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VOLUME 6, ISSUE 1 

 2023 

 

RESEARCH ARTICLE 

Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 

Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

https://jps.library.utoronto.ca/index.php/cpoj/index
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1 

Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

 

 

RESEARCH ARTICLE 

 

THE IDEAL PHYSICAL THERAPIST FROM THE PERSPECTIVE OF INDIVIDUALS WITH 

LIMB LOSS 

Lee D.J1*, Gambale A1, Nisani M1, Miller C2, Leung E2, Rodgers M2, Chilianis D2, Marra M2 

1 Department of Physical Therapy, Stony Brook University, Stony Brook, NY, USA. 
2 Department of Physical Therapy, Philadelphia College of Osteopathic Medicine, GA, USA. 

  
 

 

 

 

  

 

 

 

 

 

 

 

 

INTRODUCTION   

With approximately two million individuals living with limb 

loss in the United States, it is paramount that individuals 

with limb loss receive appropriate treatment following this 

life altering event.1,2 Limb loss can impact an individual's 

quality of life and function by limiting participation in valued 

activities. However, a comprehensive individualized 

rehabilitation program can help build a functional foundation 

for a safe transition back to society and daily life for 

individuals with limb loss. 

The rehabilitation team is multidisciplinary in nature and 

includes prosthetists and Physical therapists (PT) as two 

key members. While the prosthetist has domain over the 

design, delivery, and function of the prosthetic device, the 

PT’s are responsible for promoting optimal physical function 

after the loss of a limb.3 Research has shown the 

importance of the collaborative decision-making process 

between prosthetists and individuals with limb loss and the 

positive impact it has on patient-centered outcomes.4 This 

synergistic process was echoed for PT’s, with collaborative 

goal setting and problem-solving being of importance to the 

rehabilitation process.5 

While qualitative studies have explored what those with limb 

loss value in the rehabilitation process and in their 

relationship with the prosthetist, there is little evidence on 

what traits make an ideal PT. A PT’s capacity to understand 

the qualities in which persons with limb loss value during 

rehabilitation may open the door for more efficacious 

treatment and improved outcomes. To our knowledge, there 

is a void in published research examining the traits and skill 

set of a PT that individuals with limb loss deem valuable. 

Therefore, the purpose of this study is to understand the 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: Effective rehabilitation after limb loss is necessary to maximize function and promote 

independence. Physical therapists (PT) are one of the primary drivers of the rehabilitation process. 

While general physical therapy knowledge and abilities have been shown to be important to the 

rehabilitation process, it is unclear what individuals with limb loss value in their PT’s.  

OBJECTIVE: The purpose of this study was to understand the elements that define an ideal PT from 

the perspective of individuals with limb loss. 

METHODOLOGY: Mixed-method design consisting of a 20-item web-based survey and semi-

structured interviews that were administered to individuals 18 years or older, who spoke English, and 

had a history of lower limb loss. 

FINDINGS: Individuals with limb loss describe an ideal PT as promoting a therapeutic alliance, having 

specialized knowledge, and collaborating with a prosthetist. Knowledge of the PT as it relates to limb 

loss was found to be both the greatest facilitator and barrier to the rehabilitation process. 

CONCLUSION: From the perspective of those with limb loss, an ideal PT promotes a strong therapeutic 

alliance through communication, has specialized knowledge when it comes to the limb loss 

rehabilitation process, and collaborates with the prosthetist to problem-solve throughout the 

rehabilitation process. 

ARTICLE INFO 

Received: November 14, 2023 

Accepted: December 10, 2023     

Published: December 22, 2023 

CITATION 

Lee D.J, Gambale A, Nisani M, 

Miller C, Leung E, Rodgers M, et 

al. The ideal physical therapist 

from the perspective of individuals 

with limb loss. Canadian 

Prosthetics & Orthotics Journal. 

2023; Volume 6, Issue 1, No.4. 

https://doi.org/10.33137/cpoj.v6i1.

42093 

KEYWORDS 

Physical Therapy, Therapeutic 

Alliance, Limb Loss, Amputation, 

Prosthesis, Rehabilitation 

 

* CORRESPONDING AUTHOR: 

Daniel J. Lee, PhD,  
Department of Physical Therapy, Stony Brook University, Stony Brook, 
NY, USA. 

Email: daniel.lee.8@stonybrook.edu 

ORCID ID: https://orcid.org/0000-0003-1805-2936 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 6, Issue 1, Article No.4. 2023 

 

 

https://doi.org/10.33137/cpoj.v6i1.42093
https://doi.org/10.33137/cpoj.v6i1.42093
https://doi.org/10.33137/cpoj.v6i1.42093
file:///D:/CPOJ/Published%20Articles/VOLUME%206-2023/ISSUE%201/Article%20NO.4/daniel.lee.8@stonybrook.edu
https://orcid.org/0000-0003-1805-2936
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

elements that define an ideal PT from the perspective of 

persons with limb loss. 

METHODOLOGY 

Study Design: This study utilized a mixed methods design 

following the COREQ checklist for qualitative data 

collection.  

Setting: Amputee Coalition National Conference and video 

conferencing. 

Participants: Inclusion criteria were individuals who 

attended the Amputee Coalition National Conference 

(August 2020), were 18 years of age or older, spoke 

English, had a history of lower limb loss with or without 

prosthesis use, and performed physical therapy after loss of 

limb. Exclusion criteria included individuals that 

demonstrated cognitive impairments consistent with an 

inability to complete the survey and/or interview.  

Ethics: Institutional Review Board (IRB) approval was 

obtained prior to the collection of data. All participants 

completed the informed consent process prior to starting the 

study. 

Instruments: The quantitative portion of the study utilized 

a 20-item web-based survey hosted by QualtricsXM (Provo, 

UT) designed specifically for use in this study. The survey 

can be found in Appendix A. The qualitative portion of the 

study was performed using a semi-structured interview that 

explored participants feelings and beliefs about physical 

therapy care. The interview questions can be found in 

Appendix B. Prior to data collection, the survey and 

interview were piloted for ease of use, logic functionality, 

and efficiency, then revised based on feedback. 

Researchers were trained in interview skills and procedures 

by an expert in mixed-methodology, completing two pilot 

interviews prior to data collection. Participants provided 

written and/or verbal consent prior to participating in the 

survey and semi-structured interviews. 

Procedures: All data were collected remotely using web-

based surveys and video conference interviews secondary 

to social distancing mandates present at the time of the data 

collection (August 2020). Participants who attended the 

Amputee Coalition National Conference had the ability to 

visit the researcher’s virtual booth to learn about the survey 

and interview. An anonymous link was provided to the 

survey on a display page linked to the virtual booth. If a 

participant additionally wanted to participate in an interview 

following the survey, they were eligible for a $10 digital gift 

card.  

Interviews were conducted via video conferencing software. 

There were no relationships established between the 

participants and researchers prior to the study 

commencement. Each interview was audio recorded and 

transcribed prior to data analysis.  

Data Analysis: Quantitative data were analyzed for trends 

using SPSS v25 (IBM Corp. Aramonk, NY). Identified trends 

were presented in terms of means and likert scales ranked 

by participants. Qualitative data were analyzed using an 

inductive approach with a constant comparison method to 

identify themes. The process was multi-stage, involving a 

pair of researchers first independently analyzing the 

transcripts from the interview to generate codes. Then each 

member of the pair would compare their codes and work 

towards consensus. Each pair analyzed four to five unique 

transcripts. Once all the transcripts were coded, all research 

team members compared the generated codes and revised 

for consistency using the consensus method. Once the 

codes were agreed upon, themes were then generated 

using the same iterative process described for the codes. 

Disagreement was adjudicated by a separate researcher 

not involved in the original coding. 

Sample size calculations were not performed for the survey 

portion given its descriptive nature and lack of statistical 

comparisons requiring adequate power to yield significance. 

However, an incentive of a $10 gift card was provided to 

encourage participation in the study as the greater number 

of data points allows for a more comprehensive 

understanding of the results. The qualitative sample size is 

based on the principle of data saturation which supports a 

smaller sample (typically 10-15 participants) for 

homogenous groups (e.g. individuals with lower limb loss 

who have experienced physical therapy attending a national 

conference). 

RESULTS 

Quantitative 

Characteristics of Study Population 

Of the 92 completed surveys, 22 were excluded due to 

failure to provide complete demographic information, 

leaving 73 completed surveys. Incomplete surveys were 

excluded to reduce potential bias and provide a more 

accurate representation of the study population. The 

participants were primarily female (53.0%) with a mean age 

of 54.4 years. Most participants were educated beyond high 

school (88.0%), had an average of 13.6 years since their 

initial amputation, with most having had a transtibial level 

amputation (51%) due to trauma or infection (54.0%). 

Predominant comorbidities of hypertension (29.7%) and 

hypercholesterolemia (14.9%) were most common. A 

summary of the demographic characteristics is presented in 

Table 1. 

Barriers to Physical Therapy 

Responses from participants reported the PT's lack of 

knowledge about limb loss (58%) and PT’s lack experience 

treating persons with limb loss (47%) as having a very high 

impact as a barrier to physical therapy. Additionally, the 

personality of the PT (38%) was reported to have a high 

https://doi.org/10.33137/cpoj.v6i1.42093


 

3 

Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

impact as a barrier to physical therapy. Meanwhile, the cost 

of the physical therapy sessions (12%) and distance to the 

clinic (7%) were most frequently regarded as having no 

impact as a barrier to treatment. Responses are shown in 

Figure 1. 

Table 1: Survey Demographics. 

Demographics of study population (n =73) 

Gender: % 

• Female 

• Male 

53 
47 

Age: (Mean ± SD) 54.4 ± 16.2 

Highest Level of Education: % 

• General Educational Development Test 

• High School 

• College 

• Post-Graduate 

1 
11 
58 
30 

Years Since 1st Amputation: (Mean ± SD) 13.6 ± 14.9 

Reason for 1st Amputation: % 

• Trauma 

• Infection 

• Congenital 

• Tumor 

• Vascular Disease 

• Other 

31.1 
23.0 
10.8 
14.9 
13.5 
6.8 

Current Amputation Level: % 

• Transtibial 

• Transfemoral 

• Hip disarticulation 

• Foot 

51 
44 
4 
1 

Medical History: % 

• Diabetes 

• High blood pressure 

• High cholesterol 

• Arthritis 

• Heart Disease 

• COVID-19 

• Other 

14.9 
29.7 
17.8 
9.9 
10.9 
2.0 
14.9 

 

Facilitators to Physical Therapy 

Participants reported a PT’s knowledge about limb loss 

rehabilitation (86%), one-on-one time spent with PT (57%), 

and the personality of the PT (51%) serving as very 

important facilitators of physical therapy. Available 

equipment was most frequently (48%) regarded as an 

important facilitator of physical therapy. Participants 

regarded involvement with Amputee Coalition (15%), 

number of patients with limb loss the PT treats a month 

(11%), and cost of physical therapy session (8%) as having 

no importance as a facilitator of physical therapy. 

Responses are shown in Figure 2. 

Knowledge of the PT 

Responses from participants reported knowledge of gait 

training with prosthesis (74%), knowledge of prosthesis fit 

(63%), and knowledge of when to contact a prosthetist 

(62%) as being very important. Knowledge of current 

research regarding limb loss (35%) was most frequently 

regarded as being important. Meanwhile, knowledge of 

prosthetic components (10%) and knowledge of problem-

solving issues with fit of prosthesis (9%) were most 

frequently reported as having slight or no importance. 

Physical Therapy Experience 

Participants (79%) regarded having a very positive or 

positive experience with physical therapy, with 53% of 

participants reporting having a very positive experience. 

Responses are shown in Figure 3. 

 

 

   Figure 1: Barriers to Physical Therapy. 

0% 10% 20% 30% 40% 50% 60% 70%

Distance to clinic

Personality of Physical Therapist

Lack of equipment

PT's lack of knowledge about limb loss rehab

PT's lack of treating individuals with limb loss

PT's lack of knowledge of new prosthetic technology

PT's lack of relationship with prosthetist

Cost of PT sessions

Other:

Barriers to Physical Therapy

Very high impact High impact Moderate impact Slight impact No impact

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Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

d 

Qualitative 

Of the 73 completed surveys, 13 participants agreed to 

participate in conducted interviews. A summary of the 

demographic characteristics is presented in Table 2. Three 

themes were identified from the interviews: 

Theme 1: Communication is Key 

Participants reported valuing the therapeutic alliance that 

forms between the individual with limb loss and the PT. 

Communication, an element of the therapeutic alliance, was 

cited as either a facilitator or barrier, as expressed in the 

participant quotes below:   

“The ones I hold in the highest esteem are the ones that... one, 

listened to me and recognized things that I needed to do day in and 

day out in terms of whatever my job was.” 

“It’s got to be a relationship built with communication, where the 

therapist has to listen to what the patient is and isn’t saying in 

response to things they are asked to do.” 

“When the PT listens to what I'm asking and understands or listens 

and reacts to what I need; not necessarily what a traditional 

rehabilitation program is. Because I think it needs to be really 

individualized.” 

“I got so frustrated with the PT because I didn't need it… I wanted 

her to help me walk but she had me… every time I came, take off 

my prosthetic and do exercises. This is not why I'm here. I want to 

get on a treadmill. I want you to tell me how to walk because I'm 

walking with a limp.” 

 

Figure 2: Facilitators to Physical Therapy. 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Location of therapy clinic

Personality of therapist

One-on-one time spent with you

Equipment available to use

Physical therapist’s knowledge about limb loss rehab

Physical therapist's knowledge of new prosthetic technology

Physical therapist’s relationship with prosthetist

Involvement with Amputee Coalition

Credentials of the PT

Number of persons with limb loss the PT treats a month

Length of PT session

Cost of PT sessions

Other:

Facilitators of Physical Therapy

Very Important Important Moderately Important Slightly Important Not Important

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Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

From these quotes it is evident that positive communication 

was supportive of a healthy therapeutic relation, while lack 

of clear communication, as demonstrated in the last quote, 

can lead to frustration, which in turn can weaken the 

therapeutic alliance. 

Table 2: Interview Demographics. 

Demographics (n=13)  

Gender: % 

Female 
Male 

77 
23 

Age: (Mean ± SD) 54.5 ± 14.7 

Highest Level of Education: % 

GED 
High School 
College 
Post-Graduate 

0 
7.7 

61.5 
30.8 

Years Since 1st Amputation: (Mean ± SD) 9.9 ± 9.5 

Reason for 1st Amputation: % 

Trauma 
Infection 
Congenital 
Tumor 
Vascular Disease 
Other 

30.8 
23.1 

0 
15.4 
7.7 

23.1 

Current Amputation Level: % 

Below knee 
Above knee 
Hip disarticulation 
Foot 

54 
46 
0 
0 

Medical History: % 

Diabetes 
High blood pressure 
High cholesterol 
Arthritis 
Heart Disease 
COVID-19 
Other 

18.8 
18.8 
18.8 
6.3 

12.5 
0 
25 

 

Theme 2: Specialized Care for a Specialized Population 

Participants reported that specialized knowledge was one 

of the most significant components of high-quality therapy 

for individuals with lower limb loss. Participants in the study 

emphasized: 

“I think it’s important for amputees to work with someone who has 

an expertise in amputees and prosthetics, because it is such a 

specific niche in the field.”   

“It’s important that the PT has knowledge of the different prosthetics 

and the features, because if they don’t know it, I probably don’t 

either!”  

“First of all, a PT who is trained in the nuances of working with an 

amputee, that’s a must. Because not only do we not ambulate the 

same, but we don’t have the ability to do many of the normal limb 

functions.” 

“The reason he [the PT] knew my leg was too short was he had 

different samples of different thickness socks. What he would have 

me do is have me stand on different ones, different thicknesses, 

until he determined this is the correct height. They didn’t do that in 

the large rehab hospital. That’s that extra attention to detail, his 

experience and knowledge gave him.” 

The theme outlines how individuals with limb loss value a 

PT with specialized knowledge and equipment. A PT with 

more knowledge and an in-depth understanding of limb loss 

rehabilitation is considered a more desirable provider for 

persons with limb loss. 

 

 

Figure 3: Physical therapy Experience Following Limb Loss. 

Theme 3: The Dynamic Duo: PT’s and Prosthetists 

Participants in this study reported an increase in quality of 

care when the prosthetist was an active collaborator in their 

physical therapy plan of care. For instance, several 

participants found it beneficial to have the prosthetist 

present at their treatment sessions due to their expertise in 

handling prosthetic limbs and deeper comprehension of the 

mechanical nature of these medical supportive devices. 

Perceptions of an effective therapeutic team were reiterated 

by participants: 

“My prosthetist was at my physical therapy appointments. She 

could adjust it while I was actually with a PT, and she could see 

what was happening while I was doing it. That made it a very 

positive experience.” 

“They [the PT’s] also bring in the certified prosthetist. That 

prosthetist is going to know more about that particular prosthetic 

that individual is wearing than the PT themselves.” 

“I found that the prosthetists were really the ones that know the 

devices much better, in order to gait train properly you really have 

to understand the mechanics of the device.” 

To provide the most comprehensive care for a patient with 

limb loss, it is crucial for the PT to recognize the strength in 

the specialized knowledge possessed by a prosthetist and 

the integral role they can play in facilitating increased quality 

patient care. When asked to describe what makes a PT 

ideal for working with persons with limb loss, participants 

described: 

“Being open to the prosthetist, being open to the knowledgeable 

amputees that are out there and learning from them and then being 

able to share your expertise.”   

0%

10%

20%

30%

40%

50%

60%

Very
negative

experience

Negative
experience

Neutral Positive
experience

Very
positive

experience

Physical Therapy Experience Following Limb 
Loss 

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Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

In summary, incorporating the prosthetist benefits both the 

patient and the therapist, and therefore should be part of the 

treatment sessions and goal setting. 

DISCUSSION 

The purpose of this study was to explore the elements that 

define an ideal PT from the perspective of individuals with 

limb loss. The results of this study demonstrated that 

individuals with limb loss value the PTs knowledge 

regarding limb loss rehabilitation, the collaboration between 

the prosthetist and the PT, and a strong therapeutic alliance.  

The Therapeutic Alliance 

The therapeutic alliance defines a shared trust and 

collaboration between the patient and the healthcare 

practitioner,6 and can be promoted through collaboration, 

communication, and personalized care for individuals with 

limb loss.4,7 The core of the therapeutic alliance is a patient-

centered approach, a finding that is evident from the 

qualitative portion of this study. For example, patients who 

are engaged in decision-making for cosmetic design of the 

prosthesis felt empowered and had greater satisfaction with 

their prosthesis.7 While placing value and emphasis on 

building interpersonal relationships that foster healing has 

been found to be as important to outcomes as chosen 

interventions in physical therapy.8 Additionally, health 

professionals that express their understanding and empathy 

with the focus on the patient, increase patient trust and 

contribute to positive experiences with physical therapy and 

prosthetic management.4,9 These findings are consistent 

with our study where participants related the importance of 

collaboration as a means to support healthy therapeutic 

relationships.  

Participants in this study noted that communication can also 

be a barrier or facilitator to the rehabilitation process 

depending on the quality of the interaction. Those 

participants who had a positive experience described the 

communication to be purposeful and focused on their 

specific needs as an individual with limb loss. However, at 

least one participant noted that, despite best intentions by 

the PT, the attempts at communicating were contributing to 

a negative experience because of the lack of collaborative 

goal-setting.  

Active engagement and tailored communication related to 

decision-making and goal setting has been reported to 

enhance patient satisfaction with musculoskeletal physical 

therapy across settings and in private practice.6,10,11 

Findings from this study, corroborates results in the field of 

limb loss rehab and with other populations seen in physical 

therapy settings, further illustrating that strong therapeutic 

alliance built on positive communication leads to better 

outcomes.8,10-12  

 

Specialization  

Of interest in this study, there was a disconnect between 

some of the participants quantitative versus qualitative 

values on the PT's knowledge of prosthetic devices. 

However, Shih et al.12 found that individuals who received 

physical therapy expressed more positive comments 

related to perceived positive outcomes and benefits of 

therapy rather than on the prosthetic design. Given that 

technological changes are abundant in the field of 

prosthetics, it would seem valuable for the PT to have high 

levels of knowledge about the prosthetic devices and their 

components. While this specialized knowledge of devices 

was promoted in some of the qualitative results, we saw less 

importance placed on this knowledge area than gait training 

or being able to manage the fit of the prosthesis.  

In the United States, less than 50% of the PT programs 

have stand-alone courses that spend a considerable 

amount of time promoting prosthetic-related content in their 

programs specific to the devices and components 

themselves.13 Additionally, there is tremendous variability in 

the content emphasized and educational hours dedicated to 

training physical therapist ostensibly for reasons related to 

patient-centered outcomes. This may be interpreted as 

individuals with limb loss valuing the functional mobility and 

problem-solving aspects of patient care more than explicit 

knowledge on the prosthetic components. 

While components and devices were not regarded as being 

highly important, generally, a therapist's knowledge levels 

were shown to be either a facilitator or barrier to the 

rehabilitation process. While the mixed findings from this 

study do not clearly suggest knowledge of devices alone is 

of significant importance to the person with limb loss, it does 

emphasize the importance of being knowledgeable 

generally about the process in order to facilitate positive 

outcomes and reduce unwanted secondary 

complications.14 

Collaboration with the Prosthetist 

Building off the ideas of therapeutic alliances and the need 

for specialization, participants in this study valued the 

collaboration between the prosthetist and PT. Coordinated 

care with improved pathways for access to amputation 

management, including PT, prosthetists, and peer-visitors 

was identified as essential for timely recover in individuals 

with limb loss.15  Since the prosthesis is a medical device, 

alterations to its alignment and function are typically outside 

of the scope of a PT. This can create a frustrating 

experience during the rehabilitation process when 

modifications are needed but the prosthetist is not present. 

Therefore, expressed frustration as reported in our study 

may be mitigated by having coordinated sessions where the 

PT and prosthetist work together to problem-solve gait and 

functional issues, with the prosthetist performing real-time 

modifications during the treatment. The ideal outcome is 

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Lee D.J, Gambale A, Nisani M, Miller C, Leung E, Rodgers M, et al. The ideal physical therapist from the perspective of individuals with limb loss. Canadian 
Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X THE IDEAL PHYSICAL THERAPIST FOR LIMB LOSS 
Lee et al., 2023 

that expedient solutions to mobility issues are provided 

without delaying the progression of the rehabilitation 

process.  

Limitations 

As is the nature of qualitative research, the biases and 

beliefs of the researchers themselves may influence the 

interpretation of the data. While the research team 

employed techniques like triangulation, internal auditing, 

and independent adjudication to minimize the influence of 

bias, the fact that all members of the team were PT’s is 

worth noting. While we do not believe the data and results 

were influenced by this, we as researchers acknowledge 

that our view of physical therapy is positive and found the 

results to be confirmatory of these beliefs. Another limitation 

is the generalizability of these results outside of the 

participant pool present at the Amputee Coalition National 

Conference. While demographically they are representative 

of individuals with limb loss, the small sample size limits the 

generalizability of the results, requiring larger scale studies 

for future research. 

CONCLUSION 

From the perspective of those with limb loss, an ideal PT 

promotes a strong therapeutic alliance through 

communication, has specialized knowledge when it comes 

to the limb loss rehabilitation process, and collaborates with 

the prosthetist to problem-solve throughout the 

rehabilitation process. 

ACKNOWLEDGEMENTS 

We would like to thank the Amputee Coalition and all the 

participants in the study for their assistance. 

DECLARATION OF CONFLICTING INTERESTS 

None.  

AUTHORS CONTRIBUTION 

• Daniel J. Lee: Contributed to and oversaw all aspects of the 

study. 

• Albert Gambale: Contributed to data collection, analysis, and 

writing of the manuscript. 

• Maya Nisani: Contributed to data collection, analysis, and 

writing of the manuscript. 

• Carol Miller: Contributed to review and interpretation of results 

and writing of the manuscript. 

• Elizabeth Leung: Contributed to data collection and analysis. 

• Madeline Rodgers: Contributed to data collection and 

analysis. 

• Daniel Chilianis: Contributed to data collection and analysis. 

• Matthew Marra: Contributed to data collection and analysis. 

 

SOURCES OF SUPPORT 

No sources of support to report. 

ETHICAL APPROVAL 

Institutional Review Board (IRB) approval was obtained prior to the 

collection of data. All participants completed the informed consent 

process prior to starting the study. 

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8 

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Prosthetics & Orthotics Journal. 2023; Volume 6, Issue 1, No.4. https://doi.org/10.33137/cpoj.v6i1.42093 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

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APPENDICES 

 

Appendix A 

a) Rate your physical therapy experiences (overall): 0-5 (5 is the 

highest) 

b) Rate and rank factors that influence your physical therapy 

experience  

i. Location of therapy clinic 

ii. Personality of therapist 

iii. One-on-one time spent with you 

iv. Equipment available to use 

v. PT’s knowledge about limb loss rehab 

vi. PT’s knowledge of new prosthetic technology 

vii. PT’s relationship with prosthetist 

viii. Involvement with Amputee Coalition 

ix. Credentials of the PT 

x. Number of persons with limb loss PT treats a month 

xi. Specialized equipment 

xii. Length of PT session 

xiii. Home program 

xiv. Cost of PT 

xv. Other:______________ 

c) Rate and rank barriers to physical therapy  

i. Distance to clinic 

ii. Transportation to the clinic 

iii. PT’s’ personality 

iv. Lack of equipment 

v. PT’s lack of knowledge about limb loss rehab 

vi. PT’s lack of treating amps 

vii. PT’s lack of knowledge about new prosthetic technology 

viii. PT’s lack of relationship with prosthetist 

ix. Cost of PT 

x. Other:______________ 

d) Rate and rank the importance of the PT’s knowledge 

i. Knowledge of the prosthetic components 

ii. Knowledge of gait training with a prosthesis 

iii. Knowledge about donning and fitting the prosthesis 

iv. Knowledge about problem-solving issues with the fit of 

the prosthesis 

v. Knowledge of knowing when to contact prosthetist 

vi. Knowledge of current research regarding limb loss 

e) Do you believe you would have benefited from more, less, or the 

same amount of physical therapy rehabilitation?  

 

Appendix B 

1. What is/was your experience with physical therapy in regard to 

your limb loss? 

2. In your opinion, what made or makes a physical therapy 

experience positive for you? 

3. In your opinion, what made or makes a physical therapy 

experience negative for you? 

4. What are ways you believe physical therapy can be improved for 

persons with limb loss? 

5. Can you describe any things that your PT does or says that make 

them “ideal” for working with persons with limb loss? 

 

 

https://doi.org/10.33137/cpoj.v6i1.42093

