Barriers and Facilitators to Physical Activity Participation for Men with Transtibial Osteomyoplastic Amputation: A Thematic Analysis

Abstract

Background Lower-limb amputation (LLA) results in participation restrictions in major life activities in personal, work, and leisure environments. By participating in significantly less physical activity (PA) than those who are otherwise healthy, people with LLA are at risk for developing secondary chronic health conditions. Barriers and facilitators to PA participation for those with conventional LLA are well documented. However, these factors are not well understood for those with transtibial osteomyoplastic amputation (TOA). Purpose The aim of this study was to qualitatively investigate the barriers and facilitators to PA participation in the TOA population. Design This study is an observational, qualitative research using thematic analysis. Methods Semistructured interviews were utilized to collect information-rich data from nine men with TOA. Results The participants reported minimal body structure impairments but still experience impairment to body functions. Participants reported that they were limited during running and resistance exercises during before and after the actual amputation surgery. The majority of participants value PA benefits as they relate to prevention of chronic disease but fail to recognize potential benefits on function. An individual's motivation to participate can serve as both a facilitator and barrier to PA. Having the opportunity to socialize during PA is important to these participants. The quality of postoperative care program has a direct influence on the long-term PA participation for these participants. Conclusions People with TOA continue to experience body function impairment, activity limitations, and participation restrictions. The health care team can play a significant role in the adoption of a physically active lifestyle for people with TOA.

Development of the ECLIPSE model of meaningful outcome domains following lower limb amputation and prosthetic rehabilitation, through systematic review and best fit framework synthesis

“…The subtheme of role fulfilment is linked to ‘participation in important activities’, and was discussed in 13 papers [13,34,39,40,42,43,45,48,61,65,66,70,71]. Fulfilment of a role such as a parent, spouse or valued member of the community, was described as an important outcome following lower limb amputation.…”

“…Participants in 9 of the included studies highlighted concerns about the impact amputation and prosthesis use would have on their health and wellbeing throughout their life course [36,39,41,44,56,60,61,70,71]. Participants described concerns about the impact of amputation on their remaining joints [61], the need to remain physically active to avoid health issues later in life, and to manage weight gain [36,39,56]. I think just talking about hopping.…”

“…The first domain 'I am able to participate in my important activities', set out in table 9, was expanded to include an additional subtheme describing the importance of returning to valued roles. The subtheme of role fulfilment is linked to `participation in important activities', and was discussed in 13 papers [13,34,39,40,42,43,45,48,61,65,66,70,71]. Fulfilment of a role such as a parent, spouse or valued member of the community, was described as an important outcome following lower limb amputation.…”

Training program intervention to encourage physical activity for health in people with transtibial amputation: A feasibility study

“…These include musculoskeletal barriers-limitations of the prosthesis and remaining musculature that increase the energy cost of moving [6][7][8] and affect walking, running, and other movement patterns and increase the risk of falling when active [9][10][11][12] ; psychosocial barriers-internal perceptions and those of the wider community, fear of pain, and falling 6,13,14 ; environmental barriers-accessibility and appropriate resources, cost, and specialized equipment; 2,15 and educational barriersknowledge of types of physical activity that are safe to complete and how to adapt exercises to accommodate musculoskeletal issues and residual limb skin blistering and breakdown. 6,15 Previous exercise interventions for PTTA that have been developed are limited to those focusing on developing specific components of fitness and have demonstrated improvements in those targeted components, including cardiovascular endurance 16 and strength. 17 Interventions that address multiple components of fitness have demonstrated positive results in reducing falls in ambulatory people with LLA, 18 and in developing capacity for weight bearing on their prosthetic limb.…”

“…These include musculoskeletal barriers—limitations of the prosthesis and remaining musculature that increase the energy cost of moving 6-8 and affect walking, running, and other movement patterns and increase the risk of falling when active 9-12 ; psychosocial barriers—internal perceptions and those of the wider community, fear of pain, and falling 6,13,14 ; environmental barriers—accessibility and appropriate resources, cost, and specialized equipment; 2,15 and educational barriers—knowledge of types of physical activity that are safe to complete and how to adapt exercises to accommodate musculoskeletal issues and residual limb skin blistering and breakdown. 6,15…”