Functional performance, participation and autonomy after discharge from prosthetic rehabilitation: barriers, facilitators and outcomes.

Objective: To examine functional performance, participation and autonomy after discharge from prosthetic rehabilitation and to identify the barriers and facilitators affecting these outcomes. Design: 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. Subjects: 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. Conclusion: 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.