. 2025 Jul 10;20(7):e0326761.

doi: 10.1371/journal.pone.0326761. eCollection 2025.

A behaviour change intervention promoting physical activity following dysvascular amputation: Protocol for a pilot study

Crystal MacKay^{1

2

3}, Diana Zidarov^{4

5

6}, Brian Chan^{2

7}, Steven Dilkas^{2

8

9}, Sander L Hitzig^{10

11}, Andresa R Marinho-Buzelli¹⁰, Amanda L Mayo^{9

10}, Michael W Payne¹², Amy Schneeberg¹³, Julia O Totosy de Zepetnek¹⁴, Dalton Wolfe^{15

16}, José Zariffa^{2

17}, Audrey Zucker-Levin¹⁸, Susan Jaglal^{2

3}, Brittany Pousett¹³, Heather Underwood¹⁹, William C Miller²⁰

Affiliations

¹ Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
² Kite Research Institute, University Health Network, Toronto, Ontario, Canada.
³ Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
⁴ Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.
⁵ Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
⁶ Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ West Park Healthcare Centre, University Health Network, Toronto, Ontario, Canada.
⁹ Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹¹ Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
¹³ University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada.
¹⁵ Lawson Health Research Institute, London, Ontario, Canada.
¹⁶ Faculty of Health Science, University of Western Ontario, London, Ontario, Canada.
¹⁷ Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
¹⁸ School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁹ GF Strong Rehabilitation, Vancouver, British Columbia, Canada.
²⁰ Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 40638625
PMCID: PMC12244559
DOI: 10.1371/journal.pone.0326761

A behaviour change intervention promoting physical activity following dysvascular amputation: Protocol for a pilot study

Crystal MacKay et al. PLoS One. 2025.

. 2025 Jul 10;20(7):e0326761.

doi: 10.1371/journal.pone.0326761. eCollection 2025.

Authors

Affiliations

¹ Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
² Kite Research Institute, University Health Network, Toronto, Ontario, Canada.
³ Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
⁴ Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.
⁵ Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
⁶ Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Canada.
⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁸ West Park Healthcare Centre, University Health Network, Toronto, Ontario, Canada.
⁹ Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹¹ Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹² Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
¹³ University of British Columbia, Vancouver, British Columbia, Canada.
¹⁴ Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada.
¹⁵ Lawson Health Research Institute, London, Ontario, Canada.
¹⁶ Faculty of Health Science, University of Western Ontario, London, Ontario, Canada.
¹⁷ Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
¹⁸ School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
¹⁹ GF Strong Rehabilitation, Vancouver, British Columbia, Canada.
²⁰ Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 40638625
PMCID: PMC12244559
DOI: 10.1371/journal.pone.0326761

Abstract

Background: Diabetes-related lower limb amputation (LLA) is a leading cause of disability globally, impacting individuals' physical and mental health, and ultimately their quality of life. Physical activity can reduce risk of chronic disease and mortality while improving quality of life. However, people with LLA often have reduced balance and walking ability resulting in sedentary behaviour. We co-created a physical activity intervention, IMproving Physical Activity through Coaching and Technology following Lower Limb Loss (IMPACT-L3), to support physical activity behaviour change in people with dysvasular LLA. To date, no studies have assessed a peer-led physical activity behaviour change intervention for people with LLA. Prior to launching a large trial, a pilot study is required to assess feasibility and optimize design of a future trial.

Methods: This pilot study is a parallel group randomized controlled trial (RCT) with an embedded qualitative component. The intervention group will have access to once-weekly virtual peer coaching sessions with a peer trained in brief action planning; web-based physical activity modules; and a wearable activity monitor for 8 weeks. The control group will continue usual care and be offered the intervention at the end of the follow-up period. Data on feasibility will be collected including assessment of process, resource, management and treatment indicators. The proposed primary outcomes will be measured at baseline, post-intervention and one month later: total physical activity counts per day measured by the ActiGraphTM activity monitor and self-efficacy measured by the Self-efficacy for Exercise scale. Secondary measures include patient reported outcome measures of physical activity, mobility, depression, social participation, balance confidence and quality of life. Semi-structured interviews will explore feasibility and acceptability of the intervention to participants and peers.

Discussion: This study will inform the design of a definitive RCT to determine the effectiveness of a peer-led physical activity intervention for people with dysvascular LLA.

Copyright: © 2025 MacKay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

**Fig 1. Schedule of enrolment, interventions, and assessments.**

See this image and copyright information in PMC

References

1. Sinha R, Van Den Heuvel WJA. A systematic literature review of quality of life in lower limb amputees. Disabil Rehabil. 2011;33(11):883–99. doi: 10.3109/09638288.2010.514646 - DOI - PubMed
1. Pezzin LE, Dillingham TR, MacKenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma-related amputations. Arch Phys Med Rehabil. 2000;81(3):292–300. doi: 10.1016/s0003-9993(00)90074-1 - DOI - PubMed
1. Graz H, D’Souza VK, Alderson DEC, Graz M. Diabetes-related amputations create considerable public health burden in the UK. Diabetes Res Clin Pract. 2018;135:158–65. doi: 10.1016/j.diabres.2017.10.030 - DOI - PubMed
1. Fortington LV, Rommers GM, Geertzen JHB, Postema K, Dijkstra PU. Mobility in elderly people with a lower limb amputation: a systematic review. J Am Med Dir Assoc. 2012;13(4):319–25. doi: 10.1016/j.jamda.2010.12.097 - DOI - PubMed
1. Fortington LV, Dijkstra PU, Bosmans JC, Post WJ, Geertzen JHB. Change in health-related quality of life in the first 18 months after lower limb amputation: a prospective, longitudinal study. J Rehabil Med. 2013;45(6):587–94. doi: 10.2340/16501977-1146 - DOI - PubMed

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A behaviour change intervention promoting physical activity following dysvascular amputation: Protocol for a pilot study

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A behaviour change intervention promoting physical activity following dysvascular amputation: Protocol for a pilot study

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