Factors influencing physical activity among individuals with lower limb amputations: a qualitative study

The purpose of this study was to explore the barriers and facilitators to physical activity from multiple stakeholder perspectives including individuals with LLA and health professionals. A qualitative descriptive study situated within an interpretive research paradigm was conducted. Semi-structured interviews were held with individuals with LLA recruited from rehabilitation hospitals in a metropolitan city in Canada. Health professionals with experience in amputation care were recruited from across Canada. Data were analysed using codebook thematic analysis. Thirty-three individuals with LLA and eighteen health professionals participated. Six themes were generated which represent the perceived barriers and facilitators to physical activity. Themes including Informal and Formal Supports, Availability of and Access to Community Resources, and Fit and Function of the Prosthesis were perceived by many individuals as facilitators, while acting as a barrier for others depending on an individual’s circumstances. These findings provide us with a basis of understanding from which we can begin addressing barriers to physical activity for individuals with LLA, in support of developing patient-centred interventions and physical activity programs for this population. IMPLICATIONS FOR REHABILITATIONIrrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity.Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation.A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient’s motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change.The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals. Irrespective of amputation etiology, individuals who have lower limb amputation experience several barriers to engaging in physical activity. Many system-level barriers to physical activity exist for people with lower limb amputation, which include lack of availability and access to community resources and specialised prostheses conducive to physical activity participation. A participatory approach engaging both patients and rehabilitation professionals can address the patient-provider discordance with respect to a patient’s motivation and attitude towards physical activity participation by creating a supportive environment conducive to behaviour change. The development of future, patient-centered interventions, and physical activity programs for individuals with lower limb amputation must consider fear of falling as a prominent barrier to physical activity and devise potential strategies to address this barrier, by setting realistic and actionable goals.

本研究旨在从多利益相关方视角探究体育活动的阻碍因素与促进因素，研究对象涵盖下肢截肢（lower limb amputation, LLA）患者与医疗卫生专业人员。本研究采用诠释性研究范式下的质性描述性研究设计，招募了加拿大某大都市康复医院的下肢截肢患者，以及加拿大各地具备截肢护理经验的医疗卫生专业人员，对其开展半结构化访谈。研究采用编码手册主题分析法对数据进行分析，最终共有33名下肢截肢患者与18名医疗卫生专业人员参与本研究，提炼出6个用以反映体育活动相关感知阻碍与促进因素的主题。其中，非正式与正式支持、社区资源的可获得性与可及性，以及假肢的适配性与功能，被多数患者视为体育活动的促进因素，但也有部分患者因自身情况将其视作阻碍因素。本研究结果为理解下肢截肢患者的体育活动阻碍提供了基础，可为该人群制定以患者为中心的干预措施与体育活动方案提供支撑。

康复领域启示
无论截肢病因如何，下肢截肢患者在参与体育活动时均面临多重阻碍。下肢截肢患者的体育活动存在诸多系统层面的障碍，包括社区资源与适配体育活动的专用假肢的可获得性及可及性不足。采用患者与康复专业人员共同参与的参与式方法，可通过构建有助于行为改变的支持性环境，解决患者与医疗服务提供者在患者参与体育活动的动机与态度方面的认知分歧。未来为下肢截肢患者制定以患者为中心的干预措施与体育活动方案时，需将跌倒恐惧视为体育活动的主要阻碍因素，并通过设定切实可行的目标制定针对性解决策略。

无论截肢病因如何，下肢截肢患者在参与体育活动时均面临多重阻碍。下肢截肢患者的体育活动存在诸多系统层面的障碍，包括社区资源与适配体育活动的专用假肢的可获得性及可及性不足。采用患者与康复专业人员共同参与的参与式方法，可通过构建有助于行为改变的支持性环境，解决患者与医疗服务提供者在患者参与体育活动的动机与态度方面的认知分歧。未来为下肢截肢患者制定以患者为中心的干预措施与体育活动方案时，需将跌倒恐惧视为体育活动的主要阻碍因素，并通过设定切实可行的目标制定针对性解决策略。