Identifying successful outcomes and important factors to consider in upper limb amputation rehabilitation: an international web-based Delphi survey

Abstract

Purpose: To identify and gain agreement on successful outcomes of and important factors to consider in rehabilitation following upper limb absence (ULA). Method: Fifty-three participants consisting of multi-disciplinary rehabilitation professionals, and individuals with ULA were invited to complete a three-round modified Delphi iterative survey. Following three Delphi questionnaire rounds, participants clarified the definitions of success in three areas (prosthesis use, activities and participation and self-image). In addition, participants identified and agreed the important factors to consider in rehabilitation after ULA. Results: Results showed that participants reached agreement (having a SD <1) over the three rounds on 78 out of 81 rated items. Of these, 54 rated items were “accepted” as important by panel members (mean score of 4 on a five-point Likert scale). Twenty-four items were rejected. Only three rated items had not reached agreement by the third round. Conclusions: Clarification of successful outcomes and factors that should be taken into consideration in a patient’s rehabilitation allows a clearer evaluation of what should be the focus of rehabilitation. The findings from the Delphi study can help form the basis for a screening tool for clinicians to be able to identify areas of concern and subsequent treatment for a patient in their care.Implications for RehabilitationTo date, there has been no definitive guidance on which outcomes should be assessed in amputation rehabilitation.This study identified the seven core domains of importance regarding the rehabilitation of individuals with ULA and created a starting point for developing a new portfolio of research that aims to address all relevant aspects of patients’ rehabilitation.This study reached a consensus and enabled an insight into what defines successful prosthesis use, self-image and activities and participation, and provided evidence that the current definition of prosthesis use in the literature does not sufficiently capture what RPs and individuals with ULA consider important, such as specific use of the prosthesis, as often as an individual wishes, while using it as intended.This study provided RPs and individuals with ULA an opportunity to communicate their opinions and knowledge anonymously regarding the important areas to consider in rehabilitation.