Dissemination of Amputation and Prosthetic Evidenced-based Medicine (DAP-EM)

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DESCRIPTION (provided by the applicant): The purpose of this proposal is to: (1) increase the impact and effective use of evidence-based health information by adding health information to an existing virtual world support space infrastructure and (2) conduct a randomized clinical trial to compare individual-amputee outcomes of the intervention delivered on CD-Rom versus a virtual environment. The proposed project enhances the existing Amputee Virtual Environmental Support Space (AVESS) virtual infrastructure to provide physical, emotional, and technology based evidence-based health information to individuals with upper and lower limb amputation(s) and the clinicians who serve individuals with amputation. Aim 1 develops one upper limb and one lower limb 3- module self-management intervention. The first module provides declarative evidence-based information. The second and third modules provide interactive experiences that will, as examples, address choosing a prosthesis, prosthetic training, emotional aspects of living with an amputation, and managing co morbidity, and social integration. Aim 2 evaluates the usability of the 3-module self-management interventions; data from focus group sessions will be analyzed for thematic areas related to ease of use, appropriateness and usefulness of content, look of the visual presentation, and likeliness of use. Aim 3 conducts a randomized clinical trial to compare individual-amputee outcomes of intervention delivered on CD-Rom versus the AVESS environment. The outcomes are use of prosthetic devices, self-efficacy, psychosocial status, pain interference, and physical function. Aim 4 evaluates user satisfaction with the AVESS dissemination strategy. We will enroll 92 individuals with amputation: 46 upper limb amputees and 46 lower extremity amputees. Subjects will complete pretests, the 3-module intervention, and posttests after the invention and again at five months follow-up. A mixed methods design will be used. Aim 1 is development. Aims 2 and 4 will use qualitative methods based on Grounded (Aim 2) and Interpretative Phenomenological Approaches (Aim 4). Aim 3 will use a quantitative randomized control design and generalized linear models for analyses.