Factors influencing participation in physical activity after dysvascular amputation: a qualitative meta-synthesis

Abstract

Purpose: Identifying factors associated with physical activity after dysvascular lower limb amputation (LLA) could provide targets for improving rehabilitation outcomes. The purpose of this meta-synthesis was to identify modifiable factors that may influence physical activity after LLA, a condition characterized by amputation in the setting of older age, diabetes mellitus (DM), and/or peripheral artery disease (PAD).

Methods: A systematic search of the literature identified qualitative studies exploring the perceptions of physical activity in people with lower limb amputation, older age, DM, or PAD. Qualitative rigor was assessed using the McMaster University’s Guidelines for Qualitative Review. Meta-synthesis was undertaken to analyze the findings of included studies.

Results: Fourteen studies of variable methodological quality were included for analysis. Three overarching factors that may influence physical activity after LLA emerged: 1) educational experiences and motivation, 2) support and self-efficacy, and 3) special concerns after lower limb amputation (e.g., prosthesis, equipment, and environment).

Conclusions: Physical activity after LLA is influenced by relationships among health understanding, motivation, support, and self-efficacy in the presence of disability. Themes from this meta-synthesis can be used to develop and test behavior-based interventions to improve physical activity after LLA.

Implications for rehabilitation

• Physical activity participation after dysvascular lower limb amputation is complicated by the presence of chronic conditions, severe disability, and unaddressed psychosocial factors.

• Addressing a patient’s self-efficacy, social support, motivation, and understanding during physically focused rehabilitation may improve participation in physical activity after dysvascular lower limb amputation.

• Rehabilitation professionals can address self-efficacy, motivation, and understanding by using collaborative, empathetic communication strategies known to enhance a patient’s sense of support.

Keywords:

• Dysvascular amputation
• chronic disease
• qualitative meta-synthesis
• physical activity
• behavior

Disclosure statement

This material is the result of work supported with resources and facilities of the VA Eastern Colorado Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Additional information

Funding

This work was supported by the National Institutes of Health [NIH K12 HD055931] and the Foundation for Physical Therapy [Promotion of Doctoral Studies Scholarship].