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Study Examines Impact of Prosthetic Feet on Participation in ADLs

The published literature describes mobility problems people may experience after undergoing lower-limb amputations, yet there have been few published accounts of peoples’ participation experiences at home or in the community. To this end, a team of researchers undertook a study to increase understanding of the impact of prosthetic feet on participation in activities of daily living (ADLs) by examining the experience of prosthetic users and professionals. Their study was published in the October 2016 issue of the Journal of Prosthetics and Orthotics.

Users of prosthetic feet and healthcare professionals who prescribe prosthetic feet were invited to complete a brief online questionnaire before participating in one of five focus groups. In total, 11 prosthetic foot users and 11 professionals completed the online questionnaires, and 16 prosthetic foot users and 11 healthcare professionals took part in focus groups.

Although the prosthetic foot users rated their difficulty with usual activities as none to slight, 36 percent reported falling within the prior six months and 45 percent indicated that they modified their participation because of the potential for falls. There was a significant overlap in themes discussed by prosthetic foot users and healthcare professionals. Identified barriers to full participation included the ability to stand for extended periods, navigate in confined spaces, carry heavy objects, and change body posture. Absence of sensory feedback created significant concerns about safety when driving a car, navigating uneven terrain, and climbing ladders. Characteristics of existing prosthetic feet that impact participation included limited durability, lack of waterproofing, and limited range of motion. Current designs limited choices of footwear and created difficulties donning and doffing shoes.

Given the results, the researchers concluded that participants’ reported confidence in forward walking on even ground suggests that current prosthetic feet are well-suited for this limited use. However, the participants also identified a number of situations in which their current prosthetic feet caused significant difficulties, often with safety implications. While stories about problems such as rocks on the sidewalk are consistent with the literature, stories describing such problems as climbing ladders and stepstools are not well documented.

“Our study highlights the utility of focus groups in identifying previously unrecognized needs and concerns, with significant implications for the design of prosthetic feet. Future studies should include more diverse participants, particularly with regard to age and overall physical health,” said the study authors.