How do users define success with a lower limb prosthesis? A focus group study.

PURPOSE In this study, we sought to examine how lower limb prosthesis users define success, what constructs they associate with success, and what barriers and facilitators contribute to achieving success. MATERIALS AND METHODS Purposively sampled lower limb prosthesis users were recruited to participate in a focus group study. Verbatim transcripts from focus groups were analyzed using inductive thematic analysis. Identified constructs were mapped to existing outcome measures, and a conceptual framework for success with a lower limb prosthesis was proposed. RESULTS Thirty-one lower limb prosthesis users participated in one of five focus groups. Five themes were developed: keep moving forward, despite ups and downs; being able to live MY normal life and do the things I want to do with ease; learning what works for me and how to manage my prosthesis; only I can define my success; and what about my mental health? Several constructs that do not align with existing measures were identified, including prosthetic attention, grief/loss after amputation, and trust in prosthesis. Facilitators for success described by participants included peer connection, finding the right prosthetist, and mental health support. CONCLUSIONS According to lower limb prosthesis users, success must be patient-driven, individually defined, and continually reassessed.

[1]  Sara J. Morgan,et al.  Prevalence of secondary prosthesis use in lower limb prosthesis users. , 2023, Disability and rehabilitation.

[2]  Sara J. Morgan,et al.  Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS‐M) , 2023, PM & R : the journal of injury, function, and rehabilitation.

[3]  C. Metcalf,et al.  Exploring meaningful outcome domains of recovery following lower limb amputation and prosthetic rehabilitation: the patient’s perspective , 2022, Disability and rehabilitation.

[4]  Cynthia L. Bennett,et al.  Perceptions of ability among adults with upper limb absence: impacts of learning, identity, and community , 2020, Disability and rehabilitation.

[5]  Andrew Gary Darwin Holmes.  Researcher Positionality - A Consideration of Its Influence and Place in Qualitative Research - A New Researcher Guide , 2020, Shanlax International Journal of Education.

[6]  A. Zucker-Levin,et al.  A Focus Group- and Patient-Driven Study to Understand Patients' and Health Care Providers' Perspectives on Services for People with Amputation. , 2020, Physiotherapy Canada. Physiotherapie Canada.

[7]  B. Vaughan,et al.  PROMIS® General Life Satisfaction scale: construct validity in musculoskeletal pain patients , 2020, Chiropractic & Manual Therapies.

[8]  M. Morris,et al.  Qualitative analysis of resilience characteristics of people with unilateral transtibial amputation. , 2020, Disability and health journal.

[9]  Paul A. Harris,et al.  The REDCap consortium: Building an international community of software platform partners , 2019, J. Biomed. Informatics.

[10]  S. Farrokhi,et al.  Biomechanical improvements following foot strike biofeedback training for a patient using a passive dynamic ankle-foot orthosis during running , 2019, Prosthetics and orthotics international.

[11]  Kathleen E. Yancosek,et al.  Amputees Unanimous: A 12-step program , 2019, Prosthetics and orthotics international.

[12]  Sara J. Morgan,et al.  Energy expenditure in people with transtibial amputation walking with crossover and energy storing prosthetic feet: A randomized within-subject study. , 2018, Gait & posture.

[13]  J. Macdermid,et al.  Characteristics of therapeutic alliance in musculoskeletal physiotherapy and occupational therapy practice: a scoping review of the literature , 2017, BMC Health Services Research.

[14]  Robert Gailey,et al.  Use of and confidence in administering outcome measures among clinical prosthetists: Results from a national survey and mixed-methods training program , 2015, Prosthetics and orthotics international.

[15]  Mark Philbin,et al.  Being “just normal”: a grounded theory of prosthesis use , 2015, Disability and rehabilitation.

[16]  C. Ellis-Hill,et al.  Expectations of rehabilitation following lower limb amputation: a qualitative study , 2014, Disability and rehabilitation.

[17]  Stefania Fatone,et al.  Outcome instruments for prosthetics: clinical applications. , 2014, Physical medicine and rehabilitation clinics of North America.

[18]  D. Pilgrim.  Some implications of critical realism for mental health research , 2014 .

[19]  B. Dick,et al.  Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study , 2013, Physical Therapy.

[20]  Stefania Fatone,et al.  Assessing the prosthetic needs of farmers and ranchers with amputations , 2013, Disability and rehabilitation. Assistive technology.

[21]  C. Murray,et al.  ‘Don’t you talk to your prosthetist?’ Communicational problems in the prescription of artificial limbs , 2013, Disability and rehabilitation.

[22]  K. Refshauge,et al.  The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain , 2012, Physical Therapy.

[23]  K. T. Foley,et al.  Factors influencing the use of outcome measures in physical therapy practice , 2012, Physiotherapy theory and practice.

[24]  T. F. van de Mortel,et al.  A path of perpetual resilience: Exploring the experience of a diabetes-related amputation through grounded theory , 2011, Contemporary Nurse: health care across the lifespan.

[25]  Nicolas Vuillerme,et al.  Biomechanics and physiological parameters during gait in lower-limb amputees: a systematic review. , 2011, Gait & posture.

[26]  L. Resnik,et al.  Reliability of Outcome Measures for People With Lower-Limb Amputations: Distinguishing True Change From Statistical Error , 2011, Physical Therapy.

[27]  Pamela Gallagher,et al.  Understanding the benefits of prosthetic prescription: exploring the experiences of practitioners and lower limb prosthetic users , 2011, Disability and rehabilitation.

[28]  Daniel J Buysse,et al.  The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. , 2010, Journal of clinical epidemiology.

[29]  M. Dorahy,et al.  Experiences of psychosocial adjustment within 18 months of amputation: an interpretative phenomenological analysis , 2010, Disability and rehabilitation.

[30]  P. Harris,et al.  Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support , 2009, J. Biomed. Informatics.

[31]  D. Jette,et al.  Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications , 2009, Physical Therapy.

[32]  C. Murray,et al.  Being like everybody else: the personal meanings of being a prosthesis user , 2009, Disability and rehabilitation.

[33]  N. Frude,et al.  Positive Coping and Stress-Related Psychological Growth Following Lower Limb Amputation. , 2005 .

[34]  O. Horgan,et al.  Psychosocial adjustment to lower-limb amputation: A review , 2004, Disability and rehabilitation.

[35]  A. Heinemann,et al.  Development and measurement properties of the Orthotics and Prosthetics Users’ Survey (OPUS): A comprehensive set of clinical outcome instruments , 2003, Prosthetics and orthotics international.

[36]  L. Göeken,et al.  Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees. , 2003, Archives of physical medicine and rehabilitation.

[37]  M Maclachlan,et al.  Adjustment to an Artificial Limb: A Qualitative Perspective , 2001, Journal of health psychology.

[38]  Malcolm MacLachlan,et al.  Development and psychometric evaluation of the Trinity Amputation and Prosthesis Experience Scales (TAPES). , 2000 .

[39]  A. Madill,et al.  Objectivity and reliability in qualitative analysis: realist, contextualist and radical constructionist epistemologies. , 2000, British journal of psychology.

[40]  G D Reiber,et al.  Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life. , 1998, Archives of physical medicine and rehabilitation.

[41]  Paul W. Stratford,et al.  Assessing Disability and Change on Individual Patients: A Report of a Patient Specific Measure , 1995 .

[42]  Janice M. Morse,et al.  Qualitative Nursing Research: A Contemporary Dialogue , 1990 .

[43]  S. Fitzgerald,et al.  Prosthesis and wheelchair use in veterans with lower-limb amputation. , 2009, Journal of rehabilitation research and development.

[44]  M. Nash,et al.  The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate. , 2002, Archives of physical medicine and rehabilitation.