Exploring the impact of psychological intervention on self-esteem and body image in post-traumatic limb amputation patients: A mixed methods study

Abstract

Despite the dearth of prevalence statistics regarding traumatic limb loss in South Africa, traumatic limb loss through amputation has been predominantly associated with motor vehicle accidents. Traumatic limb amputation has been described as both a physically and psychologically traumatic event. It is associated with the development of trauma-related psychopathology, for example, posttraumatic stress disorder (PTSD), and changes in body image and self-esteem, which have been well documented. However, the treatment of posttraumatic limb amputation is predominantly associated with medical intervention, neglecting psychological intervention. This study thus aimed to 1) compare the level of body image and self-esteem in post-trauma amputee patients who have received psychological intervention, as compared to those who have not; and 2) to explore the perceptions of body image and self-esteem amongst post-trauma amputee patients. A quant-qual sequential explanatory mixed method design, underpinned by a pragmatic paradigm, was employed. Participants were recruited via non-probability sampling through Patient Advocacy Groups and the Prosthetics Medical Community. They included South African post-amputee patients as well as Healthcare professionals (HCPs) who treat post-amputee patients. The quantitative part of the study, which addressed the first research aim, included collecting data from the patient cohort through two online questionnaires: 1) The Multidimensional Body-Self Relations Questionnaire (MBSRQ) (Cash, 1990) and 2) The Rosenberg Self-esteem (RSE) scale (Rosenberg, 1965). A t-test was used to analyse the data. No statistically significant difference in self-esteem scores was found between participants who received psychological counselling and those who did not (p = .104), although the counselling group had higher mean scores. Similarly, trauma-related amputees who accessed psychological support reported higher body-image scores than those without support, but the difference was also nonsignificant (p = .481). The qualitative part of the study, which addressed the second research aim, comprised semi-structured individual interviews with 4 posttraumatic amputee patients who had undergone psychotherapy, 3 posttraumatic amputee patients who had not undergone psychotherapy, and 5 HCPs. Qualitative insights demonstrated a shared view among patients and HCPs that psychological intervention constitutes a critical aspect of recovery and should be embedded as a standard component of post-trauma amputee rehabilitation programmes. All ethical considerations were adhered to. This study contributes to the enhancement and improvement of treatment programmes for traumatic post-amputee patients.