During the Iraq and Afghanistan conflicts there was a rise in the number of trauma related military amputees with complex prosthetic needs. The level of prosthetic provision from the Ministry of Defence at that time was anecdotally high and the expectation was that the responsibility for this level of provision would be passed to the NHS when military amputees were discharged from the Armed Services. This brought about fears from NHS prosthetic providers and veteran charities around how this transition of care would be funded in the best interest of veteran amputees.
As a trained prosthetist I was also curious about how the switch of care from the Ministry of Defence to the NHS would be managed in a practical sense as well as how the NHS would manage the provision of high end prosthetic limbs within restricted prosthetic budgets. It was this interest that led me to undertake my PhD at the University of Stirling.
My project aimed to explore the decision making of prosthetists working within the NHS in Scotland with experience of treating amputee veterans. I also wanted to explore military and civilian trauma amputees’ experiences of involvement in their prosthetic care. This was achieved through analysis of a series of interviews with members of four clinical and managerial groups involved in the delivery of prosthetic care in the NHS and interviews with civilian and trauma amputees. Due to the exploratory nature of this project qualitative semi structured interviews were used to collect data which was then analysed using thematic analysis. Staff and amputee data was analysed separately.
The stories of the amputees included in my thesis show that the circumstances which led to their amputation can have a lasting effect on their rehabilitation journey. Those who have lost a limb through trauma, whether in a civilian or military setting, have experienced a unique set of experiences. This can greatly impact the way they view their amputation as well as the way they interact the clinicians who are involved in their prosthetic rehabilitation. The effect of this suggests that prosthetists and other clinicians involved in the care of trauma amputees should be conscious of the circumstances which led to their amputation and take that into account in the rehabilitation process.
My thesis Exploring decision making and patient involvement in prosthetic prescription highlighted the importance of the evolving relationship between trauma amputees and their prosthetists and the benefits that were seen by both groups from developing a good relationship and the impact that this could have on the prosthetic prescription process. Through these developing relationships combined with communication between prosthetists and patients, these groups can work together to create optimal prosthetic prescriptions. Clinical experience and communication are key in enabling prosthetists to prescribe limbs which allow patients to achieve their goals and aspirations in their post amputation lives.
Dr Karen Semple,
Researcher, Faculty of Health Sciences and Sport, University of Stirling
11 July 2016
Prosthetic photo copyright Belahoche on 123RF
Graduation photo copyright University of Stirling