Physical Therapy after Amputation in Community Dwelling Older Adults: A Quantitative and Qualitative Interview Study

Purpose/Hypothesis: To investigate participation in physical therapy in older adults after lower extremity limb loss. The secondary objective was to examine the associations between physical therapy attendance, fear of falling avoidance behavior, self-perceived prosthetic mobility, and mental well-being. Number of Subjects: 64 Materials and Methods: Community-dwelling older adults with amputation were recruited and individually interviewed. The data collection consisted of four surveys (Physical Therapy after Amputation Patient Perception Survey, Short-Form Health Survey [SF-36v2], Prosthetic Evaluation Questionnaire [PEQ, mobility group], and Fear of Falling Avoidance Behavior Questionnaire [FFABQ]). Participants\u27 demographic characteristics were analyzed using descriptive statistics. Participant comments were qualitatively categorized. Pearson Correlations were used to examine the associations between perceptions of physical therapy (10-point visual analog scale), fear of falling avoidance behavior as well as mental health and wellbeing (SF-36v2 mental health subscale). Correlation analyses were also conducted to analyze the associations between participant perception of physical therapy treatment and the patient-perceived confidence in performing functional activities. Results: Of the 64 participants who completed the study, the mean age was 66.9 (10.7) years with 47 males and 17 females. After amputation, 79.4% of the participants received physical therapy, of them 84% expressed a positive experience. The main reasons for the positive perceptions of physical therapy including achieving beneficial outcome and socioemotional support. The main negative comments included poor outcome, pain, socioemotional conflict, and external barriers such as difficulty in transportation and insurance. Significant positive correlations were observed between perception of physical therapy and selected prosthetic mobility items (walking on the street and shower/bathe; p=0.04 and 0.03, r= 0.432 and 0.453, respectively). Perception of physical therapy and FFABQ were not significantly correlated (p=0.355). Significant negative correlation between mental well-being score and FFABQ score were observed (r=-0.578, p\u3c0.001). Conclusions: A high percentage of community-dwelling older adults received physical therapy after amputation, and most of them expressed positive experiences. Positive perception of physical therapy is related to higher confidence in walking outdoors and showering/bathing. Lower mental well-being is associated with increased fear of falling avoidance behavior. Clinical Relevance: While community-dwelling older adults with limb loss generally received and expressed a positive perception of physical therapy after their amputations, patient goal-directed intervention may be needed to achieve desirable outcomes and to improve selected activity function. Physical therapists should be aware of the barriers to rehabilitation after amputation and the connection between mental health issues and fear of falling avoidance behavior in this population