Many lower-limb amputees begin one of the most important stages of rehabilitation without knowing what to expect or feeling meaningfully involved in the selection of their first prosthesis, new research led by Blatchford suggests.
The survey questioned 572 lower-limb amputees in the United Kingdom and United States between March and June 2026. Its findings identify significant gaps in preparation, communication and shared decision-making at the beginning of prosthetic rehabilitation.
Although the study did not include countries within the IMEA region, the issues it raises are highly relevant to prosthetists, rehabilitation teams and service providers working across India, the Middle East, Africa and neighbouring markets.
Patients uncertain before their first appointment
According to Blatchford, 65% of respondents entered their first prosthetic appointment unsure what to expect, while 29% described themselves as unprepared.
The survey also found that:
- 66% felt they had little or no input into choosing their prosthesis
- 85% would have preferred greater involvement
- 50% did not recall experiencing any of the shared decision-making steps examined
- 78% believed that thinking about their priorities before the appointment could have helped them choose a more appropriate prosthesis
The problem extended beyond the first consultation.
Blatchford reported that 86% experienced challenges after taking their first prosthesis home. Among these respondents, 63% experienced pain while wearing it and 45% said it limited their mobility.
The emotional consequences were also considerable. Of those experiencing difficulties, 72% reported frustration, 43% felt low or depressed and 25% said that the experience reduced their motivation to continue rehabilitation.
Almost three in ten respondents later believed that their first prosthesis had been a poor choice for them.
A prosthesis is not simply a component decision
The findings reinforce an important clinical principle: selecting a prosthesis is not the same as selecting a foot, knee, liner or suspension system.
The complete prescription must reflect the individual’s:
- Medical condition and amputation history
- Residual-limb presentation
- Strength, balance and mobility potential
- Skin condition and sensation
- Home and working environment
- Cultural and clothing requirements
- Transport needs
- Family and caregiver support
- Personal priorities
- Ability to maintain and use the device safely
- Access to servicing, repairs and replacement components
For a new amputee, these considerations may be difficult to understand before experiencing everyday life with a prosthesis.
Patients may initially focus on walking again without yet appreciating the importance of socket comfort, weight, suspension, footwear, energy expenditure, terrain, maintenance and the time required for rehabilitation.
The role of the prosthetist is therefore not merely to present available products. It is to help the patient understand realistic options and make decisions that connect clinical suitability with the life they want to resume.
What shared decision-making means
Shared decision-making does not mean that the patient selects any device they request or that clinical responsibility is transferred away from the professional.
It is a structured process in which the clinician contributes clinical knowledge and the patient contributes personal experience, preferences and priorities.
A good consultation should help answer questions such as:
- What activities matter most to the patient?
- Where and how will the prosthesis be used?
- What are the realistic functional objectives?
- Which compromises accompany each available option?
- How involved does the patient want to be in the decision?
- What will the prosthesis feel like during daily use?
- What difficulties should be reported immediately?
- What adjustments are normal during early rehabilitation?
- Who should the patient contact when a problem develops?
Earlier qualitative research involving prosthetists and new lower-limb prosthesis users concluded that shared decision-making can help incorporate patient values where evidence does not clearly identify one universally superior prosthetic design.
Related research has identified opportunities to improve care by clarifying the decisions being made, defining the purpose of early communication, helping patients balance competing priorities and using experience to develop informed expectations.
New preparation resource for amputees
In response to the survey, Blatchford has worked with amputee organisations, clinicians and research partners to launch the free My Prosthetic Priorities online hub.
Partners include the University of Colorado, Blesma, Living With Amplitude, Limbs for Life Foundation, Steel Bones and LimbPower.
The hub contains a decision-making aid intended to help lower-limb amputees:
- Identify personal and lifestyle priorities
- Consider likely prosthetic choices
- Prepare questions before their appointment
- Communicate their expectations
- Decide how involved they wish to be
- Understand the wider rehabilitation journey
The initiative is designed to support—not replace—the relationship between the patient, prosthetist and multidisciplinary rehabilitation team.
What the findings mean for IMEA services
Health systems across the IMEA region differ considerably. Some patients have access to multidisciplinary prosthetic centres and advanced component choices, while others receive care through government tenders, charitable programmes, humanitarian services or workshops with limited materials.
Shared decision-making remains relevant even when the available product range is restricted.
A patient may not be able to choose between numerous prosthetic feet, but should still understand:
- Why a particular solution is being recommended
- What the device is designed to achieve
- Its functional and environmental limitations
- Which alternatives are available
- What training will be required
- How follow-up and repairs will be provided
- When the socket or other components may need replacement
Preparation resources should also be adapted to local realities. This may require Arabic, French, Urdu and other regional languages; formats suitable for different literacy levels; caregiver participation; and explanations that reflect local funding, transport and service arrangements.
A digital resource alone will not reach everyone. Printed preparation sheets, short videos, peer-support sessions, pre-prosthetic group education and structured telephone calls may be more effective in some settings.
A practical pathway for clinics
P&O providers could introduce a simple preparation and shared-decision pathway:
- Send accessible information before the first prosthetic appointment.
- Ask the patient to identify their three most important daily activities.
- Explain the clinical process and who will be involved.
- Discuss realistic expectations, available options and compromises.
- Document the patient’s priorities in the clinical record.
- Agree measurable rehabilitation goals.
- Provide written guidance about early problems and warning signs.
- Arrange a defined follow-up appointment before the patient leaves.
- Review whether the device is helping the person achieve the agreed goals.
- Modify the treatment plan when the patient’s needs or presentation change.
Peer mentors can also play a valuable role, provided that their experience is presented as personal rather than as a substitute for clinical advice.
Important limitations
The results should be interpreted carefully.
The survey was developed by a prosthetics manufacturer and involved respondents from only the UK and US. It relied on participants recalling their first prosthetic experience, which may have occurred under different healthcare systems and at different points in time.
The findings should not automatically be assumed to represent every country or prosthetic service.
Nevertheless, the scale of the reported communication gap deserves attention. It is also consistent with earlier peer-reviewed research identifying unmet expectations and opportunities to strengthen shared decision-making.
The first appointment should begin before the patient arrives
The main lesson is not that every prosthetic difficulty can be prevented through better information. Residual limbs change, sockets require adjustment and rehabilitation rarely follows a perfectly predictable path.
Preparation can, however, help patients distinguish between an expected adjustment and a serious problem. It can give them the confidence to ask questions, describe their priorities and participate in decisions that will affect their daily lives.
The quality of a prosthetic service should therefore be judged not only by the device it delivers, but by whether the patient understands the journey, has a meaningful voice and knows where to obtain continuing support.
For many amputees, the first prosthetic appointment is too important to begin without preparation.
- Blatchford: Majority of Amputees Feel Unprepared
- My Prosthetic Priorities
- Amputee Survey Results
- Improving Shared Decision-Making for Prosthetic Care