title: Functional performance, participation and autonomy after discharge from prosthetic rehabilitation: barriers, facilitators and outcomes.
abstract: OBJECTIVE
  To examine functional performance, participation and autonomy after discharge from prosthetic rehabilitation and to identify the barriers and facilitators affecting these outcomes.
  
  
  METHODS
  Concurrent mixed-methods design. Quantitative and qualitative data were collected at discharge from rehabilitation, and 3 and 6 months later. The data were integrated during analysis.
  
  
  METHODS
  Thirteen patients with a unilateral lower limb amputation participating for the first time in prosthetic rehabilitation in a Dutch rehabilitation centre.
  
  
  METHODS
  Functional performance was measured using the Two-Minute Walk Test and L test, and participation and autonomy using the Impact on Participation and Autonomy questionnaire. Barriers and facilitators were identified in semi-structured interviews.
  
  
  RESULTS
  After discharge, 9 out of 13 patients declined in functional performance. The principal problems in participation were observed in the "autonomy outdoors" and "family role" domains. Many factors affected functioning and participation and many differences were observed in the way that factors acted as barriers or facilitators for individual patients. No time patterns were found for barriers and facilitators.
  
  
  CONCLUSIONS
  Post-discharge, distinctive fluctuations were observed in functional performance and participation and autonomy in patients with lower limb amputation. It is recommended that patients are educated about these fluctuations and the barriers and facilitators identified in the environmental, personal and medical contexts.
authors: Center for Rehabilitation, University Medical Center Groningen, University of Groningen, 9751 ND Haren, The Netherlands. s.van.twillert@umcg.nl, s.van.twillert@cvr.umcg.nl.
authors: Sacha
authors: S
authors: van Twillert
authors: Ilse
authors: I
authors: Stuive
authors: Jan H B
authors: JH
authors: Geertzen
authors: Klaas
authors: K
authors: Postema
authors: Ant T
authors: AT
authors: Lettinga
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D000674:Amputees / Q000534:rehabilitation*; D001186:Artificial Limbs; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D036301:Qualitative Research; D012047:Rehabilitation Centers; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*