Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis

Miller, Matthew J.; Jones, Jacqueline; Anderson, Chelsey B; Christiansen, Cory L.

doi:10.1080/09638288.2018.1492031

Cited by 47 publications

(50 citation statements)

References 50 publications

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“…For example, a qualitative metasynthesis identified patient education, motivation, social support, self-efficacy, and prosthesis factors as overarching categories influencing physical activity for people with LLA. 65 In addition, higher age, less experience with the prosthesis, more comorbidities, and lower functional capacity are associated with lower levels of physical activity after LLA. 63,66 Also, U.S. military veterans have slightly higher physical activity than nonveterans, although veterans who use the Veterans Health Administration for health care may have slightly less physical activity than other veterans.…”

Section: Discussionmentioning

confidence: 99%

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Christiansen

Miller

Kline

et al. 2020

PM&R

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Background: Lower-limb amputation (LLA) due to non-traumatic vascular etiology is linked to extremely low physical activity and high disability. Objective: To test the feasibility of a biobehavioral intervention designed to promote physical activity. Design: A randomized, single-blind feasibility trial with a crossover design. Setting: Veterans Administration Medical Center. Participants: Military veterans (age: 65.7 [7.8] years; mean [standard deviation]) with nontraumatic lower-limb amputation (LLA), randomized to two groups: GROUP1 (n = 16) and GROUP2 (n = 15). Both groups had similar baseline amputation characteristics (level of amputation and time since amputation). Interventions: Twelve weekly, 30-minute telehealth sessions of physical activity behavior-change intervention, with GROUP1 participating in weeks 1-12 and GROUP2 in weeks 13-24. GROUP1 noncontact phase in weeks 13-24 and GROUP2 attention control telehealth phase in weeks 1-12. Main Outcome Measures: Feasibility (participant retention, dose goal attainment, intervention acceptability [Intrinsic Motivation Inventory [IMI] Interest and Enjoyment scale], safety) and signal of efficacy (free-living physical activity [accelerometer-based average daily step count], Late Life Function and Disability Index-Disability Scale [LLFDI-DS]). Results: Participant retention rate was high (90%), with three participants lost to follow-up during the intervention period. Dose goal attainment was low, with only 10% of participants achieving an a priori walking dose goal. Intervention was rated as acceptable, with mean IMI Interest and Enjoyment score (5.8) statistically higher than the null value of 5.0 (P = .002). There were no between-group differences in adverse event rates (falls: P = .19, lower extremity wounds: P = .60). There was no signal of efficacy for change in average daily step count (d = −0.15) or LLFDI-DS (d = −0.22 and 0.17 for frequency and limitations scales, respectively). Conclusions: Telehealth delivered biobehavioral intervention resulted in acceptable participant retention, low dose goal attainment, high participant acceptability, and low safety risk, while having no signal of efficacy (physical activity, disability) for people with nontraumatic LLA.

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Section: Discussionmentioning

confidence: 99%

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Christiansen

Miller

Kline

et al. 2020

PM&R

Self Cite

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“…There are significant barriers to participation in the years following LLA given limited education and access to timely rehabilitation and prosthetic services, mobility challenges, difficulties accessing the physical environment and public transport, public attitudes to disability, poor mental health, social isolation and loss of roles within family and society that define a person and bring meaning and purpose to life. [3][4][5][6] Our understanding of the impact of these factors on work participation is limited, given that most studies have used quantitative methods to examine the effects of demographic and amputation-related factors on work participation after LLA in countries with well-developed healthcare systems. [7][8][9][10] Few studies have examined the effects of pain, level of mobility or the effect of comorbidities, 11,12 or described the impact of the environmental or psychosocial factors on work participation following LLA.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation

Stuckey

Draganovic

Ullah

et al. 2020

Prosthetics &Amp; Orthotics International

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Background: Lower limb amputation due to workplace injury and motor vehicle accident is common in Bangladesh. Qualitative research may extend our understanding of how physical impairment and other factors, such as cultural norms, family roles and the built environment, facilitate or hinder work participation following lower limb amputation and prosthetic rehabilitation. Objectives: The aim of this study was to explore the experience of people in Bangladesh following lower limb amputation and prosthetic rehabilitation to understand the facilitators and barriers to their work participation. Study Design: Qualitative interviews with thematic analysis. Methods: The Worker Role Interview was used to guide semi-structured interviews in a convenience sample of 10 adults living in Bangladesh following lower limb amputation and prosthetic rehabilitation. Interviews were interpreted, and the themes that emerged were evidenced with first-person quotes. Results: Barriers and facilitators to work participation were synthesised into the following themes: spirituality, attitudes, meaning of work, planning for work participation, traditional gender roles, social support, mobility aids, environmental challenges and ergonomic adaptations. Conclusion: This qualitative approach identified barriers and facilitators to work participation, such as the role of spirituality and the effect of gender roles, that have not been well researched in this population. Being aware of their effects can help clinicians reduce barriers to work participation. Clinical relevance Greater awareness of the barriers and facilitators to work participation, such as the role of spirituality or the effect of gender roles, can assist clinicians to reduce barriers and help facilitate work participation for people living in Bangladesh following lower limb amputation and prosthetic rehabilitation.

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“…14,41,42 This is not unexpected due to the barriers to PA that this population faces, and is also consistent with previously published literature regarding PA in patients with an amputation. [21][22][23][24][29][30][31]36 The finding that female gender, increasing age, and disease burden correlate with decreased PA is also observed in the general population. 41 In addition, a prior study indicated that female patients are less likely to be successfully fitted with a lower-limb prosthesis than male patients, which could contribute to this disparity.…”

Section: Discussionmentioning

confidence: 68%

“…29 Individuals with an amputation may face challenges to exercise such as lack of accessible equipment and facilities, skin issues on the residual limb, and changes in body image. 23 Additional educational and motivational support may be needed to help initiate PA. 30 Individuals who were active prior to amputation may need to adapt their exercise and find locations where adaptive sports and exercise are possible. 31,32 These difficulties play a role in the decreased participation in sporting events observed in previously active individuals following an amputation.…”

Section: Introductionmentioning

confidence: 99%

Physical Activity in Adults With an Amputation as Assessed With a Self‐Reported Exercise Vital Sign

Sederberg

Tarkhan

Ray

et al. 2020

PM&R

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Background Physical activity (PA) is important for the prevention and treatment of numerous chronic medical conditions. Individuals with a limb amputation face unique challenges for staying physically active. There are few studies evaluating PA of civilians with amputation in the United States. Objective To evaluate self‐reported PA in persons with an amputation in the outpatient setting using a standardized exercise vital sign (EVS) and correlate PA with demographic information, amputation characteristics, and disease burden. Design Cross‐sectional observational study. Setting Outpatient rehabilitation clinic at a tertiary care institution. Interventions N/A. Participants Two hundred twenty‐nine patients with limb amputation. Main Outcome Measurements EVS (self‐reported weekly participation in moderate to vigorous intensity exercise), disease burden using a modified Charlson Comorbidity Index (CCI), possession of a prosthetic limb, amputation level, time from amputation, body mass index (BMI), gender, race, and age. Results A total of 28.8% of patients with limb amputation self‐reported exercising at or above 150 min/wk as recommended by the United States Department of Health and Human Services (HHS); 31.8% of patients with transfemoral amputations, 27.8% with transtibial amputations, and 36% with upper extremity amputations reported exercising the recommended amount. Those with a prosthesis exercised 0.91 h/wk more than those without a prosthesis (95% CI 0.01, 1.8, P = .047), and female patients exercised 1.09 h/wk less than male patients (95% confidence interval [CI] 1.69‐0.49, P < .001). Increasing age (P = .045), CCI (P = .006), and BMI (P = .005) all had a small but significant correlation with lower EVS. There was no statistically significant correlation between EVS and amputation level, race, or time from amputation. Conclusions Less than one‐third of patients with an amputation meet HHS recommendations for aerobic exercise. Male patients, those with a prosthesis, lower CCI, lower BMI, and younger age reported higher PA rates. Assessing EVS can help clinicians to identify patients with amputation that are not sufficiently active and may benefit from PA counseling and prescription.

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Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis

Abstract: 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.

Cited by 47 publications

References 50 publications

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Biobehavioral Intervention Targeting Physical Activity Behavior Change for Older Veterans after Nontraumatic Amputation: A Randomized Controlled Trial

Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation

Physical Activity in Adults With an Amputation as Assessed With a Self‐Reported Exercise Vital Sign

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