293 JRRD JRRD Volume 46, Number 3, 2009 Pages 293–304 Journal of Rehabilitation Research & Development Lower-limb amputee needs assessment using multistakeholder focus- group approach Glenn K. Klute, PhD; 1–2* Carole Kantor, MS; 3 Chris Darrouzet, PhD; 4 Helga Wild, PhD; 4 Susann Wilkinson, MSW, MPH; 4 Suzana Iveljic, MBA; 3 Graham Creasey, MD, FRCSEd 3 1 Center of Excellence for Limb Loss Prevention and Prosthetic Engineering, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA; 2 Department of Mechanical Engineering, University of Washington, Seattle, WA; 3 Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; 4 Water Cooler Logic Inc, Menlo Park, CA Abstract—To assess the needs of lower-limb amputees and identify differences between diabetic dysvascular amputees and traumatic amputees, we held a multistakeholder focus-group workshop whose participants included veteran lower-limb amputees, clinicians, researchers, and prosthetic device manu- facturers. We conducted the initial workshop sessions as tradi- tional focus-group meetings with homogeneous participant groups generating lists of issues relevant to the individual groups. Subsequent sessions assembled heterogeneous partici- pant groups for a two-phase approach: Discovery and Codesign. The Discovery phase used observation and discussion to elicit specific needs. The Codesign phase focused on emergent topics and explored potential solutions. The participants identified needs associated with desired improvements to the socket sys- tem, foot and ankle components, and alignment with the residual limb. One need was a comprehensive understanding of the recovery path following amputation that could be addressed through enhanced education and communication. Another need was remote monitoring systems that could potentially improve quality of care. No dichotomy of needs between diabetic dysvas- cular amputees and traumatic amputees was evident among the participants of this workshop. The lively, open-ended discus- sions produced numerous suggestions for improving amputee quality of life that are listed to facilitate future research and development. Key words: amputation, amputee, artificial limb, diabetes, focus group, lower limb, needs assessment, prosthesis, rehabili- tation, trauma. INTRODUCTION The loss of a lower limb can profoundly influence an individual’s quality of life (QOL). Observations of lower- limb amputees showed limited mobility, greater meta- bolic demands, and a disproportionately high incidence of pain and discomfort in comparison with nondisabled individuals [1–4]. Identifying and prioritizing the needs of lower-limb amputees may, through meaningful research and development, improve technology and care that result in a higher QOL. Importantly, the needs themselves and their priority may depend on individual patient characteristics. One sec- tion of the population of lower-limb amputees is older and at greater risk for diabetes and vascular disease than the general U.S. population [5–8]. The Veterans Health Administration performs about 5,000 lower-limb amputa- tions each year on patients with these characteristics [7]. Abbreviations: LLANA = lower-limb amputee needs assess- ment, NIDRR = National Institute on Disability and Rehabili- tation Research, QOL = quality of life, VA = Department of Veterans Affairs. * Address all correspondence to Glenn K. Klute, PhD; VA Puget Sound Health Care System, 1660 S Columbian Way, MS 151, Seattle, WA 98108; 206-277-6724; fax: 206-764- 2808. Email: gklute@u.washington.edu DOI:10.1682/JRRD.2008.02.0031