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Persons with lower limb loss (PwLLL) must self-manage their residual limb and their prosthesis to prevent self-management related complications (SMRC). However, the experience of PwLLL as it relates to self-management has not been reported. Thus, the purpose of this study was to explore the experience of self-management from the perspective of PwLLL, prosthetists, and physical therapists. This study had a qualitative design. Twenty-three participants were interviewed (PwLLL = 10, prosthetists = 7, physical therapists = 6). Interviews were transcribed and then coded using constant comparison. Four prominent themes were developed from the transcripts: (1) embodying the duty of self-management, (2) being a vigilant self-advocate, (3) setting goals collaboratively, and (4) making informed decisions. Each of the four themes were influenced by the health beliefs of the PwLLL, specifically motivation and presence of an internal locus of control. Clinicians should emphasize the therapeutic relationship, including open communication, collaborative goal setting, and promoting an internal locus of control in interactions with PwLLL, as it may play a role in decreasing SMRC and improving clinical outcomes. Self-management is a crucial aspect of preventing secondary complications associated with limb loss and prosthesis use. Self-management requires an internal locus of control, problem-solving abilities, and foundational knowledge Clinicians can promote self-management through collaborative goal setting and systematic education. [ABSTRACT FROM AUTHOR]

Health care economic science holds great potential for improving the quality of lower-limb prosthetic care. To realize this potential, health care providers need to adopt an outlook that economic analysis is not strictly limited to the scrutiny of cost, but includes a better understanding of the value generated in the provision of lower-limb prostheses. Health care providers in the United States currently have a negative perception of cost containment efforts implemented by regulators to rein in health care spending. The United States currently spends more on health care than any other developed country (17.9% of GDP; National Health Expenditure Projections 2017-2026. Centers for Medicare and Medicaid Services; 2017), whereas other countries have reduced cost and increased quality of care through health care economic science. The clinical outcome of restoring mobility and independence to a person with lower-limb amputation has an appreciable impact on quality of life. By measuring the quality improvement and comparing costs associated with available lower-limb prosthetic alternatives, health care economic science can improve decision making regarding the best use of resources and improve the overall value of care. Although limited economic evidence exists concerning lower-limb prostheses, a better understanding of the purpose of health care economic science can lead health care providers to contribute to the economic research that is needed. [ABSTRACT FROM AUTHOR]

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence based prescription guidelines and clinician training in wheeled mobility technologies. [ABSTRACT FROM AUTHOR]

Background: Individuals with lower limb amputation are routinely assessed with a variety outcome measures, however there is a lack of published data to indicate minimal clinically important differences (MCID) for many of these outcome measures. Three such important gait-specific outcome measures include walking velocity, gait profile score (GPS) and the two minute walk test (2MWT)., Research Question: Determine the MCIDs for walking velocity, GPS and 2MWT for individuals with lower limb amputation., Methods: Walking velocity and GPS (n = 60), and 2MWT (n = 119) data for individuals with unilateral transfemoral or knee disarticulation were identified retrospectively from a database held at the study centre. An anchor-based method was used with Medicare functional classification level (MFCL) acting as the impairment-related criterion, and a least-squares linear regression approach was used to calculate the gradient required for a change between MFCL levels., Results: An increase of 0.21 m/s (95 % CI: 0.13,0.29) for walking velocity, a reduction of 1.7° (95 % CI: -2.449,-1.097) for GPS and an increase of 37.2 m (95 % CI: 28.8,45.5) for 2MWT were found to correspond to an increase in MFCL of one level. Walking velocity, GPS and 2MWT correlated with MFCL with R 2 values of 0.333, 0.322 and 0.398 respectively (p < 0.00001). The authors propose that 0.21 m/s for walking velocity, 1.7° for GPS and 37.2 m for 2MWT be used as MCID values for individuals with lower limb amputation., Significance: The results of this study can be used to help both researchers and clinicians to objectively evaluate if interventions for individuals with lower limb amputation are effective., (Copyright © 2021 Elsevier B.V. All rights reserved.)