Clinicians' perspectives on decision making in lower limb amputee rehabilitation.

OBJECTIVE Decision making within amputee rehabilitation includes the assessment of whether a patient is suitable for a prosthesis and if so, what components to provide. This study seeks to increase understanding about clinicians' perspectives on what factors influence these decisions. METHOD One-to-one semi-structured interviews were completed with 23 experienced clinicians at their place of work at 4 UK amputee rehabilitation centres. Thematic analysis using a theoretical, semantic approach was used to identify key themes from the data. RESULTS Four key themes were identified: estimating outcome; difficulties predicting outcome; patient choice and barriers to prescribing. There was variation in the importance placed on each theme between individual clinicians and services, with factors such as budget and risk aversion acting as barriers to prescribing. Only one of the 4 centres used formal prescribing guidelines. CONCLUSION The results highlight the difficulties clinicians experience in estimating outcome and suggest inequity of prosthetic provision in the UK, with variation in the provision of high cost items. The development of national prescription guidelines is suggested to improve equality of prosthetic provision.