Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study

Imam, Bita; Miller, William C.; Finlayson, Heather; Eng, Janice J.; Jarus, Tal

doi:10.3138/ptc.2017-39

Cited by 9 publications

(9 citation statements)

References 20 publications

(24 reference statements)

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“… 6 The failed prosthetic fitting rate was also high compared with reports from other countries 12 , 25 but similar to the rate (23.3%) reported by other Canadian facilities. 6 Although evidence from the United Kingdom and the United States support the delivery of inpatient rehabilitation for individuals with LLA leading to improved outcomes 26 , 27 and earlier achievement of rehabilitation milestones, 28 identifying and targeting factors that affect outcomes before admission could improve prosthetic candidate selection and improve the likelihood of success. Data supporting the use of screening for amputees are sparse, 29 and further research is required to verify the potential benefits of pre-emptively addressing barriers to successful prosthetic fitting.…”

Section: Discussionsupporting

confidence: 83%

“…More than 80% of Canadian rehabilitation centers provide inpatient prosthetic rehabilitation. 6 Prosthetic rehabilitation is a resource-intensive process that does not always lead to successful fitting. With most rehabilitation centers providing 4 to 9 weeks of inpatient rehabilitation, 6 it may not be wise to invest resources into prosthetic fitting if the likelihood of a successful outcome is low.…”

mentioning

confidence: 99%

“… 6 Prosthetic rehabilitation is a resource-intensive process that does not always lead to successful fitting. With most rehabilitation centers providing 4 to 9 weeks of inpatient rehabilitation, 6 it may not be wise to invest resources into prosthetic fitting if the likelihood of a successful outcome is low. Identifying factors that predict prolonged length of stay (LOS) or fitting failure can help avoid unnecessary admissions and streamline the process for individuals with LLA and health care providers.…”

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confidence: 99%

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Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation

Chislett

Ploughman

McCarthy

2020

Archives of Rehabilitation Research and Clinical Translation

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Objective To identify variables associated with rehabilitation length of stay (LOS) and prosthetic fitting success for people with lower limb amputation (LLA). Design Retrospective analysis of clinically collected cohort. Setting Canadian inpatient rehabilitation hospital. Participants Consecutive individuals with LLA (N=103) admitted for prosthetic fitting (mean age, 65.3±10.6y). Interventions Not applicable. Main Outcome Measures Independent variables included the Lower Limb Amputee Measurement Scale (LLAMS), which is a 31-question tool to predict LOS with items in medical, cognitive, social, physical, activities of daily living, and other subsections; admission FIM; age; sex; level of amputation (below- or above-knee); and time from surgery to admission. LOS was measured as days from admission to discharge. Successful prosthetic fitting was defined as the ability to use a prosthesis on discharge. Results The mean LOS was 63.6 ± 33.3 days, and 21.4% of patients failed prosthetic fitting. Higher LLAMS, lower FIM, and above-knee amputation were significantly associated with longer LOS ( P <.001, R 2 =0.36). Age, sex, and time from surgery were not significantly associated with LOS or prosthetic fitting. Higher LLAMS was significantly associated with unsuccessful prosthetic fitting ( P =.032). Of the 31 items in the LLAMS, 5 were associated with prolonged LOS and 5 were associated with failed prosthetic fitting ( P <.10). Conclusions The LLAMS, level of amputation, and admission FIM can be used to predict LOS in lower limb amputees admitted for prosthetic fitting. The LLAMS was weak in identifying patients who failed prosthetic fitting. Future research should consider shortening the LLAMS.

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Section: Discussionsupporting

confidence: 83%

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confidence: 99%

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confidence: 99%

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Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation

Chislett

Ploughman

McCarthy

2020

Archives of Rehabilitation Research and Clinical Translation

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“…Currently in Canada, few rehabilitation facilities offer return-to-work or recreational therapy that could support these needs. 2 This study reported several personal and social environment factors that help the older adults using their prosthesis. As the older adults progress through their rehabilitation and increase their mobility, they gained confidence and reported an increased sense of freedom and independence, similar to users of all ages in previous studies.…”

Section: Discussionmentioning

confidence: 96%

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

Pousett¹,

Budzinski

Labbé

et al. 2021

Can. Prosthet. Orthot. J.

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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

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“…In the broader context of post-acute lower limb prosthetic rehabilitation, practice and resourcing remain regional and clinician specific. 34 As such, the WiiNWalk intervention, or some form of Wii Fit for lower limb prosthetic rehabilitation, may still be a useful tool to improve or maintain balance confidence if the device is readily available. However, it should be integrated with a more multifaceted program of rehabilitation aimed at improving walking capacity.…”

Section: Discussionmentioning

confidence: 99%

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

et al. 2021

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Objective Determine efficacy of the novel WiiNWalk intervention on walking-related outcomes in older adults with lower limb amputation. Design Multi-site, parallel, evaluator-masked randomized controlled trial. Setting Home-setting in three Canadian cities. Participants Community-dwelling lower limb prosthesis users over 50 years of age. Interventions The WiiNWalk group (n = 38) used modified Wii Fit activities for prosthetic rehabilitation. The attention control group (n = 33) used Big Brain Academy: Wii Degree, comprising of cognitive activities. Both groups completed a 4-week supervised phase with three 1-h sessions/week in groups of three overseen by a clinician via videoconferencing and a 4-week unstructured and unsupervised phase. Main Measures Primary outcome was walking capacity (2 min walk test); secondary outcomes were balance confidence (activities-specific balance confidence scale), dynamic balance (four-step square test), and lower limb functioning (short physical performance battery). Outcomes were compared across time points with repeated measures analysis of covariance, adjusting for baseline and age. Results Mean age was 65.0 (8.4) years, with 179.5 (223.5) months post-amputation and 80% transtibial amputation. No group difference in a 2 min walk test with an effect size: 1.53 95% CI [−3.17, 6.23] m. Activities balance confidence was greater in the WiiNWalk group by 5.53 [2.53, 8.52]%. No group difference in the four-step square test −0.16 [−1.25, 0.92] s, nor short physical performance battery 0.48 [−0.65, 1.61]. A post-hoc analysis showed the greatest difference in balance confidence immediately after an unsupervised phase. Conclusions The WiiNWalk intervention improved balance confidence, but not walking-related physical function in older adult lower limb prosthesis users. Future rehabilitation games should be specific to the amputation context. Clinical Trial Registration number, NCT 01942798.

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Lower Limb Prosthetic Rehabilitation in Canada: A Survey Study

Cited by 9 publications

References 20 publications

Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation

Factors Associated With Prolonged Length of Stay and Failed Lower Limb Prosthetic Fitting During Inpatient Rehabilitation

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

Group-based telerehabilitation intervention using Wii Fit to improve walking in older adults with lower limb amputation (WiiNWalk): A randomized control trial

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