Self-Management to Improve Function After Amputation: A Randomized Controlled Trial of the VETPALS Intervention.
Aaron P Turner, Stephen T Wegener, Rhonda M Williams and 5 others
PMID 33811854WHAT IT FOUND
The VETPALS self-management program did not improve physical function, which was the primary outcome.
However, it did reduce depression and improve satisfaction with health at six months compared to standard education. Participants rated the program highly.
Key findings
01VETPALS did not improve physical functioning relative to the education control at either 6 weeks or 6 months.
02VETPALS participants showed greater improvement in psychosocial functioning (reduced depression) at the 6-month follow-up compared to controls.
03VETPALS participants reported greater satisfaction with health at the 6-month follow-up compared to controls.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
There was significant differential attrition, particularly in the VETPALS arm, where many randomized individuals never started the intervention, potentially introducing bias. The study population was limited to veterans with amputation due to chronic limb-threatening ischemia, which may not generalize to individuals with amputation from other causes, such as trauma. Participants and facilitators were aware of their treatment assignment, which could introduce performance bias, although assessors were blinded. The sample size was insufficient to detect smaller treatment effects or to analyze subgroups, such as comparing telehealth versus in-person delivery. The intervention was added to usual care, making it difficult to separate the specific contribution of VETPALS from other concurrent treatments.
Declared interests
Funding was provided by the Department of Veterans Affairs (Non-P.H.S. support). No specific commercial conflicts of interest were declared in the provided text, though the study was conducted within the VA system.
The easy way to misread this
Do not interpret the lack of physical function improvement as evidence that self-management is ineffective. The study showed significant benefits for depression and satisfaction with health at six months, indicating the intervention works for psychosocial outcomes even if it does not change physical function scores.