Date of Award

12-2009

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing

Research Advisor

Veronica F. Engle, PhD.

Committee

Lawrence W. Faulkner, PhD Marshall J. Graney, PhD Margaret T. Hartig, PhD Richard A. Sherman, PhD

Keywords

Amputation, Function, Mid-South United States, Pain, Phantom Limb Pain, Residual Limb Pain

Abstract

Background: Limb loss affects about 1 in 190 people in the US. Risk factors for limb loss include diabetes, obesity, smoking, minority race, and poverty, which are all common in the Mid-South population. Function is impaired by limb loss, and pain associated with limb loss may further impair function.

Purpose: Describe the function, pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the relationship between function and pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss. Estimate the joint influences on function by pain, health status, and demographics of community-dwelling, adult Mid-Southerners with limb loss.

Methods: Adult community-dwelling Mid-Southerners with limb loss (n=61; male 65.6%; Non-White race/ethnicity 31.1%; mean age 51.6) were recruited from the Mid-South using a purposive snowball sampling technique. Study participants were administered a 1-hour verbal survey that included questions regarding demographics, health status, SIP68 total a generic measure of sickness-related dysfunction, and the LLIP12 total a measure of the specific impact of limb loss on function, and a comprehensive pain assessment of Phantom limb pain (PLP), Residual limb pain (RLP), and Other Pain (OP). Pain intensity was assessed with a 5 point verbal descriptor scale converted to a numeric scale of 0-4.

Results: The mean SIP68 was 19.7 (range 1-54) and the mean LLIP12 was 4.4 (range 0-12). The prevalence of pain was PLP 83.6%, RLP 55.0%, and OP 62.7%, with mean usual pain intensity was PLP 1.1, RLP 0.8, and OP 1.1. The significant correlations of the total SIP68 with usual pain intensity was PLP 0.62 (p≤.001), and OP 0.39 (p=.002). Three statistical models of pain, health status, and demographic variables predicted 46%-52% of the shared variance of global function, physical function, and psychosocial function.

Discussion: Unique contributions of the demographics included a Mid-South sample with representation of Non-White race/ethnicity, especially Blacks (21.3%) as well as women. The pain results are similar to phantom limb and residual limb pain studies done over the past three decades which show that there has been little progress in alleviating the frequency or severity of pain associated with limb loss. The phantom limb pain intensity variables usual PLP and worst PLP were most closely related to function. Usual RLP intensity was related to global function impaired by limb loss only. The high correlations of current OP and usual OP and continuous OP with function suggest both acute and chronic pain at a site not associated with an amputation can impair function. Pain quality descriptors were related to function with tiring PLP, tight band PLP, tiring RLP, abnormal position RLP, and tight band RLP had close relationships. Both continuous PLP and OP were closely related to impaired function suggesting that chronic pain was more disabling that acute. In the statistical models, usual phantom limb pain intensity was the greatest predictor of global function and psychosocial function. Continuous PLP was the greatest predictor of physical function. The magnitude of the influence of usual PLP and continuous PLP show that phantom pain intensity and chronicity predict the greatest variance in function. Non-White race/ethnicity was an important predictor in all three statistical models.

DOI

10.21007/etd.cghs.2009.0086

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