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. 2023 Oct 1;47(5):511-518.
doi: 10.1097/PXR.0000000000000192. Epub 2023 Jan 5.

Footwear limitations in women prosthesis users relate to more than preference

Elizabeth Russell Esposito  1   2   3   4 , Andrew H Hansen  5   6 , Billie Savvas Slater  5 , Matthew J Major  7   8 , Katherine Muschler  5 , Andrea J Ikeda  9 , Christopher Erbes  5   6
Affiliations

Footwear limitations in women prosthesis users relate to more than preference

Elizabeth Russell Esposito et al. Prosthet Orthot Int. .

Abstract

Background: The option to wear desired footwear may be an important part of community reintegration after lower-limb amputation.

Objectives: This study explored outcomes related to footwear, health, and participation in women Veterans with lower-limb amputation.

Methods: A cross-sectional questionnaire was mailed to all women Veterans age 18-82 years with major lower-limb amputation(s) who had received prosthetics services in the US Department of Veterans Affairs (N = 538). The questionnaire assessed Perceived Challenges (including clothing limitations, prosthetic foot limitations [width, height, and shape], and shoe avoidance for safety concerns), type of footwear used and preference, and included subscales from the Patient-Reported Outcome Measurement Information System, Amputee Body Image Scale Prosthetic Limb Users' Survey of Mobility, Community Participation Index, Activities-Specific Balance Confidence Scale, and Prosthesis Evaluation Questionnaire. Bivariate correlations examined relationships between a composite measure of Perceived Challenges and patient-reported outcomes.

Results: One hundred questionnaires were returned (18.6% response rate; 3 excluded for limited prosthesis use). The Perceived Challenges score was significantly correlated with scores for the Amputee Body Image Scale-Revised (r = 0.24, p = 0.019), Patient-Reported Outcome Measurement Information System (ability to participate: r = -0.25, p = 0.014), Prosthesis Evaluation Questionnaire (utility: r = -0.32, p = 0.001, appearance: r = -0.48, p < 0.001), Activities-Specific Balance Confidence Scale (r = -0.20, p = 0.046), and Prosthetic Limb Users' Survey of Mobility (r = -0.21, p = 0.036), but not depression or anxiety.

Conclusions: Women who have greater issues with how their prosthesis affects the shoes and clothing they can wear also have poorer body image, reduced functional capabilities, and lower reported participation in activities. Improved prosthetic foot design may help to improve social participation and other important outcomes for women prosthesis users.

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References

    1. United States Government Accountability Office. Veterans Health Care: Agency Efforts to Provide and Study Prosthetics for Small but Growing Female Veteran Population. In: United States Government Accountability Office, ed. Washington, DC: United States Government Accountability Office; 2020.
    1. Ziegler-Graham K, MacKenzie EJ, Ephraim PL, et al. Estimating the prevalence of limb loss in the United States: 2005 to 2050. Arch Phys Med Rehabil 2008; 89: 422–429.
    1. Elnitsky CA, Latlief GA, Andrews EE, et al. Preferences for rehabilitation services among women with major limb amputations. Rehabil Nurs 2013; 38: 32–36.
    1. Singh R, Hunter J, Philip A, et al. Gender differences in amputation outcome. Disabil Rehabil 2008; 30: 122–125.
    1. Webster JB, Crunkhorn A, Sall J, et al. Clinical practice guidelines for the rehabilitation of lower limb amputation: An update from the Department of Veterans Affairs and Department of Defense. Am J Phys Med Rehabil 2019; 98: 820–829.

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