The influence of environmental and personal factors on participation of lower-limb prosthetic users in low-income countries: prosthetists' perspectives.

PURPOSE: To examine the environmental and personal factors in low-income countries (LICs) that influence prosthetic rehabilitation of adults with lower-limb (LL) amputations and their ability to participate in daily activities.

METHODS: In this qualitative descriptive study, 11 prosthetists participated in semi-structured interviews by telephone or Skype. Qualitative thematic analysis was guided by the International Classification of Function.

RESULTS: Facilitating continuity of care, consideration of physical environments and usage, prosthetic quality including durability and socket fit, and minimizing the visibility of disability, were found to be important factors affecting the provision of prosthetic services in LICs.

CONCLUSIONS: Environmental and personal factors must be considered when providing prosthetic rehabilitation for adults with LL amputations in LICs in order to optimize participation in activities. Results from this study provide new insights about some of the factors that influence the ability of individuals with LL amputations to rehabilitate to a level where they are able to participate in meaningful activities within their communities.

IMPLICATIONS FOR REHABILITATION: There are unique environmental and personal components that can influence activity and participation of lower-limb (LL) prosthetic users in low-income countries (LICs). These components are often overlooked in the design of prosthetic devices and provision of prosthetic services. Continuity of care, condition of the post-surgical residuum, outdoor environments of common occupations, aesthetics and durability of prostheses, and user comfort should all be considered when providing prosthetic rehabilitation to adults with LL amputations in LICs to promote activity and participation. Results of our study can inform the practice of prosthetists in LICs by highlighting their contributions in enabling participation for LL prosthetic users. Our results can also inform the design of durable and comfortable prostheses and the provision of more appropriate prosthetic rehabilitation to LL prosthetic users in LICs to facilitate and optimize participation.