Exploring the participation of people with lower limb absence or amputation: a mixed methods study

Abstract

PURPOSE: People with lower limb absence or amputation (LLA) face challenges in their ability to participate in their communities. This study examines what influences how people with LLA participate in meaningful activities and social roles within the context of British Columbia. METHODS: We used a sequential mixed methods design consisting of 48 semi-structured interviews and 114 survey responses. Qualitative data were analyzed using reflexive thematic analysis. Quantitative data included Ability to Participate in Social Roles and Activities Questionnaire and Prosthesis Evaluation Questionnaire Ambulation subscale. Multiple regression explored predictors of participation. RESULTS: Participants demonstrated participation impairment, with restrictions in mobility, sport and exercise. Ambulation was the strongest predictor of participation, followed by female sex. Five themes described factors shaping participation: physical abilities and assistive technology (including prosthesis use); built and natural environments; social relationships; access to prosthetic care, peer support, and adaptive sport; and coping strategies. Physical challenges and funding limitations intensified barriers, while appropriate prosthetic treatment, social support, and mindset facilitated participation. CONCLUSIONS: Participation among people with LLA is influenced by interconnected physical, environmental, social, systemic, and psychosocial factors. Prioritizing mobility, improving funding equity, enhancing access to prosthetic care, and supporting psychosocial wellbeing may reduce participation restrictions.