A Training Intervention which Safely Increases Physical Activity Levels in People with Transtibial Amputation.

Abstract

The primary aim of this thesis was to develop and implement a multidimensional training programme for people with transtibial amputation (PTTA) and to assess its effectiveness on increasing their levels of physical activity (PA), without increasing the incidence of acute or chronic injury. Such a programme is warranted since the low levels of activity in PTTA, which is detrimental to their health, has been attributed to the lack of understanding and limited facilitation of PA experienced by such a population.
The secondary aims of the thesis were to determine the i) current clinical practice/programmes supporting PA participation in PTTA, ii) types of activities that PTTA currently participate in and those they would like to take part in, iii) profile of capacity in the components of fitness of PTTA, and iv) effectiveness of an intervention on PTTA’s health, safety, and overall fitness.
A questionnaire response by 20 physiotherapists, working in PTTA rehabilitation, indicated no programmes were administered to support PA participation. The outcomes of a survey completed by 86 active PTTA reported that walking (49%) was the most popular PA participated in and 29 sedentary PTTA expressed a desire to participate in walking (34%).
Walking was the most popular PA which currently sedentary PTTA would like to perform whether amputation was due to trauma or other causes. Field-based research on 18 PTTA found a significant relationship (p=0.04) between time spent in walking and cardiovascular endurance although ‘walking at work’ proved to be an outlier in the statistical model. No significant changes associated with a short bout of exertion were found in gait symmetry or stride regularity in any dimension, nor any relationship between time spent in recreational walking and these gait variables.
These studies, supported by the literature, informed the development of a 12-week training programme which was trialled in the final study. The outcomes of the programme completed by 10 PTTA demonstrated an improved time in walking (p=0.01) and increased participation in PA which contribute to health gains (p=0.01). The intervention group also indicated significant improvements in cardiovascular endurance (p=0.05) with no change in gait symmetry or regularity, nor increase in reported pain or falls incidence.
The results indicate that the training programme is a safe and effective programme to enhance PA in PTTA, although further research is required on a broader population of PTTA. The programme is being developed as ‘UR:Enabled’ with the intention that it will be made publicly available.

Date of Award	16 Feb 2022
Original language	English
Awarding Institution	University of Roehampton
Supervisor	Siobhan Strike (Director of Studies) & Ceri Diss (Co-Supervisor)