Lauren Lopez The lived experience of older adults’ adjustment to amputation in the context of wheelchair use

Aug 23, 2026

Study explores how older adults adjust psychologically after lower-limb amputation while using wheelchairs. Interpretative Phenomenological Analysis (IPA) was conducted with four men with vascular-related lower-limb amputations who identified as wheelchair users. Adjustment experiences clustered into two themes: actively becoming an agent through self-reflection and decision-making, and psychosocial adjustment as an iterative, ongoing process linked to earlier life events. Mobility aids were not shown as directly shaping adjustment, but instead provided opportunities for change. Findings support clinician strategies during amputation care.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

Context: vascular disease and amputation outcomes

Wheelchair use after amputation: reported challenges

Defining adjustment: negative vs positive adjustment

Adjustment as a staged psychological process

REsEaRch REpORt the lived experience of older adults’ adjustment to amputation in the context of wheelchair use Lauren Lopez BPhty, MHealSc (Rebahilitation) Graduate research student, Rehabilitation Treatment and Research Unit, University of Otago Wellington. Fiona Graham BOccTher (Otago), PhD Senior Lecturer, University of Otago Wellington. Elliot Bell MA, PGDipClinPsych, PhD Lecturer, Department of Psychological Medicine and Rehabilitation Teaching and Research Unit, University of Otago Wellington. E. Jean C. Hay-Smith DipPhty, MSc, PhD Associate Professor in Rehabilitation, University of Otago Wellington. ABSTRACT Amputation has a profound psychological impact on recipients. The experience of adjustment to lower limb amputation (LLA) by older adults who use wheelchairs was explored using Interpretative Phenomenological Analysis (IPA) . Four men with lower limb amputations due to vascular disease who identified as wheelchair users were interviewed. Participants’ experiences of adjustment to LLA are represented by two themes: “Being an Active Agent” and “Psychosocial Adjustment as an Iterative Process”. Being an Active Agent included three elements: self-reflection, a sense of control over one’s LLA and the belief one is able to take action indecision-making in daily life. The second theme ‘Psychosocial Adjustment as an Iterative Process’ described the ongoing nature of the participants’ narratives of adjustment to LLA. This theme also encompassed participants’ experiences of adjustment to LLA as firmly linked to management of previous life events. Participants’ adjustment did not appear to be directly influenced by the mobility aid they used; rather, the mobility aid provided opportunities for adjustment to occur. Older adults’ adjustment to LLA appears tobe influenced by their perception of being an active agent in their adjustment process, particularly in relation to decision-making. Adjustment also appears to be a process which older adults continue to engage in after the amputation event. The findings of this study suggest practical strategies that clinicians can use with older adults undergoing amputation. Lopez, L., Graham, F., Bell, E., Hay-Smith, EJC. The lived experience of older adults’ adjustment to amputation in the context of wheelchair use. New Zealand Journal of Physiotherapy 45(2): 67-74. doi: 10.15619/NZJP/45.2.03 Key words: Amputation, Psychological adjustment, Aged, Resilience, Agency INTRODUCTION Amputation is an end stage treatment option for individuals with vascular disease suffering profound and unresolving infection, pain and consequent immobility. Those undergoing (even) lifesaving amputation are likely to have lasting psychological sequelae. Those who undergo amputation because of vascular disease tend to be older and more likely to have both pain and lower physical functioning before their amputation, compared to those undergoing traumatic amputation (Kratz et al., 2010) . They may also have comorbidities such as diabetes (Peters et al., 2001), pain and obesity (Roberts et al. , 2006), cardiovascular disease (Priebe, Davidoff, & Lampman, 1991), peripheral neuropathy (Potter, Maryniak, Yaworski, & Jones, 1998), reduced cognitive ability (Hanspal & Fisher, 1997) and phantom pain after amputation (Nikolajsen, Ilkjær, Krøner, Christensen, & Jensen, 1997) . Within this population, wheelchair users tend to be older, have more co-morbidities, report higher levels of pain and fatigue and ambulate less efficiently (Karmarkar et al., 2009) compared to prosthesis users. Therefore it seems likely that wheelchair users may experience psychosocial adjustment to LLA in a different way to prosthesis users given their more complex health and personal profiles. While adjustment in the context of prosthesis use post amputation has been well documented (Atherton & Robertson, 2006; Desmond, Gallagher, Henderson-Slater, & Chatfield, 2008; Murray & Forshaw, 2013), wheelchair use after amp

FAQs

How was the study of older adults’ adjustment to amputation conducted?

The study used Interpretative Phenomenological Analysis (IPA) and interviewed four men with lower-limb amputations due to vascular disease who identified as wheelchair users.

What themes describe participants’ adjustment experiences?

Two themes emerged: “Being an Active Agent,” and “Psychosocial Adjustment as an Iterative Process.” The active-agent theme included self-reflection, control in relation to the amputation, and decision-making in daily life.

Does wheelchair use directly influence psychological adjustment?

The findings suggest adjustment was not directly influenced by the mobility aid itself; rather, the mobility aid provided opportunities for adjustment to occur and continue after the amputation event.

Aug 23, 2026

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