OT for adults with Lower Limb Amputation: What is Best Practice?

Date: 08/03/2016 Host: @OT_Vicky

Vicky Leonard
Twitter: @OT_Vicky
Occupational Therapist at Nottingham University Hospitals
Student at the University of Nottingham, Masters is Research Methods (NIHR Funded).

Amputation of the lower limb is life changing both physically and emotionally and has consequences for daily functioning and quality of life. The aim of occupational therapy is to reduce the impact of amputation on the person’s functioning and to promote re-integration into activities of daily living and their environment (COT 2011). Through occupational therapy, people who have had a new amputation should be enabled to achieve the highest level of independence possible for them. This is important as hospital length of stay following surgery for lower limb amputation is often extended due to environmental or social issues and many of the patients in this group are elderly with co-morbidities. These are all factors which fall within the remit of occupational therapy.

Although clinical wisdom supports the role of occupational therapy in the acute setting for people with lower limb amputation (LLA), current literature does not confirm or refute this. Despite recommendations from the College of Occupational Therapists (COT), there are currently no primary research studies to support the effectiveness of occupational therapy rehabilitation for inpatients following LLA (Spiliotopoulou and Atwal 2011). What evidence there is does not explore the occupational therapist’s role in recovery and rehabilitation and most of the literature which currently exists originates from studies of people referred for prosthetic training to rehabilitation centres (Fleury et al 2013, Pernot et al 1997).

I am keen to start a discussion around what types of assessments and interventions OTs use for adults with LLA, what they feel is best practice and what they perceive to be the benefits and limitations of their current practice.

I am currently undertaking a Masters in Research Methods and my empirical work will specifically investigate current OT practice in the UK for adults with new LLA, with a view to sending out a survey to OTs who work in this clinical area.

References:

COT (2011) Occupational therapy with people who have had lower limb amputations: Evidence Based Guidelines, London: College of Occupational Therapists

Fleury, A M., Salih, S A., Peel, N M. (2013) ‘Rehabilitation of the older vascular amputee: A review of the literature’, Geriatrics Gerontology International, 13, pp. 264 – 273

Pernot, H F M., De Witte, L P., Lindeman, E., Cluitmans, J. (1997) ‘Daily functioning of the lower extremity amputee: an overview of literature’, Clinical Rehabilitation, 11, pp. 93-106

Spiliotopoulou, G. and Atwal, A. (2011) ‘Is occupational therapy practice for older adults with lower limb amputations evidence based? A systematic review’, Prosthetics and Orthotics International, 36 (1), pp. 7-14