May 19, 2015

Of the 2 million people in the U.S. who have had an amputation, approximately 25 to 30 percent will develop clinical depression at some point in their lifetime. Well aware of this phenomenon, Stephen Wegener has been helping patients manage the emotional and physical adaptation following amputation. In 2006, he collaborated with a team of colleagues from the Johns Hopkins Bloomberg School of Public to develop PALS — Promoting Amputee Life Skills — a 10-week group course that empowers those with the limb loss through the learning of coping skills, problem solving and goal setting.

Wegener, who directs the Johns Hopkins Division of Rehabilitation Psychology and Neuropsychology, says that while most people cope well with limb loss, “our research has shown that many individuals with limb loss do experience depression and do not get the help they need to manage their emotional distress.”

To address this deficit in care, Wegener and colleagues at the Amputee Coalition — the nation’s largest consumer organization for people with limb loss — have identified what they believe may be a novel and untapped professional community to help depressed patients with limb loss recognize their symptoms and access resources.

“It’s the prosthetist who often has an ongoing relationship with patients over the course of their lives and sees them on a regular basis,” says Wegener. “So if we provide prosthestists with the tools and training to screen patients for depression and make referrals to local resources, more patients can get the help they need.”

Working with the Amputee Coalition and prosthetic practices, including prosthetist Mark Hopkins at the Johns Hopkins Orthotics and Prosthetics Clinics, the research team obtained support from prosthetic services leaders Hanger Orthopedic Group Inc. and Ossur, as well as from individual philanthropy to develop and evaluate an approach called the Improving Well-Being Program.          

An initial pilot project at three prosthetic offices demonstrated the feasibility of prosthetists taking a role in providing depression and well-being screening, says Wegener. Then, the prosthetists were able to offer recommendations for boosting well-being, as well as a customizable resource brochure to lead these patients to local mental health experts. The pilot study indicated that both patients and prosthetists were highly satisfied with the program and saw it as an appropriate component of the patient-provider relationship.

With additional support from the initial funders, a larger demonstration project is underway at six prosthetic practices throughout the country to determine if the Well-Being Program results in improved utilization of resources and higher satisfaction with prosthetic staff. 

Considering that some 185,000 people undergo amputation every year, says Wegener, teaching prosthetists how to help patients recognize and find help for depression can go a long way in improving these individuals’ daily lives.

Learn more about the study: bit.ly/amputeecoalitionstudy; to see a case presentation, visit hopkinsmedicine.org/restore/limb-loss.