The purpose of this qualitative study was to explore the impact of an amputation and of phantom pain on the subjective well-being of amputees. Sixteen lower-limb amputees were interviewed. A semi-structured interview and two Visual Analogue Scales were used. To interpret the results, a new socio-medical model joining two models, 'The Disablement Process model' and the 'Social Production Function theory', was used. Questions were asked concerning the factors influencing patients' subjective well-being prior to, at the time of and after an amputation. These factors were patients' medical history, their phantom sensations and phantom pain, their daily activities, the social support they received, and the influence of an amputation and phantom pain on long-term behaviour and on their subjective well-being. All factors were found to have an influence on the individual's subjective well-being. All these factors, however, seemed to reinforce each other. Therefore, the greatest influence of factors on subjective well-being occurred when more than one factor was involved. Substituting certain activities by others then becomes less and less effective in inducing a sense of subjective well-being.
Introduction: In clinical practice AP pelvis standard protocols are suitable for average size patients. However, as the average body size has increased over the past decades, radiographers have had to improve their practice in order to ensure that adequate image quality with minimal radiation dose to the patient is achieved. Gonad shielding has been found to be an effective way to reduce the radiation dose to the ovaries. However, the effect of increased body size, or fat thickness, in combination with gonad shielding is unclear. The goal of the study was to investigate the impact of gonad shielding in a phantom of adult female stature with increasing fat thicknesses on SNR (as a measure for image quality) and dose for AP pelvis examination. Methods: An adult Alderson female pelvis phantom was imaged with a variety of fat thickness categories as a representation of increasing BMI. 72 images were acquired using both AEC and manual exposure with and without gonad shielding. The radiation dose to the ovaries was measured using a MOSFET system. The relationship between fat thickness, SNR and dose when the AP pelvis was performed with and without shielding was investigated using the Wilcoxon signed rank test. P-values < 0.05 were considered to be statistically significant. Results: Ovary dose and SNR remained constant despite the use of gonad shielding while introducing fat layers. Conclusion: The ovary dose did not increase with an increase of fat thickness and the image quality was not altered. Implications for practice: Based on this phantom study it can be suggested that obese patients can expect the same image quality as average patients while respecting ALARA principle when using adequate protocols.
PURPOSE: Walking ability in general and specifically for lower limb amputees is of major importance for social mobility and ADL independence. Walking determines prosthesis prescription. The aim of this study was to mathematically analyse factors influencing claimed walking distance of lower limb amputees of 500 m or more.METHOD: A total of 437 patients returned two questionnaires: the Groningen Questionnaire Problems after Leg Amputation, in which walking distance was assessed, and the RAND 36.RESULTS: The chance of walking 500 m or more reduced when a transfemoral amputation was performed. The chance reduced even more when phantom pain or stump pains were present. If the amputation was performed because of vascular disease or because of vascular problems because of diabetes the chance reduced again. Independently of these factors, age reduced the chance of walking 500 m or more.CONCLUSION: The chance of walking 500 m or more reduces with increase in age and a more proximal amputation. The chance reduces even further when the amputation is performed because of diabetes or vascular disease and also if phantom pain and or stump pain is present.
