Clinicians' perspectives on decision making in lower limb amputee rehabilitation
Sammanfattning
OBJECTIVE: Decision making within amputee rehabilitation includes the assessment of whether
a patient is suitable for a prosthesis and if so, what components to provide. This study seeks to
increase understanding about clinicians’ perspectives on what factors influence these decisions.
Method: One-to-one semi-structured interviews were completed with 23 experienced clinicians at their
place of work at 4 UK amputee rehabilitation centres. Thematic analysis using a theoretical, semantic
approach was used to identify key themes from the data.
RESULTS: Four key themes were identified: estimating outcome; difficulties predicting outcome;
patient choice and barriers to prescribing. There was variation in the importance placed on each
theme between individual clinicians and services, with factors such as budget and risk aversion
acting as barriers to prescribing. Only one of the 4 centres used formal prescribing guidelines.
CONCLUSION: The results highlight the difficulties clinicians experience in estimating outcome and
suggest inequity of prosthetic provision in the UK, with variation in the provision of high cost items.
The development of national prescription guidelines is suggested to improve equality of prosthetic
provision.