Development of a co-created online self-management program for people with lower limb loss: self-management for amputee rehabilitation using technology (SMART)

Abstract

Purpose

To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART).

Materials and methods

We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial.

Results

Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning.

Conclusions

Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies.

Implications for rehabilitation

• Learning new coping strategies and habits are essential after lower limb loss.

• Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery.

• Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer.

Keywords:

• Telemedicine
• amputation
• lower extremity
• prosthesis
• self-care
• information

Disclosure statement

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

Additional information

Funding

This study was funded by the Vancouver Coastal Health Research Institute (VCHRI) [Grant Number: F18-02260 for Self-Management for Amputees using Rehabilitation Technology (SMART)] and Canadian Institute of Health Research (CIHR) [Grant Number: 438258 for Self-Management for Amputee Rehabilitation using Technology (SMART) program: A peer supported mHealth approach for rehabilitation after lower limb amputation]. We acknowledge two years doctoral support for Elham Esfandiari from AGE-WELL: Canada’s Technology and Aging Network. Associate professor Mortenson is supported by a New Investigator Award from the Canadian Institutes of Health Research. Professor Ashe gratefully acknowledges the support of the Canada Research Chairs Program.