‘A whole different ball game’: the qualitative experience of older adults with a transtibial amputation and the use of a self-aligning prosthetic ankle-foot on the STEPFORWARD trial

Abstract

Background

Older patients with lower limb amputation, categorised as having “limited community mobility”, are under-researched. Understanding their experience with a new prosthetic ankle-foot is important when designing clinical trials. The aim of this qualitative study was to explore the adjustments they made after amputation and the acceptability of a self-aligning ankle-foot (SA-AF) to older adults.

Methods

Fourteen participants, who took part in the STEPFORWARD randomised controlled feasibility trial (ISRCTN15043643), were purposively recruited; nine were intervention participants and five were standard care participants. They were asked to reflect on their life prior to and consider the adjustments they made following their amputation. Participants in the intervention group were also asked about their views of the new SA-AF compared to their standard non-SA-AF. A thematic analysis was undertaken.

Results

Three broad themes were identified: The impact of the amputation; Role of clinical support; and Experiences of the SA-AF. The findings tell a narrative of the long-term impact that amputation has on these individuals’ lives. Participants randomised to receive the SA-AF were very positive about it, reporting less pain, greater mobility and being able to do more.

Conclusion

Participants who used the SA-AF found it an acceptable intervention. These findings suggest that a full-scale RCT is warranted.

IMPLICATIONS FOR REHABILITATION

• There is a high degree of acceptability among an older patient group with a transtibial amputation to use a self-aligning ankle foot.

• Patients reported experiencing better mobility and more prosthetic comfort with the self-aligning ankle-foot.

• Key outcomes important to participants include engagement in social and daily activities and balance confidence.

Keywords:

• Transtibial amputation
• self-aligning prosthetic ankle-foot
• vascular disease
• limited mobility
• a qualitative study

Acknowledgements

The authors wish to thank all the participants in this study who generously gave their time and shared their experiences with the team.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the NIHR Research for Patient Benefit [grant number PB-PG- 0816-20029].