Forging an Amputee Rehabilitation Clinic

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By Toran D. MacLeod, PT, PhD

I emphasize my background and training in gait analysis in my practice as a physical therapist and as an educator of doctorate-level physical therapy (PT) students at California State University, Sacramento, applying the syllabus of Amputations and Prosthetics: A Case Study Approach. In 2016, my second year at the university, in lieu of lecture, I decided that adding a pro bono clinic for people with amputations would give my students an intensive learning experience.

We started with a three-day clinic over three weeks. To develop the clinic's multidisciplinary, interprofessional approach, I invited other faculty within the College of Health and Human Services to participate. Each year, 68 student clinicians (two master's of social work, 32 doctoral physical therapy, 16 undergraduate recreation therapy, 16 undergraduate nursing, and two speech language pathology students) have served 16 community members with limb loss. Faculty members from each of the departments serve their respective students. Evidence-based medicine is practiced using interventions, outcome measures, prognostics, and diagnostics from supporting literature, clinical experience, and clinical practice guidelines. Notes are coordinated and written as a group. We have served 25 community members across the range of functional, amputation, and participation levels.

The clinic has grown to four days over four weeks. Faculty start planning in the spring for the upcoming year and send out invitations to enroll members. Early in the fall semester, I recruit and complete the participants' intake/screening forms. Students are tested on each of the disciplines and the interprofessional clinic model. The week before the clinic opens, the student clinicians meet for the first time. Each participant has a dedicated team that includes two PT students, one recreational therapy student, and one nursing student, with specialty services provided when appropriate. Each student team reviews the intake form together and plans for the first visit the following week by initiating PICOT questions, as they are required to do within the course. PICOT, which stands for population/patient, intervention, comparison, outcome, and time frame, is an evidence-based practice method of summarizing the effects of therapy.

Last year, a community-member participant died between visits to our clinic. This created another learning opportunity and a poignant understanding of the often-critical set of needs in this population. We have established a community where patients and clinicians see the benefit of a single location with a holistic approach to health. Many of our clients had never seen a physical therapist before coming to our clinic, and we hope to change that culture. Next year, we hope to include students of nutrition and medicine to improve our students' learning and the effect on our community.

Our clinic began when I realized an opportunity. I realized that to really teach doctoral PT students all they needed to know, they needed to treat patients in a professional and safe environment. My goal is to help people participate—in whatever their goals may be—without limitation or impairment. As a physical therapist, educator, and scientist I hope to use all my skills toward this effort.

Toran D. MacLeod, PT, PhD, is an assistant professor in the Department of Physical Therapy at California State University, Sacramento. He can be reached at toran.macleod@csus.edu.

To see the clinic in action, visit https://youtu.be/xlZOCPGwHjg.