Barriers and facilitators to community reintegration in adults following traumatic upper limb amputation: an exploratory study.

ABSTRACT

PURPOSE: To explore barriers and facilitators to community reintegration experienced by people following traumatic upper limb amputation (ULA). METHODS: An exploratory qualitative study was conducted with ten adults with major ULA due to trauma. Data from individual, semi-structured interviews was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS: Underlying and influencing community reintegration for participants, was a process of adjustment to the impacts of amputation on everyday function and re-establishing their identity. Participants felt social networks and peer support facilitated the return to social and community activities, as did drawing on personal attributes such as positivity, resilience and self-belief. Prosthetic devices were facilitative for community reintegration by minimising visible differences and unwanted attention through restored cosmesis and in the performance of functional tasks to fulfil social norms and meaningful roles despite issues with comfort and function. Despite the adaptation and evolution of abilities, perspectives and identities, the functional impact of ULA on everyday community activities was an ongoing challenge for all participants. CONCLUSION: ULA has a significant and lifelong impact on an individual's ability to complete tasks and fulfil meaningful roles in the community. Recommendations based on the study's findings will inform clinicians to support community reintegration for people following traumatic ULA.

Rehabilitative environments and interventions that promote self-efficacy, positivity, problem-solving skills and resilience may support adjustment and community reintegration following upper limb amputation.Facilitating appropriate peer support and the strengthening of existing social supports may assist social and community reintegration.The facilitative effects of prosthetics on community participation and reintegration may be enhanced through client-centred, goal-directed and timely prosthetic provision and training.Ongoing barriers and challenges with community participation may indicate the need for ongoing therapeutic intervention and support.