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VOLUME 8, ISSUE 1 

 2025 
 

RESEARCH ARTICLE 

 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping 

and mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, 

No. 4. Https://doi.org/10.33137/cpoj.v8i1.45122 

 

  

 

https://jps.library.utoronto.ca/index.php/cpoj/index
mailto:cpoj@online-publication.com
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https://pmc.ncbi.nlm.nih.gov/journals/?term=%22Canadian+Prosthetics+%26+Orthotics+Journal%22
https://members.publicationethics.org/members/canadian-prosthetics-orthotics-journal
https://doi.org/10.33137/cpoj.v8i1.45122
https://pmc.ncbi.nlm.nih.gov/journals/?term=%22Canadian+Prosthetics+%26+Orthotics+Journal%22


 

1 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

 

 

RESEARCH ARTICLE 

 

USING A NOVEL PSYCHOSOCIAL GROUP INTERVENTION TO IMPROVE ADAPTION, 

COPING AND MENTAL HEALTH OUTCOMES FOLLOWING DYSVASCULAR LIMB 

AMPUTATIONS: A FEASIBILITY STUDY 

Steinberg R.J1,2 *, Robinson L.R1,3,4,5, Kachmarchuk O1, Jankey S6, Posa S1, Mayo A.L1,3,4, Simon M7, Kiss A8, MacKay C5,6,9,10, 

Simpson R1,4,5.11,12, Wasilewski M.B1,5,13, Dilkas S4,6, Hitzig S.L1,5,13,14 

  1. St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 
  2. Consultation/Liaison Psychiatry, Adult Psychiatry and Health Systems, Sunnybrook Health Sciences Centre, Toronto, Canada. 
  3. Division of Physical Medicine & Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. 
  4. Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 
  5. Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 
  6. West Park Healthcare Centre, University Health Network, Toronto, Canada. 

  7. St. John’s Rehab Hospital, Sunnybrook Health Sciences Centre, Toronto, Canada. 
  8. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. 
  9. Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 
10. School of Rehabilitation Therapy, Queen’s University, Kingston, Canada. 
11. Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom. 
12. Toronto Rehabilitation Institute, University Health Network, Toronto, Canada. 
13. Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. 
14. Dalla Lana School of Public Health, Clinical Public Health Division, University of Toronto, Toronto, Canada. 
  
 

 

 

 

  

 

 

 

 

 

 

 

 

  

INTRODUCTION   

Lower extremity amputations (LEA) are a debilitating event 

that can negatively affect an individual’s physical and 

mental health.1-3 Although there are many factors that lead 

to LEA, approximately 80% are dysvascular in etiology and 

attributed to complications of diabetes and/or peripheral 

arterial disease.4-6 Compared to other limb loss populations 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: Individuals with lower extremity amputations (LEA) often face high rates of depression and 

anxiety that hinder their rehabilitation and post-discharge coping. Group therapy is a clinically and cost-

effective way to address these mental health challenges, but evidence for its use with LEA inpatients is limited. 

OBJECTIVE: To determine the feasibility of a psychosocial group therapy intervention for individuals with 

dysvascular LEA undergoing inpatient rehabilitation. 

METHODOLOGY: This randomized controlled trial randomly assigned dysvascular LEA rehabilitation 

inpatients into a supportive-expressive group therapy (SEGT) or a treatment as usual (TAU) group. The SEGT 
intervention, a form of group therapy adapted from outpatient medical settings, consisted of six one-hour 

sessions held twice weekly over a three-week period. Participants completed baseline, exit and three-month 

surveys assessing the study’s secondary outcomes of SEGT effectiveness on depression, anxiety, coping, 

body image, health, and community participation. The main outcomes assessed recruitment, survey 

completion, treatment adherence, and participant retention rates. Interviews and a focus group were 

completed to obtain feedback on the intervention. 

FINDINGS: Twenty-five participants were recruited, with 12 randomly assigned to the SEGT group, and 13 to 

the TAU group. The average number of sessions attended by SEGT participants was 3.9 (SD = 2.1). The 

survey completion rates for all participants were 84% (21/25) for the baseline assessment, 64% (18/25) for 

discharge, and 44% (11/25) for the three-month follow-up. The SEGT group showed a significant improvement 

in anxiety and depression scores (p = 0.02). SEGT was well-received by participants and staff. 

CONCLUSION: The findings suggest a larger pragmatic SEGT trial is feasible, despite a small sample size 

and implementation challenges during the COVID-19 pandemic, given this study achieved moderate rates of 

recruitment, retention, and survey completion. Several critical insights were gained on how to optimize an 

inpatient group therapy intervention for dysvascular LEA populations in rehabilitative settings. 

ARTICLE INFO 

Received: April 2, 2025 

Accepted: May 11, 2025 

Published: May 24, 2025 
 

CITATION 

Steinberg R.J, Robinson L.R, 

Kachmarchuk O, Jankey S, 

Posa S, Mayo A.L, et al. Using a 

novel psychosocial group 

intervention to improve adaption, 

coping and mental health 

outcomes following dysvascular 

limb amputations: A feasibility 

study. Canadian Prosthetics & 

Orthotics Journal. 2025; Volume 

8, Issue 1, No. 4. 

Https://doi.org/10.33137/cpoj.v8i

1.45122  

KEYWORDS 

Psychotherapy; Amputation; 

Group; Amputees; Feasibility 

Studies; Mental Health; 

Rehabilitation; Dysvascular; 

Prosthetics.  

 

 
 

* CORRESPONDING AUTHOR: 

Dr. Rosalie J. Steinberg, MSc, MD, FRCPC 

Affiliation: St. John's Rehab Research Program, Sunnybrook Research 
Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 

E-Mail: rosalie.steinberg@sunnybrook.ca 

ORCID ID: Https://orcid.org/0000-0002-5042-1378 

Telephone: 1-416-480-4089 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 8, Issue 1, Article No. 4. 2025 

 

 

https://doi.org/10.33137/cpoj.v8i1.45122
https://doi.org/10.33137/cpoj.v8i1.45122
https://doi.org/10.33137/cpoj.v8i1.45122
mailto:rosalie.steinberg@sunnybrook.ca
https://orcid.org/0000-0002-5042-1378
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

(e.g., traumatic etiology), people with dysvascular LEA have 

been shown to have poorer quality of life,1 and higher rates 

of post-morbid complications including depression, anxiety 

and impaired body image.1,7,8 A comorbid diagnosis of 

depression is associated with lower prosthetic use, higher 

perceived vulnerability, and lower self-rated health.9  

Individuals with LEA undergoing inpatient rehabilitation may 

receive psychiatric consultations, but individual 

assessments can be time-consuming and costly.10,11 Group 

therapy is a less-resource intensive mental health 

intervention, whereby one or more healthcare providers can 

treat a group of patients simultaneously.12 There is some 

preliminary evidence that group therapy may be beneficial 

for inpatients.13-15 For instance, one randomized clinical trial 

reported that LEA inpatients experienced improvements in 

anxiety, depression and body image after participating in 

group therapy.15 Similarly, a three session group therapy 

intervention for limb loss inpatients of mixed etiologies 

(trauma, dysvascular), including upper limb amputation,  

found that group therapy participants showed significantly 

lower distress levels than participants in the comparison 

group.13  In one study, however, the etiology of the sample 

was not described,15 and the other used a comparison 

group of discharged patients who were residing in the 

community.13 As such, the variable features of these studies 

makes generalizability to inpatients with dysvascular LEA 

somewhat challenging.  

To assess the applicability of a group therapy model of care 

for dysvascular LEA inpatients, the primary aim of this study 

was to evaluate the feasibility of implementing a novel 

supportive-expressive group therapy (SEGT) program for 

inpatients with dysvascular LEA.  SEGT is one type of group 

therapy that has been previously used in patients with 

medical illness16-18 which provides emotional, social and 

cognitive support. The secondary aim was to assess 

whether these SEGT sessions had any effect on mental 

health outcomes, with the expectation that SEGT 

participants would demonstrate measurable symptomatic 

improvements compared with those participants assigned 

to a treatment as usual (TAU) condition.  

METHODOLOGY 

This two-armed feasibility trial was conducted between 

October 2021 and February 2023. A feasibility trial design 

was selected since there are only two studies13,15 regarding 

the use of group therapy for dysvascular LEA populations in 

an inpatient rehabilitation setting. The Research Ethics 

Board at the Sunnybrook Health Sciences Centre approved 

the study, and it was registered at ClinicalTrials.gov (ID# 

NCT05082870). 

Participants were randomly assigned to either a supportive-

expressive group therapy (SEGT) group or to a treatment 

as usual (TAU) group. It was hypothesized that an inpatient 

SEGT intervention would be feasible, and that a larger 

pragmatic trial could be developed as a result. The goal was 

to recruit 50 inpatients, with 25 randomized to the TAU 

group and 25 randomized to the SEGT group. To minimize 

contamination between cohorts, cluster randomization was 

used to have TAU and SEGT cohorts occur in different 

months; thereby minimizing the likelihood that SEGT 

participants would overlap with TAU participants. This was 

done in order to reduce the possibility that participants from 

different cohorts could discuss the study conditions with 

each other. A blinding protocol was followed to create the 

randomization using an online randomizer 

(https://www.randomizer.org/) consisting of six blocks (three 

for SEGT; three for TAU). 

Participants 

Participants were recruited from the Cardiac and Amputee 

unit at St. John's Rehab, Sunnybrook Health Sciences 

Centre (Ontario, Canada). The inclusion criteria were:  

• Adult inpatient aged 18 years or older; 

• Have a dysvascular LEA;  

• No clinical suspicion of cognitive impairments or a 

severe mental health diagnosis (e.g., schizophrenia, 

dementia, active psychosis); 

• English-speaking.  

Patients were excluded if actively suicidal or were unable to 

participate in a group setting (e.g., actively using 

substances, exhibiting threatening behavior).  

Study Arms 

There were two study arms: 1) TAU and 2) SEGT. 

1) The TAU group received standard care while admitted to 

hospital, which included care from an interdisciplinary team 

of rehabilitation professionals. The average length of stay 

for patients is four weeks, during which they are cared for 

by a team of nurses and hospitalists and are fitted and 

trained to use their prosthetics/orthotics under the 

supervision of prosthetists, occupational therapists, 

physiotherapists and a physical medicine and rehabilitation 

physician (physiatrist). Additional services from Social Work 

and Nutrition Services are also provided where required. 

Any TAU participants who required psychiatric care were 

also provided with mental health support from a psychiatrist 

who was not part of the study team. 

2) SEGT was previously designed for patients with 

potentially life-threatening illnesses, including HIV and 

cancer patients, and has demonstrated efficacy in 

facilitating adjustment and coping while decreasing 

psychological distress in these populations.16-18 This SEGT 

program, usually delivered longitudinally in an outpatient 

setting, was adapted for LEA inpatients to enable and 

encourage participants to openly express and manage 

illness/disability-related emotions, increase social support, 

https://doi.org/10.33137/cpoj.v8i1.45122
https://www.randomizer.org/


 

3 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

enhance relationships, improve symptoms and enhance 

body image. The treatment aims to facilitate mutual support 

and discussion of issues that are uppermost in patients' 

minds rather than imposing pre-determined topics for 

discussion.  

For this study, the SEGT group participated in six one-hour 

sessions, held twice weekly over a three-week period. The 

course of treatment and number of sessions were designed 

to align with the average length of stay for LEA inpatients. 

The sessions were co-delivered by a psychiatrist and 

occupational therapist, and were framed within social 

cognitive theory19 whereby resilience to adversity (limb loss 

in this instance) relies on personal enablement.20 Please 

see Appendix A for a high-level summary of the salient 

topics raised by participants during the SEGT sessions. 

These topics closely align with the main foci or goals of the 

SEGT model previously defined in the literature.21  

After the intervention, patients were provided with a patient-

focused resource booklet created by the study team, which 

included resources on topics such as phantom pain, 

community support groups and coping.  

Primary Outcomes 

The primary outcomes were on metrics related to the 

feasibility of implementing an inpatient SEGT trial for 

dysvascular LEA, which included:  

(1) Participant recruitment, retention, and follow-up rates; 

(2) Treatment adherence; 

(3) Survey completion rates (target set at 70%); 

(4) Completion rates of one-month post-intervention inter-

view (target set at 50%). 

 

Secondary Outcomes 

With regard to the secondary goal of determining the 

effectiveness of SEGT, the following surveys were 

administered to all participants in the study. 

• Coping Self-Efficacy Scale (CSES) measures perceived 

self-efficacy for coping with challenges and threats.22  

• Hospital Anxiety and Depression Scale (HADS) is a  

14-item depression and anxiety screening tool that asks 

participants to rank the severity of their depression and 

anxiety symptoms.23 

• Short Form-36 Survey (SF-36) is the most widely used 

health-related quality of life tool.24 The tool measures eight 

domains related to social, physical and mental health. 

• Amputee Body Image Scale-Revised (ABIS-R) is a 

measure of body image perception in people living with 

limb loss.25 

• Reintegration to Normal Living Index (RNLI) assesses 

involvement in recreational and social activities perceived 

ability to move within the community, and the degree of 

comfort people have with their relationships.26 

Qualitative interviews with the SEGT participants and a 

focus group with healthcare providers working on the 

Amputee unit were undertaken to better understand which 

factors may have influenced study feasibility, and the 

potential impact of SEGT on wellbeing and quality of life 

post-LEA. Specifically, SEGT participants were asked to 

describe what they liked or disliked about the intervention, 

what benefits (if any) were obtained by taking part, and any 

recommendations for improvement. Providers were asked 

about their views of the potential impact of SEGT for patient 

care and its feasibility within inpatient settings. 

Procedure 

Within three days of admission, all eligible LEA inpatients 

were approached by a member of their care team to 

determine if they were interested in participating. Patients 

who expressed interest in the study were then referred to 

the research team and a research coordinator obtained 

informed consent.  

Data were collected on patients’ socio-demographics and 

impairment and all participants were approached to 

complete a battery of surveys (CSES, HADS, SF-36, and 

ABIS-R), within the first week of admission, at 24-72 hours 

post-discharge or SEGT completion, and at three months 

post-discharge. At three months post-discharge, 

participants also completed the RNLI. All participants were 

provided with a $25 gift card for participation.  

Near the end of the study, the time window to collect 

discharge surveys was expanded to enhance the ability to 

capture additional data, as well as to inform our goal of 

informing the development of a future pragmatic trial. This 

protocol change was initiated due to challenges with 

contacting participants within 72 hours and other logistical 

issues (e.g., staff turnover). This change led to some of the 

discharge assessments (n = 7) being completed one month 

post-discharge, instead of the 72 hours outlined in the 

protocol.  

One month after discharge, SEGT participants were also 

invited to complete the semi-structured interview. Interviews 

were conducted over the phone or over Zoom and took 

approximately 30 minutes (See Appendix B for the 

Interview Guide). Additionally, staff were invited to 

participate in an in-person focus group about their 

perspectives on SEGT, which took approximately 45 

minutes. Both the interviews and focus group were recorded 

and transcribed for analysis. 

Sample Size and Analysis  

Since this was a feasibility trial, a large sample size was not 

needed to adequately power statistical null hypothesis 

testing. A sample of 25 per group was deemed sufficient for 

the present trial as sample size of 12 per group is generally 

accepted as being sufficient for a pilot study.27 

https://doi.org/10.33137/cpoj.v8i1.45122


 

4 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

Descriptive statistics were used to evaluate the primary 

outcome measures. For the secondary outcome measures, 

a statistician who was blinded to group allocation conducted 

the analyses using t-tests. Participants with more than 20% 

missing data on a survey were excluded from analysis. For 

the qualitative interview and focus group data, the 

investigation team did not see the interview data until the 

trial ended to minimize bias. A narrative research 

approach28-30 was used to summarize the key insights by 

patients with LEA and clinical staff regarding the SEGT 

intervention. A study team member used an open coding 

framework to identify core issues related to perceived 

benefits and implementation considerations.  

RESULTS 

The study was initiated in October 2021 and ended in 

February 2023; with 35 patients with dysvascular LEA 

identified as potential participants. Ten patients declined to 

participate because they were not interested (n = 8), not 

comfortable in participating (n = 1) or had a clinical 

suspicion of a cognitive impairment (n = 1). In total, 25 

patients (mean age: 64.6 years; range: 42–79 years) 

agreed to participate, with 13 being randomized to TAU and 

12 to SEGT. Eighteen of the participants were male and 

seven were female, with the majority of participants (n = 18; 

72%) identifying as White (North American or European). 

The leading cause for the LEA was diabetes (n = 13; 52%), 

and most participants underwent a unilateral below the knee 

amputation (n = 16; 64%). Table 1 presents the sample 

characteristics by study group. 

Of the 25 participants who consented, 21 participants 

completed the entire set of surveys for the baseline 

assessments and four participants (two in TAU; two in 

SEGT) only completed a portion of the baseline 

assessments. Following baseline surveys, one participant in 

the SEGT group was withdrawn due to COVID-19 

precautions. For the discharge assessments, 18 

participants were successfully contacted; 16 (eight in 

SEGT; eight in TAU) fully completed their discharge 

assessments and two TAU group participants partially 

completed the discharge assessments. For the three-month 

follow-up, 11 participants were successfully contacted, and 

completed the full set of assessments. Overall, 11 

participants (five in TAU and six in SEGT) completed the full 

course of the surveys (see CONSORT diagram for more 

details). The survey completion rates were 84% for the 

baseline assessment, 64% for the discharge assessment, 

and 44% for the three-month follow-up assessment. The 

CONSORT flow diagram is described in Figure 1. 

For the SEGT intervention, the mean number of sessions 

attended was 3.9 sessions (SD = 2.1). Four participants 

attended all six sessions, two attended five sessions, two 

attended three sessions, three attended two sessions, and 

one was withdrawn due to COVID-19 before attending any 

sessions. The main reasons for missed sessions included 

COVID-19 related absences (including illness and 

lockdowns), patients being transferred to different hospitals 

for medical reasons, and family visits. In total, only one 

SEGT participant completed the full course of the study, 

including all the SEGT sessions, surveys and the interview.   

Table 1: Socio-demographic and impairment characteristics.  

Demographics 
SEGT 
 (n = 12) 

TAU  
(n = 13) 

Age, mean (SD) 65.1 (10.5) 64.1 (9.7) 

Gender,  
n (%) 

Female 3 (25.0) 4 (30.8) 

Male 9 (75.0) 9 (69.2) 

Cause of 
Amputation,  
n (%) 

Diabetes  8 (66.7) 5 (38.5) 

Peripheral 
Vascular Disease 

3 (25.0) 3 (23.1) 

Ischemia/Embolism 1 (8.3) 4 (30.8) 

Other 0 1 (7.7) 

Level of 
Amputation, 
n (%) 

Below Knee (BKA) 8 (66.7) 8 (61.5) 

Above Knee (AKA) 4 (33.3) 2 (15.4) 

Bilateral AKA 0 2 (15.4) 

Bilateral BKA 0 1 (7.7) 

Racial Group,  
n (%) 

White (North 
American or 
European) 

8 (66.7) 10 (76.9) 

South Asian 2 (16.7) 1 (7.7) 

Black-Caribbean 1 (8.3) 1 (7.7) 

Mixed Heritage 0 1 (7.7) 

Hispanic 1 (8.3) 0 

Living Situation, 
n (%) 

Living Alone 4 (33.3) 5 (38.5) 

Living with Others 8 (66.7) 8 (61.5) 

Education, 
n (%) 

High school or less 4 (33.3) 6 (46.2) 

Greater than High 
School 

8 (66.7) 7 (53.8) 

Employment, n 
(%) 

Working 1 (8.3) 2 (15.4) 

Not working 11 (91.7) 11 (84.6) 

Marital Status, n 
(%) 

Married 6 (50.0) 6 (46.2) 

Not Married 6 (50.0) 7 (53.8) 
 

Due to the low survey completion rates at the three-month 

follow-up, t-tests were conducted to examine only baseline 

and exit data. The analysis of the secondary outcomes 

found no statistical significance between groups except on 

the HADS, whereby the SEGT group showed a significant 

improvement (p = 0.02; see Table 2). It should be noted that 

the ABIS-R had a high number of missing values as a result 

of most participants leaving more than half the items blank, 

which did not allow for an analysis of this outcome measure. 
As well, there were no significant differences in RNLI scores 

between the groups (SEGT M = 16.7; TAU M = 17.2), which 

was only collected at the three-month follow-up. 

For the qualitative component of the trial, which was only 

offered to the SEGT group, six participants completed their 

one-month post-discharge semi-structured interview. All of 

the interviewed participants indicated they enjoyed 

participating in the group because it allowed them to 

socialize and form social connections with peers. For 

instance, one participant (ID#5022 [Male, age 63]) noted: “I 

think the sessions created an opportunity to open up and 

embrace other people, and learn about other people, and 

understanding that basically we’re all here on a journey and 

we’re going through things that we can all relate to.”  

https://doi.org/10.33137/cpoj.v8i1.45122


 

5 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

Many of the patients reported they experienced benefits 

from the sessions, such as getting out of their rooms, and 

hearing about the experiences of their peers. Regardless of 

the reason, participants reflected on how the group enabled 

them to increase comfort with disclosing their emotions. 

“I think I might cry, but you guys taught me. If you’d ask me 

a year ago, would I share what I’m feeling, I would’ve said 

no. I’d keep it in, I wouldn’t tell anybody, and I would work it 

out in my own head…And I think, thinking back, all those 

guys in that room, it made me realize I can be vulnerable 

and I can open up” ID#5008 (Male, aged 57). 

Additionally, the topics discussed during the sessions were 

viewed by most participants as offering information that was 

useful and relevant to their lives. Even in cases when people 

did not feel the information was applicable to them 

personally, the group stimulated opportunities for personal 

reflection and mutual support. 

Table 2: Mean change scores on secondary outcomes and  

p-values for CSES, HADS, SF-36, and ABIS-R. 

Outcome Group N 
Baseline / Exit 

Change Score (SD) 
P-

value 

CSES 
SEGT 10 -7.46 

0.37 
TAU 8 8.94 

HADS 
(depression) 

SEGT 9 -0.11 
0.74 

TAU 8 0.38 

HADS  
(anxiety) 

SEGT 9 -4.39 
0.02* 

TAU 8 -0.75 

SF-36 PCS 
SEGT 23 30.05 

0.97 
TAU 24 30.13 

SF-36 MCS 
SEGT 23 56.12 

0.16 
TAU 24 59.95 

ABIS-R 
SEGT N/A N/A 

N/A 
TAU N/A N/A 

 

CSES: Coping Self-Efficacy Scale; HADS: Hospital Anxiety and Depression 

Scale; SF-36 PCS: Short-Form 36 Physical Component Summary; SF-36 

MCS: Short-Form 36 Mental Component Summary; ABIS-R: Amputee Body 

Image Scale-Revised; SEGT: Supportive-Expressive Group Therapy; TAU: 

Treatment as Usual; N/A: Not available; * Significant difference.  

Assessed for eligibility (n = 35) 

Randomized (n = 25) 

TAU group  

(n = 13) 

SEGT group  

(n = 12) 

Baseline survey 

(n = 13) 
Baseline survey 

(n = 12) 

Discharge 

survey (n = 8) 

Discharge 

survey (n = 10) 

Three-month 

follow-up (n = 5) 

Three-month 

follow-up survey  

(n = 6) 

One-month post 

discharge 

interview (n = 6) 

Excluded (n = 10) 

• Declined (n = 8) 

• Ineligible (n = 2) 
 

Lost to follow-

up (n = 5) 

Lost to follow-

up (n = 3) 

Withdrawn from study due 

to COVID-19 (n = 1) 

Lost to follow-up (n = 1) 

Enrollment  

Lost to follow-up (n = 3) 

Withdrew: did not 

understand questions 

(n = 1) 

Lost to follow-up  

(n = 4) 

Recruited and consent obtained (n = 25) 

Allocation 

Study participation 

Figure 1: CONSORT flow diagram. 

https://doi.org/10.33137/cpoj.v8i1.45122


 

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Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

In terms of recommendations, participants indicated they 

would have liked additional sessions (e.g. more than six) 

and to have larger group sizes. In particular, having 

someone with lived experience with limb loss who is further 

along in their recovery journey to join the group and share 

their post-discharge experience was seen as an important 

factor for gaining insight into adaptive coping. One 

participant (ID#5008 [Male, age 57]) suggested: “I would’ve 

changed just one thing. I would’ve had a former patient in 

there the entire way, and just let them interject when they 

felt they needed to with the group. I think that would’ve 

helped me a lot, just to hear the truth... I want to hear that 

when I go home, I could hit a brick wall, I could do this, this 

could happen, this could happen.”  

As well, participants also requested additional educational 

resources outlining what their recovery and discharge may 

look like. 

For the focus group, seven clinical staff took part, which 

included an occupational therapist (n = 1), nurses (n = 2), 

and physiotherapists (n = 4). Staff noted that a large number 

of patients are admitted with comorbid mental health and 

psychosocial challenges and that there is not enough 

mental health/psychosocial support offered to them. For 

instance, one staff (ID#PA2) commented: “They usually 

have a lot of underlying mental health, psychosocial issues 

to begin with before the amputation. A lot of them, actually, 

in the lower socioeconomic status situation before they 

come. So, in terms of the support of mental health, they 

need a lot of practical support in terms of housing, funding 

for equipment, funding for transportation.”  

Importantly, they expressed concerns about the lack of 

mental health follow-up once patients were discharged into 

the community due to difficulty accessing community 

resources. 

As for feasibility feedback for the group sessions, staff 

suggested that sessions occur in the afternoon to minimize 

conflict with their physical therapy and that more sessions 

be offered per week to increase opportunities for patient 

socialization. Staff also suggested implementing a system 

for patients to continue with sessions during outbreaks (e.g., 

use of tablet devices to move the group online when 

needed). Echoing the desires that the LEA participants 

expressed, staff suggested increasing the total number of 

sessions and providing more resources and educational 

materials on limb loss and recovery. Overall, the staff felt 

the group sessions were helpful and suggested continuing 

with them in an outpatient capacity to support the patients 

when they are discharged. 

DISCUSSION 

The primary aim of this study was to collect feasibility data 

for an inpatient SEGT trial designed to help support the 

mental health needs of rehabilitation inpatients with LEA.  

Although in normal circumstances the feasibility of this 

study may be questioned, its completion during the COVID-

19 pandemic with moderate rates of recruitment and 

session attendance, along with moderate to low survey 

completion rates, suggested that a larger trial would be 

feasible but should be modified to address some of the 

implementation challenges we encountered throughout the 

course of the trial (e.g., expanding the time frame to collect 

discharge data). This conclusion is supported by the 

qualitative feedback provided by participants and staff, 

while also accounting for contextual factors (e.g., COVID-

19) in relation to feasibility outcomes.31 For instance, while 

the initial target sample size was 50 participants (25 for each 

group), several challenges primarily related to the COVID-

19 pandemic (e.g., outbreaks and work from home policies) 

led to the recruitment of only 25 participants. This situation 

was not unique as several studies globally were disrupted 

by the pandemic.32,33 It should be noted that almost all of 

the participants referred to the study met the inclusion 

criteria, which indicates that the parameters set for 

participation were well-suited for this population. Without a 

pandemic, recruitment would likely have been more robust. 

Other feasibility trials of psychosocial interventions in 

individuals with LEA have reported a wide range of 

recruitment rates, from as low as 19% to as high as  

79%.34-37 However, additional research is needed to 

establish appropriate recruitment and survey completion 

rates when evaluating the feasibility of delivering a group 

intervention to an inpatient dysvascular LEA population.  

  

Regarding the study assessments, the a priori target for 

survey completion was set at 70%. This target was 

exceeded at the baseline assessment (84%) but not met at 

study exit (64%) or at the three-month follow-up (44%). The 

moderate rates of completion for discharge and the low 

rates at the three-month follow-up were attributed to 

research staff not being able to contact participants just prior 

to or following their discharge. For a future trial, loss to 

follow-up could be mitigated by extending the time-window 

to contact participants after discharge from three days to 

one week (as patients are frequently engaged with other 

pre- and post-discharge appointments). Additionally, the 

outcome measure related to body image (ABIS-R) had high 

rates of missing data, which suggests participants may have 

found this measure difficult to complete. Body image issues 

post-limb loss are well-documented,1,7 and group therapy 

has been shown to help persons cope,15 but further work is 

needed to determine if the lack of response to the ABIS-R 

was related to participants’ not wanting to reflect on this 

topic or factors associated with the measure itself. 

With regard to group session attendance rates for the SEGT 

group, the average attendance was 3.9 sessions (SD = 2.1), 

with 50% attending five or more sessions. Again, the main 

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Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

factor for low attendance was related to factors associated 

with the COVID-19 pandemic. For example, the second 

SEGT group cohort was cancelled after three sessions due 

to an outbreak on the inpatient unit. For future studies 

conducted during any type of outbreak, one 

recommendation is to offer participants virtual sessions if in-

person sessions are not feasible. There is some evidence 

suggesting that it is feasible to switch from in-person to 

virtual SEGT but further work is needed to establish and 

validate best practices.38,39 

The secondary measures were largely inconclusive except 

for a larger change score in depression and anxiety by the 

SEGT group compared to the TAU condition; suggesting 

that taking part in SEGT may lead to an improvement in 

mood, which aligns with the findings of other group therapy 

interventions for persons with disabilities40, as well as for 

individuals with limb loss.15  

While promising, it is possible that this finding is due to 

chance as a result of the lack of power from having a small 

sample size and missing data; all of which limits the 

generalizability of this finding. There may also be a dose 

effect, which can only be measured if the SEGT intervention 

was extended beyond the initial six sessions. An adequately 

powered pragmatic trial would help determine the 

effectiveness of a delivering an SEGT intervention for 

dysvascular LEA. 

Participants with LEA and clinicians also offered several 

suggestions on ways to improve the feasibility and 

acceptability of the SEGT intervention. This included adding 

more sessions, delivering the group later in the day, 

increasing group size, adding more educational material as 

well as having overlapping cohorts, whereby newly admitted 

patients could interact with those closer to discharge.  

There are several limitations with the present study. First, 

the COVID-19 pandemic created a number of operational 

disruptions in terms of recruitment, delivery of the SEGT 

intervention, and follow-up with patients regarding 

discharge assessments. Although not a primary objective, 

the survey data related to the secondary outcomes is 

inconclusive, with only the depression and anxiety scales 

showing some initial promise. Due to a protocol adjustment 

toward the end of the study, some of the participants 

completed their discharge assessments a few days after 

discharge, while others completed them a month after 

discharge. This discrepancy may have affected survey 

scores given that some participants had an extended time 

of being at home. Due to the large degree of missing data 

at follow-up, examining potential confounders was not 

possible.  As such, we cannot conclusively determine the 

clinical benefits of SEGT over standard care, but qualitative 

data provides some insights about the therapeutic value of 

SEGT. Importantly, while our sample had some participants 

from diverse backgrounds, the majority were White and 

English-speaking, and further work is required to explore 

SEGT’s applicability for participants with different cultural 

attitudes, expectations and needs. 

Finally, the study protocol was relatively well-adhered to, 

although some deviations did occur due to the pandemic. 

To account for these unexpected challenges for future trials, 

it would be beneficial to extend the initial recruitment 

windows and the timeframe for survey completion. Despite 

these limitations, critical insights have been obtained to 

inform the development of a pragmatic trial, which is 

currently being pursued (ClinicalTrials.gov ID: 

NCT05798091) and that has incorporated some of the 

suggested modifications derived from our qualitative 

investigations (i.e., open–ended recruitment, continuous 

weekly sessions).  The outcomes of the pragmatic trial will 

provide additional evidence on whether SEGT is a clinically 

valid approach for this population. 

CONCLUSION 

This study provides evidence for the feasibility of a SEGT 

intervention, a form of group therapy, for inpatients with 

dysvascular LEA undergoing rehabilitation. These findings 

provide a number of important insights on how to better 

implement a SEGT program for LEA inpatients, with some 

qualitative data outlining its perceived benefits. Further work 

is needed to determine the clinical validity of SEGT for LEA, 

and to further explore implementation considerations to 

optimize its’ delivery. 

ACKNOWLEDGEMENTS 

The authors would like to thank the participants for their support of 

the study. 

DECLARATION OF CONFLICTING INTERESTS 

Rosalie J. Steinberg, Lawrence R. Robinson, Sharon Jankey, 

Amanda L. Mayo, Marina B. Wasilewski, Robert Simpson, Crystal 

MacKay, Steven Dilkas and Sander L. Hitzig were the recipients of 

a Sunnybrook Alternative Funding Plan (AFP) Innovation Grant that 

funded the present study. Oksana Kachmarchuk, Stephanie Posa, 

Mindy Simon and Alex Kiss received funding from the APF 

Innovation grant to support their involvement in the study. The 

authorship team has no other conflicts of interest to declare. 
 

AUTHORS’ CONTRIBUTION 

• Rosalie J. Steinberg: Conceptualization (Lead), Funding 

Acquisition (Lead), Methodology, Writing – Original Draft 

Preparation, Supervision.  

• Lawrence R. Robinson: Conceptualization (Supporting), 

Methodology, Supervision.  

• Oksana Kachmarchuk: Project Administration, Writing – 

Review & Editing.  

• Sharon Jankey: Conceptualization (Supporting), Writing – 

Review & Editing.  

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8 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

• Stephanie Posa: Project Administration, Writing – Review & 

Editing.  

• Amanda L. Mayo: Conceptualization (Supporting), Writing – 

Review & Editing. 

• Mindy Simon: Project Administration, Writing – Review & 

Editing. 

• Alex Kiss: Formal Analysis. 

• Crystal MacKay: Conceptualization (Supporting), Writing – 

Review & Editing. 

• Robert Simpson: Conceptualization (Supporting), Writing – 

Review & Editing. 

• Marina B. Wasilewski: Conceptualization (Supporting), 

Writing – Review & Editing. 

• Steven Dilkas: Conceptualization (Supporting), Writing – 

Review & Editing. 

• Sander L. Hitzig: Conceptualization (Supporting), Funding 

Acquisition (Supporting), Methodology, Writing – Review & 

Editing, Supervision. 

 

SOURCES OF SUPPORT 

Funding for this trial was provided from a Sunnybrook Alternative 

Funding Plan (AFP) Innovation Grant. 

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Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

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60. DOI: 10.1037/rep0000491 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

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APPENDIX  

Appendix A: 

ID#                                                                                                                                                                                     Date: DD / MM / YYYY 

Patient Interview Guide 

Thank you for agreeing to participate in an interview. For this interview, we are hoping to gain a better understanding of your experience with 

your participation in the research study testing a new group therapy approach for inpatients with limb loss at St. John’s Rehab. The questions 

listed below are intended to guide our conversation and may vary slightly depending on how that conversation unfolds. 

Throughout the interview, please feel free to share as much or as little as you feel comfortable with. 

To start off, I want to learn a little bit about who you are and your initial experiences with losing your limb(s).  

1. Please tell me a little more about where you are from, where you live, your family, etc.? 

2. Please tell me what led to you needing to have your limb(s) amputated?  

3. What were you feeling or thinking about before you had to undergo the surgery for your amputation? 

• What were your top concerns or needs? 

• How did healthcare providers meet those needs/concerns? 

Now I want to focus on your experience at St. John’s Rehab for your limb loss rehabilitation care. 

4. Could you tell me what happened when you arrived at St. John’s Rehab? 

• What happened when you arrived? 

• How were you feeling? 

• What was helpful during this time? 

• What made things more difficult? 

5. What types of mental health or social supports did you receive? 

• Were you seen by a social worker or psychiatrist? Why were you referred to them? 

These questions will focus on your experience of taking part in the psychosocial group at St. John’s Rehab.  

6. When you were first approached to take part in the study, what were your thoughts about participating in a group therapy? 

• Why were you interested in taking part? 

• What concerns, if any, did you have about it? 

• What were you expecting it to look like? 

7. Please describe the types of activities you did as part of the group? 

• How many sessions did you participate in?  If you missed any, why was that? 

8. What were the most beneficial aspects of taking part in the group? 

• What do you feel went well? Why?  

• Were your expectations met? 

• Why do you think this aspect was beneficial? 

9. What were the least beneficial aspects of taking part in the group? 

• What aspects of the program could have been improved? Why? 

• Were there any aspects you feel could be removed from the program? Why? 

• Was there something the program was missing that you’d like to see added? 

10. What were your top concerns and/or needs while taking part in the group? 

• Were these concerns/needs met during your time in the program? If not, why do you feel they were not met? 

• How did healthcare providers meet those needs/concerns? If not, how could they have better supported you? 

These last set of questions will focus on your experience of transitioning back to home from rehab. 

11. Prior to leaving St. John’s Rehab, what were your top needs or concerns? 

• Did you feel prepared to leave? 

• How did healthcare providers meet those needs/concerns? If not, how could they have better supported you? 

12. Since you’ve left the hospital, how do you feel you are adjusting to being back at home and in your community?  

• What has gone well with getting back home? 

• What has not gone as expected or well?  How have you managed or dealt with things that have not gone as planned 

13. Has there been anything from the group therapy program that you have applied to help you adjust to being back at home? 

• If so, what have you used? 

• If not, what do don’t you think you haven’t used it? 

Thank you for taking the time to share your experiences. This brings us to the end of the interview questions. Is there anything else you’d like 

to share about your experiences taking part in the therapy group or recovery that we haven’t touched on? [If yes, let participant discuss. If no, 

reiterate our gratitude for their time and participation] 

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Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

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Appendix B: 

Themes Discussed During SEGT 

Coping 
mechanisms used 
to deal with limb 
loss  

 

• Participants often discussed personal coping strategies to deal with their amputation, including humor, 
positivity, praying, smoking, and writing. 

• Acceptance of limb loss is adaptive, and can be considered as a stage of grief.  

• Trying to maintain control can be adaptive or maladaptive.  

• Relying on others for support can help with coping, but relying too much on others can drive them 
away (maladaptive).  

• It is important to find a purpose in life and to let this guide your mindset ( i.e. yoga, being athletic) 

• Importance of mindfulness and meditation as a positive coping strategy.  
 

Camaraderie with 
peers/peer 
support 

 

• Participants in the group created a “brotherhood” and united in their stories of limb loss.  

• Described finding solace and support in others who have also experienced limb loss. 

• During one of the sessions, each participant showed their residual limb to the group, and compared 
the size of wheelchairs, surgical scars, phantom pain etc. 

• Peer comparison of experiences from acute care to rehab helps with perspective and recovery.  
 

Adaptation after 
limb loss 

 

• Discussions about how adaptable the participants are.  

• The idea of having to “move past the standard”— doing things differently to enjoy the same things as 
everyone else (i.e. driving). 

 

The importance of 
self-advocacy 

 

• Discussion surrounding the importance of advocating for yourself during recovery.  

• Participants encouraged each other to ask questions and encourage help-seeking. 

• Self-advocacy can get you better care and more choices, but there is a need to ask first.  

• Rather than depending on people to offer support, there is a growing realization that with an 
amputation, one may need to show initiative to ASK for support. 

 

Attitudes towards 
healthcare and 
clinical care  

 

• Frustration around the healthcare system.  

• Some good experience with staff, but also many discussions about frustration with the skills and 
perceived lack of transparency of some healthcare providers.  

• Loss of faith in the healthcare system, feelings that the healthcare system has let them down.  

• Difficulties with navigating the healthcare system alone and a lack of guidance from professionals.  

• Wanting to be informed but feel like providers are not being transparent. 

The importance of 
family & support  

 

• Family and friends often support amputees during their entire journey, from discussions leading up to 
the amputation, their recovery post-surgery, and preparing the hope (renovations).  

• How families often act as advocates for patients.  

• Family as motivator--wanting to get better for family.  

• The “family” also includes friends who call and offer support.  
 

Relationships 
 

• Worries about how their amputation affects their families, which includes the trauma that families are 
experiencing.  

• Friends are also struggling with the participant’s amputations.  

• Talk about how to discuss limb loss with children in the family with the hope of normalizing the 
experience.  

• They also want spouses and family to have a support group, so they can better understand what the 
patient is experiencing.  

 

Pain 
 

• Discussions around physical pain and managing pain medications.  

• The idea of getting used to pain, especially chronic pain or phantom pain.  

• The connection between pain and mood — people can sometimes get irritable when in pain. 

• Bonding over emotional pain — and how to manage it.  

• Phantom pain was an important topic discussed, including the differing severity of symptoms and the 
use of mirror therapy to treat it. Most patients in the group experience it, and it is really severe. 

 

The importance of 
having meaning & 
purpose during 
recovery.  
 

• Participants desire to be occupied and to have a purpose.  

• Try to stay occupied during their recovery.  

• Feelings of helplessness and uselessness expressed throughout the recovery.   

• Pride in having hobbies (building decks, car models). 

https://doi.org/10.33137/cpoj.v8i1.45122


 

12 

Steinberg R.J, Robinson L.R, Kachmarchuk O, Jankey S, Posa S, Mayo A.L, et al. Using a novel psychosocial group intervention to improve adaption, coping and 
mental health outcomes following dysvascular limb amputations: A feasibility study. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 4. 
Https://doi.org/10.33137/cpoj.v8i1.45122 
 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL                                              

ISSN: 2561-987X PSYCHOSOCIAL GROUP INTERVENTION AFTER DYSVASCULAR AMPUTATION 

Steinberg et al., 2025 

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• Create a routine so it feels more like home.  

Setbacks during 
recovery  
 

• Discussions about procedures and medical complications that came up during their recovery.  

• Not feeling happy with recovery due to continued pain.  

Progress during 
recovery  
 

• Gaining confidence and independence with improved mobility and the use of a wheelchair.  

• Growing acceptance of their limb loss and how that changes their perspective.  

• Even small progress is a big win.  

• Progress improves self-confidence and dignity.  

Loss & grief 
 

• Grieving lost abilities as a result of amputation and having to adapt to a “new normal” (things they can 
no longer do) 

• Having to rely completely on other people for care is a loss of dignity.  

• Feelings around being completely helpless. Loss of independence.  

• Loss of driving license, independence and past self.  

• Coming to terms with all of the things you can no longer do.  

Covid difficulties 
 

• Frustrations around isolation, restrictions, and delays.  

• Missed groups due to COVID restrictions/infections.  

Faith 
 

• Having faith in Sunnybrook as a teaching hospital.  

• The idea of karma and questioning God.  

• Feeling punished by God.  

• Loss of faith due to limb loss.  

Gratitude 
 

• Participants discussed how grateful they were for recovering both physically and emotionally, and for 
social support.  

• Grateful for having hope.  

• How grateful they are for the experiences at the hospital including helpful staff and supportive peers 
that encourage recovery.   

• Participants were happy knowing their own injury was not worse.  

Worries about the 
future  
 

• Most participants agreed that they are anxious about what will happen when they are discharged.  

• Dealing with practical day-to-day challenges and worries around handling finances.  

• Being unprepared for discharge due to having an inaccessible home. 

Overall feedback 
on group 
 

• Individuals felt it was “informative” and a “nice spot” as “people listen here”. 

• Helped them build relationships with one another, despite differences in background, future 
trajectories, diagnoses etc. 

• Overall, it allowed them to learn how to relate to one another. 

• Groups might have facilitated acceptance of one’s condition. 

• Allowed people to open up and speak even though they normally would not have.  

 

 

https://doi.org/10.33137/cpoj.v8i1.45122

