Microprocessor Knee Versus Non-Microprocessor Knee for Backup Device in Lower Limb Prostheses: A Qualitative Study
Abstract: Current policy in the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC) is to provide individuals who require a prosthesis for a knee disarticulation (KD) or transfemoral (TF)-level amputation a microprocessor knee (MPK) unit for daily use and a non-microprocessor knee unit (N-MPK) as a backup prosthesis. Given the known functional differences between these two types of prosthetic knee units, the purpose of this study was to gain an understanding of user device preference and the impact of switching between the MPK and N-MPK. Four currently serving CAF members and two Veterans with unilateral TF or KD amputation participated in semi-structured interviews. Qualitative content analysis identified key themes reflecting their experiences using prostheses. Seven major categories emerged that helped shape prosthesis preferences: functionality, physical aspects, mental aspects, activity, maintenance, safety, and health-related quality of life. The MPK was superior in all categories, resulting in considerably fewer falls and improved cognitive and physical performance. The four participants who had an N-MPK backup did not use this device and instead received a loaner MPK from their prosthetist when required. For individuals who do not have ready access to their prosthetist to obtain a loaner knee unit, consideration should be given for a backup prosthesis with the same MPK unit as their daily-use prosthesis, as participants identify significant issues when trying to function with an N-MPK unit. Individuals with ready access to a loaner knee unit through their prosthetist may not require a backup prosthesis.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.