Coping Self-Efficacy Helps Explain Prosthetic Adjustment Following Lower-Limb Amputation

• Logan Szelestei, Psychology, University of Delaware

• Jaclyn Sions, Physical Therapy, University of Delaware

Coping Self-Efficacy Helps Explain Prosthetic Adjustment Following Lower-Limb Amputation

Logan Szelestei; Claire E. Vallery, MPO, CPO; Samantha J. Stauffer, MSOP, CPO1,2; John Horne, CPO2; Frank Sarlo, MD; J. Megan Sions, PT, DPT, PhD

Background and Purpose: Lower-limb amputation results in dramatic life changes, but better adjustment to prosthesis use may enrich post-amputation quality-of-life. Greater self-efficacy may enhance post-amputation adjustment, which coping self-efficacy (CSE) draws upon. This study sought to identify relationships between psychosocial factors and adjustment to prosthesis use. It was hypothesized that greater CSE would be significantly associated with better adjustment.

Methods: A cross-sectional, survey-based study collected data between 2022 and 2024. Participants were ≥18 years-old and seen in the University of Delaware interdisciplinary Limb Loss Clinic for prosthetic-related needs (Institutional Review Board approval #531197). Demographics and amputation history were collected with validated self-reported measures e.g., Coping Self-Efficacy Scale (CSES) and Trinity and Prosthesis Experience Scales Revised (TAPES-R) adjustment subscales, which evaluate general-, social-, and limitation-adjustment. Data were analyzed using stepwise linear regression with SPSS statistical software, while considering relevant covariates, e.g., perceived socioeconomic status, phantom limb pain, assistive device use, prosthesis-enabled mobility, employment status, caregiver status, anxiety, and number of pain sites.

Results: Forty-eight participants (77% male, aged 58±12.7 years) were included. CSE was the sole significant factor in explaining general adjustment; the model explained 36% of the variance. CSE and caregiver status were significant in explaining social adjustment; the model explained 27.8% of the variance. All factors were insignificant in explaining limitation adjustment.

Conclusion: Adjustment to using a prosthesis may be explained partially by ways of coping (e.g., meditation, prayer, and mindfulness), social support (e.g., emotional support), and psychological well-being (e.g., optimism and self-accomplishment). 

Clinical Significance: CSE and caregiver status appear to be significantly associated with prosthetic adjustment, while amputation-related factors appear less relevant. Clinical interventions to enhance adjustment to prosthesis might focus on increasing self-efficacy by encouraging patients to seek emotional support from their communities and develop an optimistic, solution-oriented mindset.