Portsmouth Enablement Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom.
School of Health Sciences, University of Southampton, Southampton, United Kingdom.
PLoS One. 2024 Jul 23;19(7):e0307523. doi: 10.1371/journal.pone.0307523. eCollection 2024.
Little is known about which outcome domains characterise meaningful recovery following prosthetic rehabilitation and should be measured. Our previous qualitative work developed a conceptual model of outcome domains which are meaningful to patients. This qualitative synthesis aims to develop that model by exploring views and experiences of recovery captured in the limb loss literature, and use these to produce a second iteration of the model describing outcome domains of importance following prosthetic rehabilitation from the patient's perspective.
Systematic searches were conducted using CINAHL, Psychinfo and Web of Science from 2011 to early 2023. Studies with a qualitative design focusing on views and experiences of lower limb prosthetic users were eligible for inclusion. Quality was assessed using the CASP tool. 'Best Fit' framework synthesis was used to synthesise the evidence and develop the conceptual model.
40 studies were included, describing the experiences of 539 participants. Data supported the pre-existing conceptual model and led to development of four of the five domains. The newly named ECLIPSE model describes meaningful outcome domains as 1) Being able to participate in important activities and roles, 2) Participating in the way I want to, 3) My prosthesis works for me, 4) If I am in pain, I can manage it, and 5) I am able to accept my new normal. Studies came from 15 countries showing good coverage of high-income settings. Few participants from low-and-middle-income countries were included, it is unclear if the ECLIPSE model describes outcome domains of importance in these settings.
This synthesis provides a rigorous foundation for understanding outcome domains of importance following lower limb prosthetic rehabilitation from the patient's perspective. The ECLIPSE model is an accessible representation of recovery which could direct rehabilitation programmes, as well as inform the evaluation of prosthetic care through the selection of outcome measures.
对于哪些结果领域能体现假肢康复后的有意义的恢复，以及应该测量哪些结果领域，人们知之甚少。我们之前的定性研究工作开发了一个对患者有意义的结果领域的概念模型。本定性综合研究旨在通过探索肢体丧失文献中捕捉到的关于恢复的观点和经验，来发展该模型，并使用这些观点和经验从患者的角度生成第二个迭代模型，描述假肢康复后的重要结果领域。
从 2011 年到 2023 年初，使用 CINAHL、Psychinfo 和 Web of Science 进行了系统搜索。符合条件的研究设计为定性研究，重点关注下肢假肢使用者的观点和经验。使用 CASP 工具评估质量。“最佳拟合”框架综合法用于综合证据并开发概念模型。
共纳入 40 项研究，描述了 539 名参与者的经验。数据支持了预先存在的概念模型，并导致了其中五个领域中的四个领域的发展。新命名的 ECLIPSE 模型描述了有意义的结果领域为：1）能够参与重要的活动和角色；2）以我想要的方式参与；3）我的假肢适合我；4）如果我感到疼痛，我可以控制它；5）我能够接受我的新常态。这些研究来自 15 个国家，很好地涵盖了高收入国家的情况。来自中低收入国家的参与者较少，尚不清楚 ECLIPSE 模型是否描述了这些国家重要的结果领域。
本综合研究为从患者的角度理解下肢假肢康复后的重要结果领域提供了严格的基础。ECLIPSE 模型是一种易于理解的恢复表现形式，可以指导康复计划，并通过选择结果测量来为假肢护理的评估提供信息。
