Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation.

OBJECTIVE: To evaluate the frequency and extent of prosthetic use by people with lower limb amputation and identify factors that facilitate prosthetic use. DESIGN AND SETTING: Five-year follow-up survey using the Prosthetic Profile of the Amputee (PPA) questionnaire and Dillman's mailing strategy. SUBJECTS: Adults with unilateral transtibial and transfemoral amputation (n = 396) who had completed a prosthetic training program. MAIN OUTCOME MEASURES: Frequency of prosthetic wear, in hours per week, and active prosthetic use for locomotion indoors and outdoors. RESULTS: Eighty-five percent of the respondents (mean age 62.9+/-15.9yrs) were prosthetic wearers; 53% used their prosthesis for locomotion indoors, and 64% outdoors. Ability to don the prosthesis (p < .001), locomotor capabilities with the prosthesis (p < .001), walking distances (p < .001), automaticity of gait (p < .05), and assistive devices used (p < .001) were the main factors related to the three outcome measures. People with transfemoral amputation reported greater difficulties in donning their prosthesis (p < .01) and a significantly higher rate of falls (p < .001). CONCLUSION: The majority of people with lower limb amputation wear their prosthesis daily. With the exception of resources (prosthetic laboratory and means of transportation), all enabling factors investigated were significantly associated with the outcome measures.

Prosthetic profile of the amputee questionnaire: validity and reliability.

The Prosthetic Profile of the Amputee (PPA) is a clinical follow-up questionnaire that measures the factors potentially related to prosthetic use and the actual use of the prosthesis by people with a lower extremity amputation. This profile is a report on the psychometric properties of the questionnaire. The PPA was administered, on two occasions, to 89 adults with lower extremity amputations. Test-retest data analysis demonstrated that the questionnaire was reliable in terms of repeatability. Strong test-retest agreements were obtained. When the PPA was assessed against the Reintegration to Normal Living (RNL) index, results supported the presence of construct validity. Data confirmed convergence of analogous constructs of the PPA questionnaire and the RNL index and showed evidence of discrimination between the more distantly related constructs. Based on the results of this study, we conclude that the PPA questionnaire is reliable and valid for clinical and research use.

Prosthetic profile of people with lower extremity amputation: conception and design of a follow-up questionnaire.

A questionnaire, the Prosthetic Profile of the Amputee (PPA), is described both in terms of its conceptualization and design. The objectives of the questionnaire (mail and telephone versions) were to evaluate and to determine the factors potentially related to prosthetic use by a person with a lower extremity amputation after discharge from rehabilitation. The PRECEDE theoretical model (Predisposing Reinforcing and Enabling Causes in Educational Diagnosis and Evaluation) was adapted to the present study and served as a guide for the conceptual basis of the instrument. A multidisciplinary group of 13 experts and another group of eight persons with lower limb amputation were involved in the identification, classification, and priority rating of the factors related to prosthetic use. The design of the questionnaire was structured according to Dillman's Total Design Method. To ensure the content validity of the instrument, the pertinence of each question with regard to the questionnaire's objectives was assessed by the group of experts. Pretesting of the questionnaire was then conducted with a random sample of 26 people with lower extremity amputations. The preliminary version of the instrument has already demonstrated the potential for clinical and research use.