Feasibility of self-management for amputee rehabilitation using technology and peer support for improving walking and confidence in individuals with lower limb loss

Abstract

Background: Individuals with lower limb loss (LLL) require self-management education for amputation adaptation. eHealth technologies, like online platforms, widen access to educational resources. We developed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART). Objective: To assess the feasibility of SMART for improving walking capacity and confidence for adults with recent LLL. Study Design: A single-group pre-post intervention design. Methods: We recruited community-dwelling adults, with unilateral, transtibial, or transfemoral amputation. Self-management for amputee rehabilitation using technology included 6 weekly online educational modules, for example, pain management, diet, and sock management, and 6 weekly online meetings with a peer mentor to discuss goal setting and action planning. Outcomes were assessed at baseline (before SMART) and after 6 weeks using SMART. Feasibility indicators included process (retention rate), resource (duration of training sessions), management (participant processing), and treatment issues (effect size). The primary clinical outcome was walking capacity measured using Timed Up and Go, and secondary outcome was walking confidence measured using the Ambulatory Self-Confidence Questionnaire. Results: Twelve participants were recruited. The median (range) age was 56.0 (26–79) years. The retention rate was 100%. All participants were trained in less than 15 min. Four participants had an enrollment delay of more than 10 days. Two participants reported noninjurious falls because of amputation comorbidities and increased activity. The effect sizes for walking capacity and confidence were 0.51 and 0.86, respectively. Conclusions: Only small intervention and protocol refinements are required to SMART. These will be incorporated for a future multisite randomized controlled trial. SMART is an eHealth education program for people with LLL. Self-management for amputee rehabilitation using technology with peer support is a feasible intervention. However, adjustments to the study protocol and intervention safety are necessary before proceeding with the evaluation of SMART in a larger study.