A Mixed-Methods Study on Prosthesis Use Among Older Canadians With Lower-Limb Amputations

Abstract

BACKGROUND: The prevalence of lower-limb amputations (LLA) in older adults is increasing. Due to the substantial resources required for rehabilitation, there is growing interest in exploring prosthesis use as well as the factors that impact use for individuals with LLA.
 OBJECTIVES: To examine how older adults, those over 50 years old, with a new LLA use their prostheses following rehabilitation and to identify factors that increase or decrease prosthesis use after discharge from a rehabilitation hospital.
 METHODS: The StepWatch Activity Monitor, the Prosthetic Profile of the Amputee Questionnaire, and a semi-structured interview were used to measure prosthesis use and factors affecting use at 12 weeks post-discharge from a rehabilitation hospital. Descriptive statistics were calculated for the quantitative data and the qualitative interviews were analyzed using the International Classification of Functioning and Disability.
 RESULTS: Two user profiles emerged from the 11 participants’ use patterns. The Regular Users integrated their prosthesis into their lives, using it for various types of activities, while the Strategic Users wore their prosthesis to perform specific activities of daily and instrumental activities of daily living tasks. Body functions (e.g., pain), personal (e.g., feeling of independence), and environmental factors (e.g., home adaptations or social support) impacted prosthesis use.
 CONCLUSIONS: The emergence of profiles suggests variability in how older adults with LLA use their prosthesis after rehabilitation. However, the factors affecting prosthesis use were similar between the profiles. Therefore, while it is important for rehabilitation teams to consider patients’ individual needs when setting goals for prosthetic training, they must also consider common factors affecting prosthesis use.
 Layman's Abstract
 The prevalence of lower-limb amputations (LLA) in older adults is increasing. Because of the substantial resources rehabilitation demands, there is growing interest in exploring prosthesis use as well as the factors that impact use for individuals with LLA. In this study we examine how adults over the age of 50 with LLA use their prosthesis after rehabilitation. We also identify factors that increase or decrease prosthesis use after leaving a rehabilitation hospital. We used several measures to study prosthesis use. The StepWatch Activity Monitor, the Prosthetic Profile of the Amputee Questionnaire, and a semi-structured interview were all used to measure prosthesis use after 12 weeks from leaving a rehabilitation hospital. Two user profiles emerged from our data. The Regular Users integrated their prosthesis into their lives, using it for various types of activities, while the Strategic Users wore their prosthesis to perform specific ADL and IADL tasks. Body functions (e.g., pain), personal (e.g., feeling of independence), and environmental factors (e.g., home adaptations or social support) impacted prosthesis use. Our findings suggest there is variability in how older adults with LLA use their prosthesis after rehabilitation. However, the factors affecting prosthesis use were similar between the profiles. Therefore, while it is important for rehabilitation teams to consider patients’ individual needs when setting goals for prosthetic training, they must also consider common factors affecting prosthesis use.
 Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36833/28219
 How To Cite: Pousett B, Budzinski C, Labbé D, Miller WC. A mixed-methods study on prosthesis use among older Canadians with lower-limb amputations. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.10. https://doi.org/10.33137/cpoj.v4i1.36833 
 Corresponding Author: William C Miller,University of British Columbia, Vancouver, British Columbia (BC), Canada. E-Mail: bill.miller@ubc.caORCID: https://orcid.org/ 0000-0003-3060-0210

Bone-anchored prostheses for transfemoral amputation: a systematic review of outcomes, complications, patient experiences, and cost-effectiveness

“…As the number of cases increases across centers worldwide, there is also an opportunity to further explore changes in the mental health of prosthesis users and the factors/experiences contributing to changes in the perceptions of patients about their health-related quality of life. Well-designed mixed methods studies ( 103 , 104 ) could address this need and contextualize the perceived changes in quality of life with patients’ experiences and challenges in their everyday lives. Future research on the lived experiences of patients and their caregivers and the impact of bone-anchored prostheses on productivity and vocational/employment situations will lead to a richer and more wholesome understanding of the change in the lives of patients that bone-anchored prostheses appear to promise.…”