Background: To be able to meet social harmony in a continuously globalizing world, intercultural competencies are important to possess as an individual. Thus, it is also important for Certified Prosthetists and Orthotists (CPOs) and other health care providers since they meet many diversities in connection to their work. Aim: The aim of this study is to investigate Danish CPOs’ experience and perception of their intercultural competencies in the treatment of immigrants. Method: This study is a qualitative interview study using a phenomenological approach. Semi-structured interviews are used to collect the data from five CPOs working in Danish clinics. A content analysis, with an inductive approach, is used for the analysis. Findings: From the analysis of the participant interviews, seven sub-categories were found and further divided into three categories: Treatment, work environment, and development of competencies. These contribute to describe the main category and the aim of this study. Conclusion: The Danish CPOs, who participated in this study, experienced that they did not treat immigrants differently than non-immigrants. However, they experienced that some challenges could be connected to the treatment of immigrants, such as communication difficulties, but they all had a perception, that they used specific tools and strategies to accommodate these challenges. Furthermore, they all experienced that their intercultural competencies had improved with experience, but most of them were also interested in further development of their competencies.

Background Recent conflicts have seen an increase in trauma related military amputees who incur complex injuries which result in varied residual limbs. In many cases these amputees have been provided with state of the art (SOTA) components with the expectation that they will transfer into NHS care after military discharge. However, there is a lack of knowledge around how prosthetic prescriptions are made in both the MOD and NHS, including patient involvement. It is important to explore prosthetic prescription decisions to enhance the quality, consistency and equity of care delivery for trauma amputees. This thesis explores decision making in prosthetic care for trauma amputees in the UK during this period of change. Aims To explore aspects of prosthetic care provision in the UK including clinical decision making, patient experience and the transition of prosthetic care from the MOD to the NHS. Design An exploratory qualitative project informed by decision making and patient involvement theory. Semi-structured interviews were carried out with nineteen clinical staff involved in prosthetic provision, six civilian and five veteran trauma amputees. Thematic analysis was used to analyse the data. Findings Prosthetists used a wide range of factors in making prescription decisions, including physical characteristics, patients’ goals, and predicted activity levels. Prescription decision making varied depending on the prosthetists’ level of experience and the different ‘cues’ identified. In some cases there was a lack of transparency about drivers for the prescription choice. Prescription decisions are influenced by long term relationships between prosthetist and patient, allowing a trial and error approach with increasing patient involvement over time. Patient experiences of their trauma amputation influenced their approach to rehabilitation. Patients reported wanting different levels of involvement in their prosthetic care, however, communication was essential for all. Veteran amputees benefited from peer support opportunities which NHS services were less conducive to. However, NHS amputees were more likely to have been ‘involved’ in care decisions. The expectations that MOD patients had of inferior care in the NHS were not realised in the majority of veteran cases. Recommendations Research is needed to support prosthetists’ decisions to become more consistent and transparent. The NHS should consider introducing a peer support model for trauma patients, and particularly in the early stages of rehabilitation.

Background: Meeting the prosthetists needs, and barriers is important to successful implement evidence into practice. Thus, several implementation methods have been initiated, the authors saw a need to create a Communication Tool based on evidence from transfemoral socket designs, to ease the process of assisting prosthetists in facilitating evidential reasoning.   Aim: To investigate if a Communication Tool can facilitate the usage of evidence into practice by assisting the clinical decision making.  Method: The study is divided into two parts. First the development of the Communication Tool, which is based on the Knowledge to Action model plus an update of studies from a systematic review by Brodie et al.2021. The second part consists of a qualitative pilot-study using semi-structured synchronously interviews to collect data from two Danish working prosthetists. For the analysis a conventional content analysis with an inductive approach was used.  Findings: Findings from the analysis of the interviews compiled eight categories and twenty-five sub-categories covering three key themes identified during the creation of the Communication Tool: Barriers, internal usability, and external usability of the Communication Tool.   Conclusion: The Communication Tool showed to be an effective method to assist and facilitate evidence-based reasonings. The participants found the tool to be useful and appraised positively regarding communicating relevant content an easy to navigate in. Minor improvements are needed, which are related to the quality assessment system and the system of reference as well as some linguistic formulations.

Although dynamic prosthetic alignment is an important process for the rehabilitation of transtibial amputees, such alignment technique is subjective and inconsistent. Using biomechanical variables and questionnaire assessments, this study compared an instrument-assisted dynamic alignment technique using the Compas™ system and conventional alignment techniques on nine adults with unilateral transtibial amputation. A focus group discussion was conducted with six prosthetists to understand clinical practice of dynamic alignment and their perception of the Compas™ system. Results found that Compas™ produced more anterior weight line displacement and greater varus moment on the prosthesis than conventional alignment techniques. Alignment changes did not affect pelvic acceleration, and the instrument-assisted alignment technique produced certain biomechanical changes but not necessarily better alignments. Although the current version of the Compas™ system is not clinically feasible, it can be used as a teaching/justification tool. Further investigation with larger sample size and ankle alignment or moment measures is needed.

Although dynamic prosthetic alignment is an important process for the rehabilitation of transtibial amputees, such alignment technique is subjective and inconsistent. Using biomechanical variables and questionnaire assessments, this study compared an instrument-assisted dynamic alignment technique using the Compas™ system and conventional alignment techniques on nine adults with unilateral transtibial amputation. A focus group discussion was conducted with six prosthetists to understand clinical practice of dynamic alignment and their perception of the Compas™ system. Results found that Compas™ produced more anterior weight line displacement and greater varus moment on the prosthesis than conventional alignment techniques. Alignment changes did not affect pelvic acceleration, and the instrument-assisted alignment technique produced certain biomechanical changes but not necessarily better alignments. Although the current version of the Compas™ system is not clinically feasible, it can be used as a teaching/justification tool. Further investigation with larger sample size and ankle alignment or moment measures is needed.