Public defence: Vegar Hjermundrud

People with unilateral lower limb loss (LLL) experience mobility impairments postamputation, making prosthetic mobility important for independence and health-related quality of life (HRQoL).

Comprehensive multimodal prosthetic rehabilitation is recognized as an important factor in the effort to regain mobility and HRQoL.

However, a literature review revealed a substantial knowledge gap regarding how comprehensive multimodal prosthetic rehabilitation affect mobility and HRQoL among prosthetic users.

Aim

The thesis aimed to examine the effects of a four-week rehabilitation program on mobility and HRQoL in new (NEW-INT) and experienced (EXP-INT) prosthetic users and explore the experiences of long-term prosthesis users influencing prosthetic mobility and the resulting impact on independence

Method

Three papers with distinct methodologies were included. Papers I and II employed quantitative designs to evaluate a four-week comprehensive individualized rehabilitation program at a specialized inpatient clinic.

NEW-INT consisted of first-time prosthesis users, while EXP-INT had at least one year of prosthetic experience. Testing was conducted before and after the intervention, with a control group (EXP-CON) undergoing testing at an interval of four weeks without intervention.

Outcome measures, guided by the International Classification of Function, Disability, and Health (ICF), assessed functional mobility and HRQoL.

Paper III adopted qualitative methods, analyzing focus group interviews with experienced prosthesis users using Systematic Text Condensation to capture their lived experiences.

Results

After four-weeks of rehabilitation, NEW-INT demonstrated significant and clinically relevant improvements across all mobility measures, as reported in paper I. The EXP-INT group improved significantly in the main outcome measure PLUS-M but only showed negligible changes in other measures of functional mobility, walking speed, walking length, and activity level.

EXP-CON showed no substantial change. In paper II, the impact of the same four-week rehabilitation on HRQoL was assessed. The NEW-INT group improved significantly and clinically relevant while EXP-INT or EXP-CON did not change notably.

At discharge, both intervention group showed considerably reduced walking speed, walking length, and activity level compared to normative results from the same age groups, indicating an unmet rehabilitation need. Paper III revealed that experienced prosthesis users valued prosthetics for mobility, independence and HRQoL.

However, they expressed frustration because this mobility was fragile and partially depended on factors they could not control, such as functioning prosthesis and the availability of necessary assistive devices.

Furthermore, they identified a knowledge gap among generalist healthcare professionals concerning the special needs of people with LLL, a void partly filled by peers sharing their skills and expertise.

Discussion

The NEW-INT group demonstrated expected gains while EXP-INT did not. The EXP-CON group did not change.

The exercises presented to the groups were the same with individualization taking place, the intensity was perceived as approximately equal, and the attendance were similar.

Other plausible explanations for the difference may be a plateau in training response in EXP-INT, changes in perceptions of importance, differences in individual responses or small samples indicating the study were not sufficiently powered.

However, the results from paper III suggest that improvements in functional mobility might be less important for experienced prosthesis users when basic prosthetic mobility is accomplished.

Applying the principle of diminishing returns, efforts to improve physical capability may be perceived as less important. Instead, solutions like prosthetic components, assistive devices, and the benefits of peer expertise, might offer greater functional gains with less effort.

Conclusion

The different outcomes in NEW-INT and EXP-INT indicate that research is needed to investigate the different needs of these groups and decide whether a similar rehabilitation program can trigger a comparable effect or if the groups are so different that an altogether differentiated rehabilitation approach is needed to provide an equally beneficial result.