Donald J. Fogelberg

Background: Mobility is challenging for individuals with lower extremity amputations due to human movement variability, environmental factors, and aspects of prosthetic foot performance. Designing and testing novel prostheses offers an opportunity to qualitatively evaluate users' experiences with the technology in their lived environment. Objective: The aim was to understand the lived experiences of people with lower extremity amputation during a clinical trial of a novel prosthetic foot. Study Design: This study was a secondary phenomenological analysis of semi-structured interview data collected during a clinical trial. Methods: This study included individuals with unilateral, below-knee amputations and mobility levels of K3 or K4. Participants used a newly designed prosthetic foot in home and community for 2 weeks, followed by 2 weeks using their usual prosthesis. Participants recorded their daily activities and challenges in a logbook. Semi-structured interviews were conducted after the investigational foot was used and at the study's conclusion. Interviews were transcribed verbatim and independently coded by at least three researchers using an inductive coding scheme until themes emerged. Results: Thirty-one participants took part in this study. Key themes included (1) adjusting to the prosthesis, (2) fluid movement in everyday life, (3) testing prosthesis limits, and (4) natural feel of the prosthesis. Some participants reported experiences consistent with prosthetic embodiment. Conclusion: Gathering qualitative perspectives on novel prosthetic technology is essential to understanding user priorities, adaptation strategies, and functional needs. Participants identified both advantages and drawbacks in the new prosthetic foot design while noting challenges in trialing it. This research contributes to understanding the process of adapting to a new prosthesis and the impact of prosthetic feet on users' daily lives. Clinical Relevance Statement: Users identified opportunities for longer, real-world trial periods of prosthetic technology as critical to understanding the contextual benefits and challenges associated with novel prosthetic design options. ( J Prosthet Orthot . XXXX;X:XX–XX)

Background: The primary objective of this study is to investigate whether a novel prosthetic foot with a polycentric ankle, which offers side-to-side adaptability, improves mobility and daily performance in individuals with (1) unilateral above-knee amputation, (2) unilateral below-knee amputation with a lower mobility level (K2) , or (3) bilateral amputation, any level of amputation. Traditional prostheses are primarily designed for forward walking and lack adaptability for navigating uneven terrain, turning, and executing other multidirectional tasks, often resulting in pain, instability, and limited function. Objective: The objective of this testing protocol is to better understand the functional impact of a novel foot design that offers more inversion/eversion rotation of the polycentric ankle. Although the foot has the potential to address mobility challenges, it is unknown whether people with different amputations and mobility levels respond differently. Methods: The study includes community-based mobility assessments, standardized questionnaires, and participant feedback. Although side-to-side adaptability prosthetic feet have shown benefits for highly active users, this study aims to evaluate the impact on individuals with more significant mobility limitations. Results: Results may guide prosthetic prescription, expand access to advanced prosthetic technology, and inform reimbursement policies, particularly benefiting veterans and service members with combat-related amputations. The study began recruiting in October 2023; as of September 2025, there were 66 participants (17 below the knee, 34 above the knee, and 15 bilateral) who completed the protocol. The clinical trial is expected to be completed by March 2027. Dissemination of results is expected to be completed by December 2027. Conclusions: This procedural study presents a model for evaluating prosthetic feet and other mobility-assistive technologies in real-world contexts, supporting broader efforts to match components to user needs through clinical trials that are grounded in both functional performance and user experience.

Fatigue is one of the most burdensome and disabling symptoms in numerous acute and chronic conditions and is associated with reduced participation in all aspects of daily life, for example, parenting, employment, and socialization. Historically, occupational practitioners played key roles in fatigue management by creating and implementing interventions. The American Occupational Therapy Foundation convened a Planning Grant Collective workshop with the goal to develop collaborative research ideas and proposals to advance the understanding and management of fatigue. Participants from occupational therapy and other disciplines, with expertise with fatigue or who were conducting research on fatigue, participated in a 3-day virtual workshop. Four main topics emerged: implementation science, treatment taxonomy, trial design and comparative effectiveness, and phenotyping. This white paper describes the proceedings, summarizes the discussions, and outlines recommendations from the PGC workshop on fatigue.

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X²-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

Poor sleep contributes to adverse health outcomes making it important to understand sleep in medically vulnerable populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively affect sleep, or to consequences of poor sleep in this population. The objective of this study was to examine the experience of sleep among individuals with SCI. Secondary analysis using thematic coding of qualitative data from an ethnographic study of community-dwelling adults with SCI was conducted. Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. This study highlights the extent of sleep disturbance experienced after SCI and the subsequent impact on occupational performance, and provides direction for clinical practice.

Introduction: Most people with lower-limb amputation (LLA) rely on a prosthetic foot for participation at home and in the community. The published literature describes problems with mobility after LLA, yet there have been few published accounts of peoples' participation experiences. The purpose of this study was to increase understanding of the impact of prosthetic feet on participation in the activities of daily life by examining the experience of prosthetic users and professionals.Materials and Methods: Users of prosthetic feet and health care professionals who prescribe prosthetic feet were invited to complete a brief online questionnaire before participating in one of five focus groups. Descriptive statistics were used to summarize questionnaire data. Focus group sessions were audio recorded and transcribed. Each transcript was thematically coded independently by four researchers. Emergent themes were discussed, categorized, and cross-referenced.Results: Eleven prosthetic foot users (68.8%) and 11 professionals (100%) completed the online questionnaires. Although the prosthetic foot users rated their difficulty with usual activities as none to slight, 36% reported falling within the last 6 months, and 45% indicated that they modified their participation because of the potential for falls. Sixteen prosthetic foot users and 11 health care professionals took part in focus groups. There was a significant overlap in themes discussed by prosthetic foot users and health care professionals. Identified barriers to full participation included the ability to stand for extended periods, navigate in confined spaces, carry heavy objects, and change body posture. Absence of sensory feedback created significant concerns about safety when driving a car, navigating uneven terrain, or climbing ladders. Characteristics of existing prosthetic feet that impact participation included limited durability, lack of waterproofing, and limited range of motion. Current designs limited choices of footwear and created difficulties donning and doffing shoes.Conclusions: Participants' reported confidence in forward walking on even ground suggests that current prosthetic feet are well-suited for this limited use. However, they also identified a number of situations in which their current prosthetic feet caused significant difficulties, often with safety implications. While some stories, such as rocks on the sidewalk, are consistent with the literature, other stories describe situations such as ladders and stepstools that are not well documented. Our study highlights the utility of focus groups in identifying previously unrecognized needs and concerns, with significant implications for the design of prosthetic feet. Future studies should include more diverse participants, particularly with regard to age and overall physical health.

Background: Despite the existence of numerous prevention strategies, pressure ulcers remain highly prevalent in those with spinal cord injury (SCI). The concept of habit, broadly defined, may help understand the persistence of this problem and offer strategies for its mitigation by occupational therapy. Aim: The aim of this paper is to describe the relationship between habits established prior to sustaining an SCI and post-injury habits that impacted on pressure ulcer risk. Methods: Secondary analysis of qualitative data collected during an ethnographic study of community-dwelling adults with SCI. Results: Participants’ habits appeared to substantially affect their risk of developing pressure ulcers. Habits established before incurring the SCI either facilitated or hindered the acquisition of new habits intended to prevent pressure ulcers. Conclusions: An understanding of the individual’s pre-existing habits may be important when designing a rehabilitation programme intended to minimize risk of pressure ulcer development following SCI. Habit-change strategies could be used to supplement education in pressure ulcer prevention techniques. Significance: Occupational therapists have a longstanding interest in habit. A more comprehensive understanding of this concept may provide important insights into the persistence and management of pressure ulcers following SCI.

Sleep problems, prevalent among older adults, are associated with poor outcomes and high health care costs. In 2008, rest and sleep became its own area of occupation in the American Occupational Therapy Association's Occupational Therapy Practice Framework. The current scoping review examined a broad context of sleep research to highlight efficacious interventions for older adults that fall within the occupational therapy scope of practice and present an agenda for research and practice. Four sleep intervention areas clearly aligned with the practice framework, including cognitive behavioral therapy for insomnia, physical activity, multicomponent interventions, and other interventions. Occupational therapy is primed to address sleep problems by targeting the context and environment, performance patterns, and limited engagement in evening activities that may contribute to poor sleep. Occupational therapy researchers and clinicians need to work collaboratively to establish the evidence base for occupation-centered sleep interventions to improve the health and quality of life of older adults.