness Inventory was designed specifically to help upper limb prosthetic patients reach their maximum rehabilitation potential by:
 
  • Screening in key psychosocial areas: resilience, pain, post-traumatic anxiety, drug and alcohol use, health-related quality of life, depression
  • Identifying potential emotional or behavioral challenges
  • Letting patients know it’s okay/safe to talk about these concerns
  • Promoting self-understanding and awareness
  • Assisting patients in locating additional support as requested

Key Findings

The data collected during the screening increases awareness of some of the psychological challenges that may impact a patient's successful rehabilitation. Key findings from each screening are shared with the patient by one of our clinical therapy specialists who assures them that other people are facing the same challenges. This confidential, one-on-one interaction can help normalize the patient's feelings and encourage them to consider seeking more specialized support.
 

Interestingly, Wellness Inventory data from Arm Dynamics patients indicates that partial hand amputees are more likely to screen positive for depression and posttraumatic stress disorder (PTSD) than those with amputation levels proximal to the wrist. This is significant because 90 percent of upper limb amputations are at the partial hand level. 4

For these reasons, it’s important for therapists and other clinical care providers in acute and subacute settings to be aware of the increased potential for psychosocial issues among people with upper limb loss.

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The Wellness Inventory data below confirms that many patients with upper limb loss or limb difference experience significant psychosocial challenges.

Positive for Depression
Positive for PTSD
Reported extreme levels of pain

By proactively identifying these challenges, Arm Dynamics increases the patient’s awareness of hidden obstacles that could affect their overall rehabilitation and initiates a safe conversation where they can talk about these concerns. Our therapists assist patients in locating additional support when needed, to overcome obstacles in their prosthetic rehabilitation.

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"Losing any part of the body is extremely traumatic. Screening new amputees for psychosocial issues provides important information to the patient and the rehabilitation team. Addressing these challenges could be the difference between a person having the patience and motivation to learn how to use their prosthesis, or becoming frustrated and giving up."
Suzi Phelps

Suzi Phelps, Ph.D.
Clinical Psychologist - Houston, Texas

References

  1. Pasquina PF, et al. Ethics in rehabilitation: access to prosthetics and quality care following amputation. AMA J Ethics. 2015; 17 (6):535-546.
  2. Darnall BD, et al. Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey. Arch Phys Med Rehabil.2005; 86:650-658.
  3. Desmond DM. Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations. Journal of Psychosomatic Research, 2007; 62:15-21.
  4. Dillingham TR, et al. Limb amputation and limb deficiency. Southern Medical Journal. 2002; 95 (8):875-883.