Despite substantial improvements made over the last two decades in orthopedic trauma care, severe leg injuries often result in poor functional outcomes for otherwise young, healthy individuals. Center faculty research, the Lower Extremity Assessment Project (LEAP), found that for many individuals undergoing reconstruction or amputation following limb-threatening leg injuries, disability remains high at two years post-injury and rates of return to work were low. The LEAP study further demonstrated that outcomes were more affected by the patient's economic, social and personal resources than by the initial treatment of the injury, specifically amputation versus reconstruction and level of amputation. In particular, it was found that patients, who at baseline reported low self-efficacy, weak social support and high levels of depression, anxiety and pain, were significantly more likely to have poor long-term outcomes. These results strongly suggest that major improvements in functional outcome require interventions in the early post-acute phase of recovery to directly address the patients’ psychosocial needs and to assist survivors in self-managing the multi-factorial consequences of injury.
Self-management (SM) interventions based on cognitive behavioral theory are particularly effective in increasing self-efficacy, reducing secondary conditions such as pain, anxiety and depression, and improving overall function and quality of life. These programs have gained widespread application with chronic conditions in which pain and disability are common. They have not, however, been broadly applied to younger, acutely injured individuals. With funding from the CDC and U.S. Department of Defense, Center faculty are developing and evaluating the efficacy of a computer-based self- management program, NextSteps, for reducing secondary conditions and improving function following major lower limb trauma. The intervention will build on widely accepted self-management programs developed for persons with arthritis, as well as components of a face-to-face self-management program recently developed by the research team for civilians with longstanding limb loss. The content and delivery of these programs will be tailored to accommodate the needs of a young, acutely injured population. Interventions for those injured in military service will require additional modification and specialization. Specific needs not typically addressed in the existing programs include the management of acute anxiety and post-traumatic stress disorder (PTSD), as well as finding and maintaining employment, and returning to active duty. For more information, contact Ellen MacKenzie at emackenz@jhsph.edu .
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