This study investigated the reactions of arm amputees to their prostheses and explored possible reasons for these reactions. A questionnaire was constructed to determine the use to which the recipients put their prostheses. A preliminary validation study was conducted to determine the final form of the questionnaire. Rather than selecting a sample of prosthesis recipients, a census of the recipient population was attempted with 48.57 per cent responding. Respondents were asked questions measuring their use of the prosthesis, the nature of their prosthesis, the rehabilitation services they had used, and various demographic variables including age, sex, occupation and so on. It was found that up to 55.9% of the respondents could be classified as low-users of their prosthesis. A regression analysis showed that 44 per cent of the variance in the use of the prosthesis was due to the two variables of prosthesis type and prosthesis length. No other variables explained significant amounts of the variance. A lower-user and a high-user were selected to pilot a further study examining psychological factors that may affect prosthesis use. The areas examined were those of training, perceptions of independence and stigma, and perceptions of the prosthesis. A number of modifications were made to the original questions as a result of the pilot study. The results of the pilot study indicated that the areas of training and expectations of the prosthesis' capabilities prior to receiving it would be most likely to prove useful in explaining different levels of prosthesis use. Some issues relating to possible future research, interventions, and the rehabilitation process were also discussed

Burrough, Stephen

English

Massey Research Online

Copyright is owned by the Author of the thesis.  Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only.  The thesis may not be reproduced elsewhere without the permission of the Author.  AN EXPLORATORY EVALUATION OF PSYCHOLOGICAL FACTORS IN THE REJECTION OF UPPER LIMB PROSTHESES STEPHEN FRANCIS BURROUGH 1983 AN EXPLORATORY EVALUATION OF PSYCHOLOGICAL FACTORS IN THE REJECTION OF UPPER LIMB PROSTHESES A thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University. Stephen Francis Burrough 1983 ii ABSTRACT This study investigated the reactions of arm amputees to their prostheses and explored possible reasons for these reactions. A questionnaire was constructed to determine the use to which the recipients put their prostheses. A preliminary validation study was conducted to determine the final form of the questionnaire. Rather than selecting a sample of prosthesis recipients, a census of the recipient population was attempted with 48.57 per cent responding. Respondents were asked questions measuring their use of the prosthesis, the nature of their prosthesis, the rehabilitation services they had used, and various demographic variables including age, sex, occupation and so on. It was found that up to 55.9~ of the respondents could be classified as low-users of their prosthesis. A regression analysis showed that 44 per cent of the variance in the use of the prosthesis was due to the two variables of prosthesis type and prosthesis length. No other variables explained significant a~ounts of the variance. A lower-user and a hiah-user were selected to pilot a further study exaMining psychological factors that may affect ~rosthesis use. The areas examined were those of training, perceptions of independence and stigma, and perceptions of the prosthesis. A number of modifications were made to the original questions as a result of the pilot study. The results of the pilot study indicated that the areas of training and expectations of the prosthesis' capabilities prior to receiving it would be most likely to prove useful in explaining different levels of prosthesis use. iii Some issues relating to possible future research, interventions, and the rehabilitation process were also discussed. iv ACKNOWLEDGEMENTS I would like to acknowledge my Supervisor, Judith Brook, for her guidance, perseverence and constructive e valuation of my work throughout the course of this study. My sincere thanks to the staff of the Rehabilitation Unit at the Palmerston North Hospital and the Artificial Limb Centre in Wellington for the support they have given to this study. Most importantly to the prosthesis rec ipients who gracefully participated in the study. A final word of thanks to the typist for her help in making this a readable thesis. TABLE OF CONTENTS ABSTRACT ii ACKNOWLEDGEMENTS iv Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. INTRODUCTION LITERATURE REVIEW Prior research Training Perceptions of Independence and Stigma Perceptions of the prosthesis THE QUESTIONNAIRE Introduction Questionnaire Development Introduction Method Results Discussion THE INTERVIEW 1 10 11 13 17 23 28 29 32 32 34 37 42 Introduction 47 Research Interviews 47 Interview Content 49 Training 49 Perceptions of Independence and Stigma 51 Perceptions of the prosthesis 53 METHODS Questionnaire Administration Subjects Apparatus Procedure Analysis Interview Administration Subjects Procedure 57 57 58 58 59 61 61 61 Chapter 6. Chapter 7. Chapter 8. Chapter 9. APPENDICES BIBLIOGRAPHY QUESTIONNAIRE RESULTS AND DISCUSSION Results Discussion INTERVIEW: PILOT STUDY Results 63 64 70 73 Case I 74 Case II 77 Discussion 80 Training 80 Perceptions of the prosthesis 82 Perceptions of Independence and Stigma 84 Modified Interview 88 GENERAL DISCUSSION. Summary of Findings Application of Findings Possible Interventions Types of prostheses Education Rehabilitation Processes Future Developments Target population One handedness CONCLUSIONS 89 90 90 91 91 92 93 94 94 95 96 99 137 Table 1. Table 2. Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12 : LIST OF TABLES Professions of expert judges in validation sample. Judges ratings for all questions on three point scale of Important, Useful, Irrelevant. C.V.R. score for all questions. Using 'Important' rating. Ratings by judges of activities and ranking of each activity. Ratings by judges of places prosthesis worn and rank scores for each place. Choice of judges between Questions 1 and 2. Independence and help needed when wearing the prosthesis as against when not wearing it for low and high users. Types of prostheses worn by respondents. Length of prostheses worn by respondents. Type of terminal units used by respondents. Scores achieved on 'Leve l of Use ' var i ab l e . Se l ected statistic s from r egressio n analysis. 34 38 38 39 41 42 52 66 66 67 68 69 LIST OF APPENDICES Page Appendix A: Glossary 99 Appendix B: Questionnaire Validation 103 Appendix C: Questionnaire Information 109 Appendix D: Interview Questions 116 Appendix E: Preliminary Report 122 1 CHAPTER 1. INTRODUCTION 2 In order to introduce the concepts and ideas that this Study will be examining, it would be useful to focus attention for a moment on the situation of a young Siamang ape named Sai Buri. Sai unfortunately had had her arm chewed off by her father. This left her in the predicament of having to live with a severe disability. This was particularly serious in her case because her species' usual mode of transport is by swinging from tree to tree. A unique solution to this problem was attempted when Sai was fitted with a prosthesis, having a hook attachment, to enable her to swing again. Sadly Sai's reaction was so~ewhat less than total acceptance, ranging from vigorous attempts at removing it to at best, ignoring its presence altogether. As with Sai there are many individuals who are faced with a disability through a limb deficiency (due to some congenital problem) or having lost a limb (through trauma or surgery). The common practice in rehabilitation is to fit these people with prostheses called artificial limbs. These prostheses range from simple cosmetic attachments through mechanically powered units to complex myoelectric units, the purpose of which is to in some way cor1pensate for the limb deficiency. Many questions can be asked as to w~at style or tyn.e of prosthesis is most suitable in a given situation. However with the wide range of options and technical ex~ertise available it is more important to start asking the question of how recipients react to their prostheses; questions such as the actual levels of use of the prosthesis, the perce?tions of the individual towards their 9rosthesis, the reactions of other people, and skill levels achieved in the use of the orosthesis. These could be key factors affecting the use of prostheses. The Thesis will be addressing itself to these ~uestions, with S?ecific reference to the New Zealand 3 situation. The emphasis of the study will not be a simple examination of how recipients feel towards the prosthesis. It will take the approach of asking, "Are there recipients who, like Sai the a~e, have upon receiving a prosthesis tended to reject or ignore it?" Attempts will then be made to ascertain what psychological factors have influenced or caused this reaction. This approach could facilitate the development of rehabilitation approaches to remedy the problem. Within the realms of limb deficiences and prostheses this Study will limit itself to the area of upper limb deficiencies. Throughout the study, unless specificially stated otherwise, all references to prostheses or limb deficiences will be within the framework of arm prostheses and deficiencies. Restricting the study in this way is a logical approach as the nature of upper and lower limb prostheses are essentially different. Firstly, the lower limo prosthesis can more completely duplicate the basic function of a leg than an upper limb prosthesis can of an arm. This is due to the complex manipulative and grasping functions of a hand. Secondly, the wearing of a lower limb prosthesis can be more completely disguised. Trousers and shoes can completely hide a lower limb prosthesis. The hand of an upper limb prosthesis, while often looking realistic, does not have the continual movement of a natural hand, making it more obvious. These things mean that it is reasonable to assume that the reactions of the recipients of upper limb prostheses will differ substantially from those of lower limb prostheses. The concern over possible reactions by recipients was first raised during discussions with soecific staff members at the Rehabilitation Unit of the Palmerston North Public Hospital. They perceived that patients fitted with prostheses would wear and utilise them while in the supervised environment of the Centre. However, in the words of one staff member, "They took them off as they went out the door." These perceptions point to the specificity of the problem to upper limb prostheses and indicate that there is a very real problem worthy of investigation. Prior to discussing the details of the issue it 4 would be useful to examine the services available to the limb deficient person. The main organisation in the sout~rnNorth Island of New Zealand would be the Artificial Limb Centre attached to the Wellington Hospital. This unit is the main assembly and construction centre for prostheses in New Zealand with fitting centres in Auckland and Christchurch being served by the Wellington workshop. The usual procedure is for a person requiring a prosthesis to be referred to the Limb Centre by their orthopedic surgeon. Following this a series of visits to the Centre would accommodate the measurement for and fitting of the prosthesis. This procedure would include the training of the recipient in the use of the prosthesis. In some cases, where the necessary services are available, follow up rehabilitation is exercised through a rehabilitation unit attached to a hospital in the person's home district. In determining the possible psychological factors involved in the reaction of recipients to their prostheses it must, of course, be first shown that a problem exists. It is important to clearly determine known levels of use. Unfortunately there is an extremely limited amount of information available regarding this question. One study, while not centrally concerned with this question, took a measure of the number of recipients who were still using the prosthesis after a given period of time. That study found that with certain types of prostheses there was a marked decrease in use over time (this and other studies are covered more fully in the Literature Review.) This dearth of information has meant that the present study faces a dual difficulty. 5 The first is the need to establish the nature and extent of the problem; that is, to measure the reactions of recipients to their prostheses, in particular to examine whether 'rejection' of the prosthesis occurs (operationalisation of 'rejection' will be discussed later in the study). This leads into the second concern that because the question of 'rejection' has not been examined appropriate means of measuring it have not been developed. This means that an initial requirement of the study is to develop a criterion for 'rejection' and to operationalise that criterion in the form of usable quantitative measures. This prerequisite must be fulfilled if the question of the factors contributing to the different reactions to prostheses can be examined. In examining the psychological factors relating to the rejection of prostheses there are a large number of avenues which could be explored. This study will therefore first of all need to establish the areas of interest. An initial consideration suggests that there are three divergent areas that could usefully be examined for their relevance. The first of these areas is training , t he effect of training, o r p erceptio ns of adequacy of training, on use . Second ly t h e r e is the a r ea l oos e l y called 'bo d y i mage '. This re l a tes t o the reci p i e n t s' per cepti ons of themselves, the e ffe ct tha t the pro sthes is has o n tha t s e lf i mag e , and the rec ipie nts' perceptio ns o f ho w o thers see them. The final a r e a is how the rec ipie nt v i ews the prosthesis and its function. The nature of this latter perception, especially among recipients whose limb deficiency is due to trauma, and its relation to the role of a natural arm could have ~ajor effects on levels of use. (The details of these different possible contributing factors will be expounded both in the Literature Review and at further appropriate points in the Study). Knowing the gen e ral aims that ne ed t o be ach ieve d 6 by the study, the next step is to decide upon a specific design that consistantly follows them through. Before fully developing this design there are a number of different factors, beyond those already discussed, that limit the design choice. The first concern is related to the population of prosthesis recipients. The available population are those recipients who have been serviced directly by the Artificial Limb Centre. Two characteristics of this population are likely to affect the chosen design. The first of these is its size. There are approximately ten recipients of prostheses a year. These small numbers, mostly of amputees, and the low need for followup by the Limb Centre will make the contacting of recipients from earlier years difficult. It also places limitations on the sampling schemes that can be adopted. The other characteristic is the geographical distribution of the population. Because the recipients are scattered over six regions there would be a great time and expenditure cost in physically interviewing them all. The design used is a form that will circumvent these limiting factors while still maintaining the ability to provide adequate answers to the questions r aised for study . T~e study is separated into two stage s that will deal successively with the dimensions of the problem that have been discussed. The first stage will examine the question of the reactions of recipients to prostheses for the purpose of exploring the possibility of there being a sector of the population who actively 'reject' the prosthesis to some degree. The first step in this will be the development of the concept of rejection. This will particularly involve the exploration of measures of rejection that can be used in a quantitative way. Because of the limiting factors mentioned earlier, direct behavioural measures and interviewing could not be used as data collection methods. The nethod that seemed the most 7 practical under the circumstances was a postal question-naire. This format will therefore be adopted for the first stage. The content of the questionnaire will, in general terms, be comprised of the following kinds of items; items designed to act as measures of the concept of rejection; items covering the kind of prosthesis that the recipient has been fitted with, and the health services involved in the fitting and rehabilitation processes; items relating to relevant biographical variables. This questionnaire content will enable a number of things to be achieved. The rejection measures will allow all respondents to be rated on that dimension, thus giving an immediate answer to the questions regarding how recipients are reacting to their prostheses. The measures of types of prostheses, services used, and biographical variables can be compared to the measures of rejection. This will help to determine how much of the variance in reactions can be explained directly by these variables. Apart from these primary objectives the questionnaire will enable the collection of data on the make up of the recipient population, especially in terms of different groups of people and the kinds of prostheses they use. This kind of data may be of value to services such as the Artificial Limb Centre in the continuing development of their role in assisting Limb deficient people. The final requirement that the questionnaire will achieve is that it will enable the selection of subjects for the second stage of the Study. The rating of each respondent on the 'rejection' dimension will mean that high scorers on that dimension (high-users) and low scorers on that dimension (low-users) can be selected so that their responses in stage two can be compared with each other. The second stage in this Study will de al with the 8 possible psychological factors that may be contributing to the types of reactions that will have been identified in the first stage. Due to the type of material being explored in this stage the use of a postal questionnaire was rejected. The personal type of responses required may have biased subjects against c ompleting such a questionnaire. Moreover the areas of interest would not lend themselve s easily to presentation in such a format. This means that the most appropriate methodology is the interview. Research interviewing allows the respondent the freedom to give full and complex responses that are very useful in the evaluation of psychological factors. Also the fact that only a small proportion of recipients would be involved means that the time and finance involved would not prove prohibitive as was the case with the first stage of the study. The content of the interviews will of course be related to such things a s training in the use of the ~r o sthesis, the perce ptions o f the r ecipients of the p urpose and n a ture o f the pro sthe sis, the r ecipie nts pe r ceptio ns o f how the pro sthesis a f f ects the ir self-image an d h ow it a ffec t s t h e wa y that o the r people a c t towards t h em. Th e q uest i ons re l a t i ng to each of t hese areas will be structured to allow t he i ndi vidual t he maxi mum possible freedom of re s ponse whi le still e n s uring t h a t useable dat a is o b taine d. By inte r v i ewing both r e j e ctors and non-re j e ctors, o f prostheses, the differences in response patterns between the two groups can be used to indicate which of the psychological factors are relevant, in explaining reactions of recipients to their prostheses. Due to the time commitment required in both stages of the proposed research, this report will present only a pilot study used to refine the measures for use in the second stage. 9 The major academic relevance of these results will be in the provision of indications of the most fruitful direction for future comprehensive research into recipients' reactions to prostheses. There may also be some basis to suggest a generalisation to other specific rehabilitation aids. An immediate practical result will be that the findings may be of use to workers in the helping professions when they are dealing with individuals who seem to be rejecting their prostheses. In summary it is hoped that this study will be able to demonstrate clearly the nature of the situation that is present among the recipient population; to supply future research with the tools to evaluate other populations of recipients, and to provide some clues as to psychological factors that could be usefully explored in attempts to fully understand the causes of reactions to prostheses. It is also aimed at giving helping professionals some tentative basis for the development of services to assist the rehabilitation of prosthesis recipients. Furthermore this study should demonstrate that the examination of reactions to rehabilitation aids is a fruitful avenue for applied research, not only to answer academic questions but also to contribute towards the continuing development and growth of rehabilitation medicine and services. 

An exploratory evaluation of psychological factors in the rejection of upper limb prostheses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University

https://mro.massey.ac.nz/bitstream/10179/12731/1/01_front.pdf

An exploratory evaluation of psychological factors in the rejection of upper limb prostheses : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology at Massey University

Abstract

Similar works

Full text

Available Versions

Massey Research Online