STAR ‘Stanmore Amputation Rehabilitation’ age-appropriate paediatric exercise sheets for lower limb amputations

Name: Rosie Dutton

Abstract

Across the NHS, there are no available paediatric age-appropriate amputation exercise sheets specific to the post operative stage. Adult based exercise programmes such as PIRPAG (Physiotherapy Inter Regional Prosthetic Audit Group) have been used. Completing tailored exercises are essential for successful prosthetic limb use. This service improvement aims to create exercise sheets which are tailored to grouped paediatric ages to promote adherence to exercises, encourage engagement and provide empowerment throughout stages of amputation rehabilitation. Informal verbal and written feedback using a qualitative questionnaire were obtained from parents and children. This contributed towards the development process involving modifying and re-designing the PIRPAG exercise sheets. Exercise sheets were created for under 10’s and ages 10-18. The feedback was collected from four post operative paediatric patients, three established paediatric prosthetic limb users and their parents, three therapists and two prosthetists. The exercise sheets were made in collaboration with the Royal National Orthopaedic Hospital Communications Department for the designing of illustrations and formatting. The exercise sheets were assessed for readability using the automated readability index and scored 3.92 for U10 (Under 10) and 7.13 for 10-18 years. There has been consistent engagement with the prescribing therapists issuing the age-appropriate exercise sheets during their treatment. The qualitative feedback suggests that the targeted population prefer exercise sheets that have the example exercise photos of a child of a similar age who have had an amputation rather than illustrations or photos of an adult. In addition to this, there was consistent positive feedback on the illustrations of animals on U10 exercise sheets as it allowed for meaningful play and encouraged engagement to task. There was consistent positive feedback from parents that the adherence tools of the ‘Star Chart’ and an ‘Exercise Diary’ promoted daily completion of exercises during the post-operative stage. The main findings concluded that the exercise sheets were effective in exercise adherence and engagement to physiotherapy. Future work will include ensuring there is broad representation of ethnic diversity of children in the photos and exercise sheets for paediatric upper limb amputations, bilateral amputations and types of prosthetic limbs. Lastly, although these exercises are standardised, it is important to implement exercise prescription based on clinical reasoning of an individuals assessment. The potential impact will allow paediatric specific exercise programmes for amputations to be used across the NHS.