Amputee Rehabilitation

Original Editor - Liezel Wegner and Caroline Cater as part of the World Physiotherapy Network for Amputee Rehabilitation Project

Top Contributors - Admin, Stacy Schiurring, Sheik Abdul Khadir, Tony Lowe, Chrysolite Jyothi Kommu, Kim Jackson, Aminat Abolade, Alexandra Stead, Olajumoke Ogunleye, Jess Bell, Shaimaa Eldib, Karen Wilson, Simisola Ajeyalemi, Tarina van der Stockt, Richard Benes, Naomi O'Reilly and Oyemi Sillo

Introduction

The loss of a lower limb has severe implications for a person’s mobility, and ability to perform activities of daily living, negatively impacting their participation and integration into society. The ultimate goal of rehabilitation after limb loss is successful ambulation with a prosthesis and a high level of social reintegration. However, many people experience poor physical function and psychosocial outcomes after lower limb amputation, which can be worsened by under-informed prosthesis-user expectations. Prosthetic rehabilitation is a complex task best delivered by a transdisciplinary rehabilitation team; which member formally leads that team varies by healthcare system, as discussed below.

The Nine Phases of Amputee Rehabilitation

The rehabilitation process for a person with a lower limb amputation is traditionally described in nine phases, first proposed by Esquenazi & Meier and still widely used as the organising framework for amputee rehabilitation services. Physiotherapist roles and responsibilities across this pathway are now set out in detail in the British Association of Chartered Physiotherapists in Limb Absence Rehabilitation (BACPAR) evidence-graded clinical guideline (3rd edition, 2025).

Table 1.0: Phases of amputee rehabilitation, modified from Esquenazi & Meier.

Phase	Hallmark
Pre-operative	Assess body condition, patient education, surgical level discussion, postoperative prosthetic planning
Amputation Surgery/Reconstruction	Length, myoplastic closure, soft tissue coverage, nerve handling, rigid dressing
Acute Post-surgical	Wound healing, pain control, proximal body motion, emotional support
Pre-prosthetic	Shaping, shrinking, increasing muscle strength, restoring patient locus of control
Prosthetic Prescription	Team consensus on prosthetic prescription and fabrication
Prosthetic Training	Increasing prosthetic wearing time and functional utilisation
Community Integration	Resumption of family/community roles, emotional equilibrium, coping strategies, recreation
Vocational Rehabilitation	Assess and plan future work activities; may need further education, training, or job modification
Follow-up	Life-long prosthetic, functional, medical, and emotional review

Throughout all nine phases, a rehabilitation treatment plan guides care. This plan is built from assessment by every specialty involved and used by the whole team to track goals agreed with the patient and family. The scope of rehabilitation intervention is considered from hospital admission, refined after surgery, and finalised before discharge, and comprises of ongoing medical assessment of impairments, and therapy interventions addressing disability and activity limitation.

The Rehabilitation Team

Amputee rehabilitation is a multidisciplinary undertaking. Professionals commonly involved include:

Table 2.0: Multidisciplinary team in amputee rehabilitation

Professional	Role
Physiatrist / rehabilitation physician	In some models, leads the team and the rehabilitation process from assessment through lifelong management (see leadership models, below)
Physiotherapist	In other models, coordinates rehabilitation care across the pathway; leads gait and functional rehabilitation
Prosthetist	Casting, fabrication, and ongoing management of the prosthesis
Occupational therapist	Home/work environment assessment and adaptation, ADL retraining
Nurse	Specialist wound care
Psychologist/counsellor	Cognitive support, psychological adjustment support
Dietitian	Nutrition education, particularly with poorly controlled diabetes
Physician	Medical management, including phantom pain
Social worker	Financial/disability support, discharge planning, case management
Podiatrist/foot care specialist	Contralateral limb risk management
Vascular/plastic/orthopaedic surgeon	Surgical planning and management, wound coverage
Recreational therapist / adaptive sports provider	Return to leisure and sport
Amputation support group	Peer support
Patient and carer(s)	Central members of the team; goal-setting, decision-making, and day-to-day self-management

The exact composition of the team, and who leads at each phase, varies by setting and resourcing. For examples of how this pathway adapts where specialist resources are limited, please see Physical Disabilities Rehabilitation in Africa and Rehabilitation of Amputations in Disasters and Conflicts.

Two Leadership Models: Physiotherapist vs Physiatrist

Learners working internationally will encounter two different models of who formally leads the team, and it's worth recognising both rather than assuming one is universal. Some services reflected, for example, in BACPAR's UK guideline, position the physiotherapist as the professional who coordinates rehabilitation care across the pathway. Others, including the current VA/DoD amputation care team model used across the US Veterans Affairs and Department of Defense systems, position a physiatrist (a physical medicine and rehabilitation physician) as team leader, responsible for the rehabilitation process from assessment through lifelong management, with physiotherapy and occupational therapy operating in close collaboration under that leadership. Neither model is "correct" in an absolute sense, rather they reflect different national healthcare structures and scopes of practice. What matters clinically is that every team member understands who holds coordinating responsibility in their own service, since ambiguity about this role is itself a recognised source of poor communication and delayed care.

Multidisciplinary vs Interdisciplinary Working

Two working models are described in the literature:

Multidisciplinary team (MDT): professionals from different disciplines work in parallel, each setting their own discipline-specific goals and communicating outcomes to the rest of the team where relevant.

Interdisciplinary team (IDT): goals are shared and practice overlaps rather than running in parallel; professionals engage in joint problem-solving, working beyond their own scope, with regular communication built into the process rather than added afterwards.

Many limb centres are shifting from MDT towards IDT working, on the premise that closer, overlapping collaboration between prosthetists, physiotherapists, and physicians produces better outcomes than coordinated-but-separate input.

Communication Within the Team

Regular, structured communication is what turns a list of professionals into a functioning team. Common mechanisms include:

Goal-setting meetings, typically fortnightly (every two weeks) or monthly, where the team reviews progress against patient-defined goals, using a formal outcome measure where the service has one in place. Please see this Physiopedia Page to learn more about outcome measures for patients with lower limb amputation.

Regular case conferences, particularly during inpatient and early prosthetic phases, to surface concerns early and agree a joint approach to problem-solving.

Shared digital systems (eg. secure messaging, shared records, video conferencing) for teams spread across satellite clinics or multiple sites. However this option will only be successful if every team member is trained on the system and checks it consistently.

Whichever mechanism is used, the underlying principle is the same: without a reliable channel for referral and information-sharing, even a well-staffed team can produce the delays and missed referrals described above.

Why This Matters Clinically

Outcomes after lower limb amputation are shaped less by any single profession's input than by how well the team coordinates across phases. A patient can receive excellent surgical care and still have a poor functional outcome if pre-prosthetic shaping is inadequate or if psychosocial adjustment is missed. Poorly timed handover between phases is likewise associated with delayed discharge and missed referrals. Recognising where you sit in this nine-phase pathway, and who else needs to be involved at each stage, is not a peripheral administrative concern, it is as central to good clinical practice as any individual technical skill. Strong team coordination drives successful interventions.

Additional Resources

Optional Additional Video

This video overview the role of the multidisciplinary team in amputee rehabilitation using case study examples.

Clinical Resources

• Beckley AA, Wong CK. Implementation of an evidence-based multidisciplinary post-operative lower extremity amputation protocol (LEAP): barriers, facilitators, and strategies. Implementation Science Communications. 2025 Nov 18;6(1):125.
• Burii O, Oliinyk R, Dushenko S, Nahornyi D, Kosovska M, Lykhach V, Soroka N. The role of a multidisciplinary team in the rehabilitation of a patient with quadruple amputation. Journal of Rehabilitation Medicine. 2026 Jan 14;58:jrm44843-.
• Clinical guidelines for the pre- and post-operative physiotherapy management of adults with lower limb amputations. 3rd ed. (BACPAR, 2025)
• Multidisciplinary Care of Lower Limb Amputations webinar presentation slides (Gary Clark, MD; Paradigm Medical Director)