Clinical and psychological adjustment to prosthesis use in lower-limb amputees: focus on differences between...

Introduction: Advanced rehabilitation technologies are increasingly being implemented in transtibial amputation, although evidence remains limited regarding whether non-immersive virtual reality systems and biofeedback provide additional benefits beyond conventional rehabilitation approaches. Methods: This prospective randomized clinical trial included 21 male patients (mean age 61.7 ± 7.21 years) with transtibial amputation due to vascular disease or type 2 diabetes. Eleven participants received traditional rehabilitation, while ten underwent a combined protocol integrating conventional physiotherapy with D-Wall technology over a 3-week inpatient program. Results: Across the entire sample, functional outcomes related to autonomy and prosthetic mobility improved from baseline to discharge, including the Barthel Index, Functional Independence Measure, and Amputee Mobility Predictor, independent of rehabilitation condition. A non-significant trend toward reduced depressive symptoms was also observed. Baseline psychological characteristics were associated with rehabilitation outcomes. Higher self-efficacy was associated with lower depressive symptoms, anxiety, and body image distress, as well as higher prosthetic mobility. Similarly, better prosthetic adaptation at discharge was associated with lower psychological distress and higher quality of life and functional independence. Exploratory within-group analyses suggested that, in the technology-enhanced group, improvements in body image were associated with reductions in anxiety, while reductions in depressive symptoms were associated with higher functional independence. In the traditional rehabilitation group, reductions in anxiety were associated with improved perceived quality of life. Discussion: Overall, technology-enhanced rehabilitation was not associated with superior functional outcomes compared with traditional rehabilitation in this exploratory sample. However, exploratory findings suggest potential associations with psychological and perceptual processes related to emotional adjustment and body image during rehabilitation. These preliminary observations should be confirmed in adequately powered studies.