Methods: Twenty-two participants (14 female, 8 male) with a mean-age of 42 years (SD?=?10?years) were recruited to take part in two focus groups. The participants reported a range of lower-limb amputations (i.e., congenital, acquired, transfemoral, trantibial, unilateral, and bilateral) and on an average were 5 years post-surgery (SD?=?7 years). Each focus group comprised of 11 participants and was moderated by either the first or second author. The moderator asked participants to discuss their everyday experiences of life with an amputation using Charmaz’s good day/bad day approach. Focus groups were transcribed verbatim and analyzed using an inductive thematic analysis.
Results: Four themes were identified: pain, organization and planning, the embodied experience after amputation, and interactions with others.
Conclusions: These themes provide a key resource for understanding daily fluctuations in physical, social, and psychological functioning.
- Implications for Rehabilitation
Lower limb amputation can result in daily fluctuations in physical, social, and psychological functioning.
These fluctuations can be illustrated through experiences of pain, planning and organization, embodied experiences, and interactions with others.
At a policy level, evaluations of daily living after an amputation should be based on a longitudinal assessment.
Methods: We included 42 patients with partial or complete single or multiple finger amputation of one hand who visited the outpatient clinic for prosthetics and orthotics at our institute and received a silicone prosthesis. We assessed their adjustment to amputation and prosthesis with the Trinity Amputation and Prosthesis Experience Scales (TAPES).
Results: Most of the patients (28, 67%) had a single finger amputated. The average scores on all TAPES subscales (except adjustment to limitation) were above 50% of the maximum possible score. On average, the scores were the highest on the general adjustment and satisfaction with the prosthesis subscales.
Conclusions: Silicone prostheses for finger amputation of upper limb play an important role in the process of adaptation to amputation. They offer aesthetically satisfying results and alleviate social interactions, which influences overall quality of life.
- Implications for Rehabilitation
Silicone prostheses for finger amputation of upper limb offer an aesthetically satisfying result and alleviate problems with social interactions.
Their influence on hand function is not optimal, but the prosthesis improves the amputee's quality of life.
Methods: A retrospective review of 338 patients who had undergone lower limb amputation was conducted to identify characteristics that affected the success of rehabilitation with a prosthetic limb. These data were used to devise an assessment tool (the BLARt score), which was then tested and validated in 199 patients planned to undergo lower limb amputation in two UK regional centers. Functional rehabilitation outcomes were recorded at 12?months after surgery using the SIGAM mobility grading.
Results: No patient with a BLARt score?≥13 achieved good functional outcome (defined as independent mobility, SIGAM grade E or F) and only 6 patients with a BLARt score?≥17 achieved any functional outcome (defined as any ability to walk unaided, SIGAM grade C or greater).
Conclusions: In the patient cohorts studied, the BLARt assessment tool was a strong predictor of whether or not patients would be able to walk with a prosthetic limb after surgery. It is simple to administer and could be useful in clinical practice to inform expectations for patients and clinicians.
- Implications for rehabilitation
Patients undergoing lower limb amputation face major physical and psychological challenges after surgery that have a considerable impact on rehabilitation and their ability to walk independently.
Many amputees are unable to walk with a prosthetic limb, but there are no validated tools to predict this before surgery.
The BLARt is a potentially valuable measure that can predict the likelihood of being unable to walk after amputation.
It is simple to use and could be useful to inform patients’ and clinicians’ expectations before surgery.
Materials and methods: A systematic search of relevant English language articles was performed using PubMed and EMBASE. Out of 310 initial “hits,” six retrospective cohort studies, one prospective cohort study and eleven cross-sectional studies from which fall incidence and risk factors could be extracted, were selected for critical review. Fall incidence and associated risk factors were extracted and analyzed in the context of various clinical stages of recovery after amputation. The studies were evaluated for quality using the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.”
Results: Results showed that during all stages of recovery, people with a LLA are at increased risk of falling compared with able-bodied individuals, as well as other clinical populations. Each stage of recovery is associated with different fall risk factors. The current review is limited mainly by the paucity of studies on the topic.
Conclusions: Specialised care focusing on the most relevant risk factors for each stage of recovery may enhance fall prevention during post-fall recovery.
- Implications for rehabilitation
? People with a lower limb amputation are at a high risk of falling in all stages of their clinical course.
? Health professionals should be aware that people with a lower limb amputation in the first 4 years ofamputation or with four or more health-related problems are at an increased risk.
? Health professionals should also be aware that increased gait variability, excess confidence in balance andwalking abilities and less cautious stair walking, impose an elevated risk of falling and should focus theirefforts in reducing these factors.
Method: This conceptual article uses reasoning, informed by experience and a nonsystematic review of literature across diverse disciplines.
Results: For some persons with disability, optimizing recovery might be unwanted or insufficient. To expand rehabilitation, we append the Latin “ultra”, beyond, to “habilitare”, make fit. The resulting term, “ultrabilitate”, commits to human flourishing that moves persons toward, around or beyond recovery of particular functioning.
Conclusions: By expanding the scope of disability management, ultrabilitation could inform therapy selection and facilitate human flourishing. Empirical research is needed to test our ideas.
- Implications for rehabilitation
Despite significant progress, rehabilitation limits some people with disabilities.
Modern health systems still benchmark therapy for rehabilitation against “normal” or species-typical standards to aid recovery.
“Ultrabilitation”, meaning “beyond fitness”, promotes flourishing, either without an interest in recovery or in moving toward, beyond or around recovery.
Biological, social and technological conditions are needed to support ultrabilitation.
Ultrabilitation complements rehabilitation when rehabilitation is not sufficient to optimize functioning and personal growth.
Method: Adults with lower limb amputation were convenience-sampled from a major metropolitan hospital outpatient amputee service and completed the International Physical Activity Questionnaire.
Results: Seventy-two individuals (65% male), mean age 53.6 (SD?=?16.8) years, who were 10.8 (SD?=?12.6) years post amputation (60% transtibial) participated in the study. Thirty-eight percent of participants (n?=?27) undertook “high” levels, 26% (n?=?19) undertook “moderate” levels, and 36% (n?=?26) undertook “low” levels of physical activity but cumulative activity levels were low. Participants most commonly undertook domestic-related activities (n?=?53, 74%) and moderate-intensity activities (n?=?54, 75%). Physical activity levels were found to be significantly lower amongst individuals who did not work, individuals with dysvascular amputation and individuals who lived with others. Physical activity levels showed a weak, significant, correlation to age (rs (70)?=??0.259, p?=?0.028) and time post amputation (rs (70)?=?0.237, p?=?0.049).
Conclusion: This study provides clinicians with information about physical activity participation amongst individuals with lower limb amputation. The majority of participants in this study (n?=?44, 61%) did not accumulate sufficient “total physical activity” to be classified as “sufficiently active” and 33% (n?=?24) of participants were classified as “sedentary”.
- Implications for Rehabilitation
Regular physical activity participation is associated with many health benefits.
This study found the majority of individuals with lower limb amputation (61%) did not undertake sufficient total physical activity to be classified as “sufficiently active”.
Health professionals working in rehabilitation can play an important role in encouraging individuals to increase physical activity participation.
The study’s findings may guide health professionals on where to direct their focus to promote increased physical activity participation amongst individuals with lower limb amputation.
Method: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test.
Results: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed.
Conclusion: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future.
- Implications for rehabilitation
Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty:
??Enhances quadriceps strength.
??Alleviates pain.
??Enhances range of motion.
??Does not have any effect on basic functional mobility.
??Does not have any effect on knee girth.
Objective: The aim of this study was to translate and adapt the scale and to test the translated version for comprehension and suitability in Danish general practice setting.
Design and method: The process involved forward translation, backward translation, and field tests. The field tests included cognitive debriefing interviews. In all 30 general practitioners and 5 non-general practitioners participated in the process of translation. After using the scale among 1652 general practitioners statistical analysis was carried out to test internal consistency.
Setting: The study was carried out in general practice in Denmark.
Results: Several changes made during the process in order to achieve a Danish version that is acceptable, understandable and still capable of measuring medical engagement comparable of the original English version. Analysis of scale internal consistency using Cronbach’s alpha revealed acceptable reliability for all three meta-scales, which ranged from 0.69 to 0.81. The overall tool achieved a Cronbach’s alpha of 0.89.
Conclusion: The Danish version of the Medical Engagement Scale is a valid and reliable tool that is acceptable and relevant for general practice in Denmark.
- Key points
This study describes the cross-cultural adaptation of the Medical Engagement Scale from a UK primary healthcare setting to a Danish primary healthcare setting.
The process produced a relevant and acceptable questionnaire measuring medical engagement.
Internal consistency revealed acceptable reliability
The translation of the scale provides the possibility to use this scale for practical and academic purposes.
Method: Ten databases were searched. Websites of organizations active in disability and children issues were also searched.
Results: Forty-eight studies met our inclusion criteria (11 qualitative, 29 quantitative, and 8 mixed-methods). The findings indicate that the impact of environmental risk factors on development might be ameliorated by providing disability-screening services, community-based interventions, targeted, and inclusive basic services. The review also identifies key barriers to supporting these children as stigma and discrimination. Key enablers include religious support and community education.
Conclusions: Comprehensive interventions from screening services to inclusive basic services are needed and collaboration from related stakeholders, also utilization of local resources is vital.
- Implications for Rehabilitation
Environmental risk factors threaten development of young children with disabilities in developing countries.
Screening services, community-based interventions, targeted and inclusive basic services are needed to address environmental risk factors.
Religious support and community education are key in addressing stigma and discrimination in developing countries.
Design: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo.
Setting: General practices in Denmark.
Subjects: Eight interviews were conducted with an average duration of 60?min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests.
Main outcome measures: Barriers and facilitators for future use of the HIT application for patients with LBP.
Results: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process.
Conclusion: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients’ self-management; and supports the patients’ needs.
- KEY POINTS
Online information is currently applied in general practice to some patients with low back pain
Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP
It is important to address both GP and patient barriers to applying new technology and to consider the literacy level
Participatory methods could play a central role in the future development of online information material
Methods: This case series includes three women with transradial amputation. Structured surveys and semi-guided interviews were administered after completion of in-laboratory training and a home trial of the DEKA Arm. A constant comparative method with a grounded theory approach was used to generate a model describing women’s decision-making related to the DEKA Arm. Quantitative data on prosthetic satisfaction was used to triangulate findings.
Results: Factors that enhanced desirability of the DEKA Arm were improved functionality, increased abilities and the availability of someone to service the prosthesis. Factors that detracted from desirability of the device were its appearance, conspicuousness, lifestyle incompatibility, weight, need for service and difficulty of use. Each woman weighted these factors within the larger context of the capabilities of and satisfaction with her personal prostheses, her self-concept and lifestyle needs. Situational demands, particularly the desire to appear feminine and professional or need to perform certain activities, also altered the valuation of these priorities.
Conclusion: Findings strongly suggest that advanced upper limb prosthetic technologies, like the DEKA Arm, will be better accepted by women if appropriately gendered in appearance and designed with women’s priorities in mind.
- Implications for Rehabilitation
Women should be able to derive the functional benefits of advances in upper limb technology without needing to compromise their feminine identity and lifestyle preferences.
Advanced upper limb prosthetic technologies will be better accepted by women if they are appropriately gendered.
Materials and methods: We conducted five focus groups involving 29 professional (e.g., speech pathologists, teachers), paraprofessional (e.g., childcare workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim and analysed using thematic analysis.
Results: Two central themes, comprising six categories, emerged to account for the participants’ views. Initiative and Effort accounted for the range of creative strategies staff had developed to support their engagement in EBP. They also expressed the need for A Better Way involving organisational-wide support such as this engagement, including peer-to-peer mentoring.
Conclusions: The findings suggest that an organisational-wide model to support engagement in EBP, with peer-to-peer mentoring at its foundation, may provide a desirable, ecologically valid, and acceptable model.
- Implications for Rehabilitation
Clinicians and educators recognise the importance of evidence-based practice.
Efforts to support evidence-based practice have focused mostly on access to research evidence.
Clinicians and educators in this study were developing their own strategies based on intuition.
They identified a need for organisation-wide approaches to supporting evidence-based practice.
Peer-to-peer mentoring appears to be an acceptable and viable strategy.
Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.
Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.
Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.
- Implications for Rehabilitation
People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.
Research supports problem solving skills training following brain injury.
Assistive technology for cognition (smartphones, selected apps) offers a means of
supporting problem solving for this population.
This project demonstrated the feasibility of a web-based programme to address this need.
Design: Qualitative and semi-structured interviews.
Setting: Australian burn and rehabilitation units.
Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.
Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.
Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.
- Implications for rehabilitation
Burn care and rehabilitation remains a complex and challenging area of care.
Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.
Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.
Material and methods: Forty-nine interviews were conducted with 31 individuals with intellectual disabilities.
Results: Findings showed that military service helped develop the identity of soldiers, which enhanced their self-efficacy. Participants described their participation in the military as an opportunity to take an active part in socially valued roles.
Conclusions: Findings are discussed with reference to the effect of the project on the self-identity of individuals with intellectual disabilities. The meaning of successfully serving in socially valued roles for self-efficacy is discussed.
- Implications for rehabilitation
Completing socially valued roles leads to greater self-efficacy, enhanced self-esteem and greater psychological well-being among individuals with intellectual disabilities.
Inclusion of individuals with intellectual disabilities within a central community setting (specifically the military) allows them to deal with issues of identity development, as it does for other young people without intellectual disabilities.
Receiving ongoing positive input from others for one’s abilities and success is a conducive factor in positive identity formation.
Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.
Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.
Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.
Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
- Key points
The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.
This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system
The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
Minor problems with measurement structure should be addressed in future revisions of the MDI.
Methodology: Fifty-two in-depth interviews were conducted with people with various types of disabilities. These interviews were conducted in four districts in Malawi: Blantyre and Phalombe in the Southern Region; Ntchisi in the Central Region, and Rumphi in the North. A team of trained research assistants conducted the interviews.
Results: The major challenges that people with disabilities experience include the cost of accessing health care, long distances to health facilities, lack of transport, hilly terrains and flooding of rivers during the rainy season, communication challenges with the health providers and poor attitude of health workers. Some of these challenges are not unique to people with disabilities, but constitute more of a problem among people with disabilities.
Conclusion: There is a need to address these challenges through the expansion of the provision of assistive devices, implementing comprehensive outreach services targeting people with disabilities and strengthening the links between key component of access to quality health care. Attitudinal barriers and lack of resources remain major challenges.
- Implications for rehabilitation
Though people with disabilities face challenges accessing health care world-wide, the challenges are greater in low-income countries. The current study in Malawi confirms this.
Major challenges include costs of care, transport costs, and inaccessible facilities.
Lack of health worker awareness and attitudinal barriers are major issues of concern.
It is imperative, given this situation, that effort is spent in Malawi and similar contexts on dealing with issues of stigma and discrimination especially in the health care sector.
It is also important to explore cost-effective ways of assisting people with disabilities accessing appropriate transport, which should be seen as part of the healthcare system.
Though the cost of providing equitable care may be high in low-income contexts, this is a human right. Training and creating an accessible and disability-friendly service environment is a key priority.
Materials and methods: The study group consisted of 88 patients, including 48 people with dementia and 40 people without dementia. Before and after physiotherapy, the Mini Mental State Examination and Barthel Index were used.
Results: Elderly patients without dementia achieved a greater improvement in functional status. The level of cognitive functioning at the time of admission to a nursing home, but not the patient’s functional status, had a significant impact on physiotherapy efficacy.
Conclusion: Understanding the role of dementia in the rehabilitation process is important for care planning. More research is required to ascertain the efficacy of physiotherapy in people with moderate to severe dementia, including the best strategies to improve their functional status.
- Implications for Rehabilitation
The level of cognitive function is important in the rehabilitation process, and it influences effectiveness of physiotherapy.
Physiotherapy efficacy in the group of patients with coexisting dementia is lower than that in patients without dementia.
Regular physiotherapy can also improve functional status in patients with coexisting dementia.
The results of the study may have utilitarian implications, leading to a change in therapy regimens at physiotherapy centres treating disabled chronically ill people with coexisting dementia.
Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.
Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.
Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.
Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
- Key points
The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.
This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system
The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
Minor problems with measurement structure should be addressed in future revisions of the MDI.