Optimising the prescription and use of lower limb prosthetic technology: a mixed methods approach
Schaffalitzky, Elisabeth Manon (2010) Optimising the prescription and use of lower limb prosthetic technology: a mixed methods approach. PhD thesis, Dublin City University.
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Aim: Lower limb amputation is an increasingly prevalent surgical procedure in the Western world due to the increase of peripheral vascular disease. Not everyone who
receives a prosthetic limb will benefit from its use and may abandon this expensive technology, a move which may negatively effect their adjustment to the amputation
and also impact on their quality of life. There is currently no consensus on the most important outcomes to measure in lower limb prosthetic rehabilitation, or on the
specific outcome measures to be consistently used in prosthetic rehabilitation. The aim of this research is to explore ways to optimise lower limb prosthetic prescription
by identifying and gaining a consensus on 1) the most important outcomes of prescription, 2) the most important predictors of prosthetic use, and 3) the most important factors which have an effect on optimising use of the prosthesis.
Method: This is a mixed methods study. Repertory grid interviews were conducted with 2 lower limb prosthesis users to explore the values and preferences that
prosthetic users have of their prosthetic devices; to investigate users’ perceptions of alternative prosthetic options and to demonstrate a novel method for exploring the
values and preferences of lower limb prosthetic users. Semi-structured interviews were undertaken with 12 multidisciplinary service-providers within the amputation
rehabilitation setting, and 6 focus groups were completed with 24 prosthesis users to identify the outcomes and predictors of prosthetic prescription from both the patient
and professional perspective. This data was then used to create a Delphi survey of 23 experts within the amputation and prosthetic field, including users, service providers
and academics, to develop a consensus on the most important factors to address within the prosthetic prescription process.
Findings: The repertory grid interviews highlighted the need to include patient choice and opinion in the prosthetic prescription process, while the focus groups and
interviews identified the outcomes and predictors of prosthetic prescription while ascertaining what other factors affect optimal use of the prosthesis. These factors
were physical, psychological and social in nature, and in particular, showed how service provision affects optimal use. A consensus on the most important factors to
address in the fitting process and service was then established in the Delphi study.
Conclusion: By combining user and practitioner knowledge throughout the study, this research has developed a list of the essential elements to be monitored and improved in prosthetic prescription to improve outcomes, as well as highlighting the importance of patient inclusion and choice within the rehabilitation setting. This research indicates how fitting centres can potentially improve the service with the hope of improving fitting rates and user satisfaction and reducing the waste of medical resources.
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