Developing consensus on what constitutes 'success' following upper limb loss rehabilitation

The aim of this research is to explore what constitutes success following upper limb absence (ULA), and to reach consensus on which areas are important to consider in the rehabilitation of an individual following ULA. Following a review of the literature on ULA, two case studies using the repertory grid technique (RGT) was undertaken with two prosthesis users in order to understand the unique requirements that upper limb prosthetic users may have. Following this, eleven interviews were conducted with Rehabilitation Professionals (RP’s). Two focus groups were also conducted with a total of seven individuals with ULA and one to one interviews with four additional individuals were used to supplement these focus groups. These qualitative studies were conducted in order to determine prominent factors of importance following ULA from both perspectives. All data were analysed using thematic analysis. This study culminated in a Delphi study in order to reach consensus regarding what is considered successful outcomes in three key areas: ‘Prosthesis use’, Activities and Participation’ and ‘Self image’ where there is currently little knowledge or agreement in the literature. The Delphi also aimed to identify the salient factors that are important for RP’s to take into consideration following ULA. The RGT produced a unique profile of preferences regarding prosthetic technologies for each participant. The qualitative analyses with RP’s and individuals with ULA produced common themes such as ‘Prosthesis Use’, Activities and Participation’, ‘Psychological factors’, ‘Physical factors’, ‘Social factors’, ‘Satisfaction with the prosthesis’ and ‘Satisfaction with the service’. However, the emphasis within these themes differed amongst RP’s and individuals with ULA. Consensus was reached in several areas following the Delphi study, which revealed core factors and items to consider. This study identified what RP’s and individuals with ULA believe constitutes success in three key areas and identified the most important factors that RP’s should consider in the rehabilitation setting. These factors will provide a guide for RP’s in assessing the progress of individuals with ULA and identifying the important areas to target in rehabilitation.