Collaborate to Promote Patient Health and Well-being

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As a physical therapist, I value the unique skills the O&P profession provides and enjoy collaborative patient care. A passion for helping people after limb loss led me to work with others in creating a network of services and programs promoting the health and well-being of local community members.

The majority of amputations are due to vascular disease or trauma, and I am concerned about the poor health and increased mortality seen in this population, which are multifactorial. Bhuvaneswar and colleagues1 outlined the problem from the mental health perspective, which is the most compelling reason to collaborate and help our patients find proper care. Amputation carries significant mental health burdens, including poor adjustment, depression, and post-traumatic stress disorder. Add the challenges of negotiating the healthcare system and finding each provider at the right time, and it is easy to see why our patients struggle.

Coordinated care before and after amputation leads to improved health and well-being in this population.2 Obtaining well-timed care is also essential, and access to services varies widely. In the United States, patients report a variety of barriers to care that include restricted funding, limited appointment availability, and transportation challenges.3

Discussions with care providers and community members inspired me to break down barriers to high-quality, coordinated care and services for the limb-loss community. Together we started ECLIPSE: Exercise Community Living in Prosthetics and Supporting Everyone ( Last year we held a symposium for prosthetists and physical therapists to learn together and earn CEUs. We also invited community advocates, support group representatives, and manufacturers, as well as community members with limb loss. Using focus group feedback from the symposium, we expanded our services to include a student-run, pro bono physical therapy clinic for people without access to rehabilitation services; a community walking group sponsored by Össur Americas, Foothill Ranch, California; and peer-training courses. I hope to also create an online resource network for the Los Angeles area, and am contacting local therapists and prosthetists to participate.

I encourage you to reach out to your community and create a network of resources to help this at-risk population. My efforts are just beginning and I am encouraged to find many others with a shared desire to help. Community partnerships can come in all sizes—from private clinical practitioners of medicine, prosthetics, and physical therapy, to small local support groups and large corporate sponsors. Our ultimate goal is increasing the lifespan of those living with limb loss, and by working together we build a better future for our patients and the members of our community.

Vicky Graham, DPT, OCS, NCS, is an assistant professor in the Department of Physical Therapy, College of Health and Human Development at California State University, Northridge. She can be reached at .


  1. Bhuvaneswar, C. G., L. A. Epstein, and T. A. Stern. 2007. Reactions to amputation: Recognition and treatment. The Primary Care Companion to the Journal of Clinical Psychiatry 9 (4):303-8.
  2. Perkins, Z. B., H. D. De'Ath, G. Sharp, and N. R. Tai. 2012. Factors affecting outcome after traumatic limb amputation. The British Journal of Surgery 99 Suppl 1:75-86.
  3. Kullgren, J. T., C. G. McLaughlin, N. Mitra, and K. Armstrong. 2012. Nonfinancial barriers and access to care for U.S. adults. Health Services Research 47 (1 Pt 2):462-85.

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