Confirm psychosocial targets of physical activity behavior change intervention after dysvascular LLA using quantitative methods.• Develop and test a physical activity behavior change intervention tailored to the needs of people with dysvascular LLA.

Introduction Over half of all people with lower limb amputation (LLA) experience at least one fall annually. Furthermore, the majority of LLAs result from dysvascular health complications, contributing to balance deficits. However, fall‐related research specific to dysvascular LLA remains limited. Objective To characterize falls among adults with dysvascular LLA, using an existing Fall‐Type Classification Framework and to describe the functional characteristics of participants across the framework categories. Design Secondary data analysis from two randomized controlled trials. Setting Outpatient setting. Participants People (n = 69) 6 months to 5 years from dysvascular lower extremity amputation, who were ≥50 years of age and independently ambulatory using a prosthesis. Intervention None. Outcome Descriptions of self‐reported falls were collected on a weekly basis for 12 weeks, and analyzed using an existing Fall‐Type Classification Framework. Fall frequencies, estimated count, and estimated proportions were compared across all framework categories, with 95% confidence intervals. Functional measures (Timed Up and Go, Two Minute Walk, Five Meter Walk, and average step count) were collected, and averages for each participant who experienced a fall were calculated. Results Thirty participants (43.5%) reported 42 falls within 12 weeks. A variety of fall types were described. Incidence of falls was highest for intrinsic destabilization sources, from incorrect weight shift patterns during transfer activities. Conclusion Patients with dysvascular LLAs experience a variety of fall types. The high frequency of intrinsically sourced, incorrect weight‐shift falls during transfer activities emphasizes the need to focus rehabilitation efforts on improving postural control in patients with dysvascular LLAs during activities such as reaching, turning, and transferring.

Background People with dysvascular lower limb amputation (LLA) achieve one‐third of the recommended steps per day and experience severe disability. Although physical function improves with rehabilitation after dysvascular LLA, physical activity remains largely unchanged, and factors contributing to limited daily step count are unknown. Objectives To identify factors that contribute to daily step count after dysvascular LLA. Design Cross‐sectional, secondary data analysis. Setting Outpatient rehabilitation facilities. Participants Fifty‐eight patients with dysvascular major LLA (age: 64 ± 9 years, body mass index: 30 ± 8 kg/m2, male: 95%, transtibial LLA: 95%). Methods Data were collected by a blinded assessor after dysvascular LLA. Candidate explanatory variables included (1) demographics, (2) LLA characteristics, (3) comorbidities and health behaviors, and (4) physical function. Variables with univariate associations with log steps/day (transformed due to non‐normality) were included in a multiple linear regression model using backward elimination to identify factors that explained significant variability in log steps/day. Primary Outcome Measure The primary outcome, daily step count, was measured with accelerometer‐based activity monitors worn by participants for 10 days. Results Participants took an average (± SD) of 1450 ± 1309 steps/day. After backward elimination, the final model included four variables explaining 62% of the overall daily step count (P < .0001): 2‐minute walk distance (32%), assistive device use (11%), cardiovascular disease (10%), and pre‐amputation walking time (11%). Conclusions Average daily step count of 1450 steps/day reflects the lowest category of sedentary behavior. Physical function, cardiovascular disease, and pre‐amputation walking time explain 62% of daily step count after dysvascular LLA. Although physical rehabilitation commonly focuses on improving physical function, interventions to increase daily step count after dysvascular LLA should also consider chronic disease and health behaviors that predate LLA. Level of Evidence III.

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Background: Prosthesis design is complex and multiple appropriate options exist for any individual with lower-limb amputation. However, there is insufficient evidence for guiding decision-making. Shared decision-making (SDM) offers an opportunity to incorporate patient-specific values and preferences where evidence is lacking for prosthesis design decisions. To develop resources to facilitate SDM, and consistent with the International Patient Decision Aid Standards, it is necessary to identify the decisional needs of prosthetists and prosthesis users for prosthesis design decisions. Objectives: To assess the needs of prosthetists and new prosthesis users for SDM about the first prosthesis design. Study design: Qualitative descriptive design. Methods: Six focus groups were conducted with 38 prosthetists. Individual semistructured interviews were conducted with 17 new prosthesis users. Transcripts were analyzed using directed content analysis, with codes defined a priori using existing frameworks for SDM: the Three Talk Model for SDM and the Ottawa Decision Support Framework. Results: Four main themes were identified among prosthetists and prosthesis users: acknowledging complexity in communication, clarifying values, recognizing the role of experience to inform preferences, and understanding the prosthetic journey. Conclusions: Resources that support SDM for the first prosthesis design should consider methods for identifying individual communication needs, support with clarifying values, and resources such as experience for achieving informed preferences, within the context of the overall course of rehabilitation and recovery following lower-limb amputation. The themes identified in this work can inform SDM to promote collaborative discussion between prosthetists and new prosthesis users when making prosthesis design decisions.

Background: Prosthetic rehabilitation decisions depend on estimating a patient's mobility potential. However, no validated prediction models of mobility outcomes exist for people with lower-limb amputation (LLA). Objectives: To develop and test predictions for self-reported mobility after LLA, using the Prosthetic Limb Users Survey of Mobility (PLUS-M).Study Design: This is a retrospective cohort analysis. Methods: Eight hundred thirty-one patient records (1,860 PLUS-M observations) were used to develop and test a neighbors-based prediction model, using previous patient data to predict the 6-month PLUS-M T-score trajectory for a new patient (based on matching characteristics). The prediction model was developed in a training data set (n 5 552 patients) and tested in an out-of-sample data set of 279 patients with later visit dates. Prediction performance was assessed using bias, coverage, and precision. Prediction calibration was also assessed. Results: The average prediction bias for the model was 0.01 SDs, average coverage was 0.498 (ideal proportion within the 50% prediction interval 5 0.5), and prediction interval was 8.4 PLUS-M T-score points (40% improvement over population-level estimates). Predictions were well calibrated, with the median predicted scores falling within the standard error of the median of observed scores, across all deciles of the data. Conclusions: This neighbors-based prediction approach allows for accurate estimates of PLUS-M T-score trajectories for people with LLA.

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Date Presented 04/02/2022 The goal of this qualitative study was to understand barriers and facilitators influencing adoption of the Dysvascular Amputation Self-management of Health (DASH) program. DASH was designed to maximize participation in daily physical activity via targeted self-management of step count. We completed focus groups with OTs and physical therapists to understand DASH adoption, and they identified facility-, clinician-, and patient-level factors to consider for larger scale implementation. Primary Author and Speaker: Laura A. Swink Contributing Authors: Laura A. Swink, Meredith L. Mealer, Matthew J. Miller, Chelsey B. Anderson, Paul F. Cook, Jennifer E. Stevens-Lapsley, Cory L. Christiansen