Project Background Veterans with amputation are an important population facing considerable physical, social, and emotional challenges that can impede their reintegration into the community. We define community reintegration as activities and participation across a range of life roles including Relationship with spouse/significant other; Parenting; Education; Work; Social; Leisure; Spiritual/Religious, Civic; Self Care; Domestic Life; and Economic Life. While the majority of Veterans with amputation enjoy full and productive lives in these areas, studies have documented increased rates of psychological distress and role limitation within this population. Medical devices (i.e., prostheses designed to maximize balance and mobility) and psychosocial interventions (i.e., cognitive behavioral therapies) offer opportunities to further enhance community reintegration. Unfortunately, a lack of systematic data on the community reintegration of Veterans with amputation, including associated physical and contextual factors, hampers our ability to most effectively design and target future devices and interventions. Project Objectives This project is a novel collaboration between a group of psychologist clinician investigators with expertise in reintegration, qualitative (survey) methodology and quantitative methods and an accomplished group of biomedical engineers with expertise in amputation, prostheses, and mHealth technology. The overall goal of this collaboration is to generate systematic information about the community reintegration outcomes of Veterans with amputation needed to advance the development or refinement of interventions and technologies aimed at improving reintegration outcomes.
The specific aims for this pilot (SPiRE) proposal are:
Specific Aim 1 : To characterize community reintegration and its associated physical (i.e., amputation and medical comorbidity) and contextual (i.e., psychological, environmental, and medical device) factors.
Specific Aim 2 : To obtain a deeper understanding of Veterans' experience of community reintegration and discover potential barriers and facilitators of community reintegration among Veterans with amputation. Project Methods This is a mixed-methods investigation of Veterans with major lower limb amputation who have received services from the Minneapolis VA Regional Amputation Center (RAC).
Aim 1 will utilize a mailed survey of 425 Veterans with amputation identified through a RAC database. The survey will assess community reintegration with validated measures of social and community participation that are normed within disability and general population samples. It will also include important correlates of reintegration including measures of psychological (e.g., depression, anxiety, body image), physical (e.g., prosthetic use, pain) and environmental (e.g., social support) factors related to reintegration. Multiple linear regression analyses will be used to examine the independent contribution of each variable over and above demographic factors.
Aim 2 will be addressed using data from qualitative interviews with a subset of Veterans (n=24) with varying levels of community reintegration stratified by service era. In-depth interviews will explore Veterans' perspectives on reintegration; aids and supports; perceived barriers and facilitators; perceived needs for medical and psychosocial services; and interest in and use of medical technologies related to reintegration. A rapid turn- around qualitative analytic approach will be used to extrac and summarize key themes. Results will be used to inform the development of new technological (e.g., prostheses, mHealth applications) and psychosocial interventions aimed at supporting and enhancing Veteran community reintegration.
Veterans with amputations are a growing and important group within the Department of Veteran Affairs with special needs and challenges. Veterans suffer from amputations from traumatic causes, such as combat, but even more so from vascular disease such as diabetes. This project is designed to evaluate how well Veterans who suffer from amputation are reintegrating into their roles with family, friends, communities, and the workplace. It will use surveys and interviews to learn from Veterans who have lower limb amputations. The information from the study will help investigators to design new medical devices (such as wheel chairs and prosthetic limbs), mHealth programs (such as smart phone apps), and psychological treatments (such as group or individual psychotherapies) to aid Veterans who have amputations in maximizing their quality of life and participation in their families and communities.
