{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:15:57Z","timestamp":1789517757518,"version":"build-2803163510"},"reference-count":58,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"unspecified","delay-in-days":350,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prim Health Care Res Dev"],"published-print":{"date-parts":[[2020]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S146342362000064X_as1\">\n\t    <jats:title>Aim:<\/jats:title>\n\t    <jats:p>To explore the experiences of patients living with diabetic lower extremity amputation (DLEA) and its post-amputation wound in primary care.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362000064X_as2\">\n\t    <jats:title>Background:<\/jats:title>\n\t    <jats:p>DLEA, including both minor and major amputation, is a life-altering condition that brings numerous challenges to an individual\u2019s life. Post-amputation physical wound healing is complicated and challenging because of wound dehiscence and prolonged healing times. Understanding patients\u2019 experiences after DLEA with a post-amputation wound will enable healthcare professionals to develop interventions to assist patients in physical healing and psychosocial recovery.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362000064X_as3\">\n\t    <jats:title>Methods:<\/jats:title>\n\t    <jats:p>This study employs a qualitative design using interpretative phenomenological analysis (IPA). A purposive maximum variation sample of nine patients who had had lower extremity amputations and post-amputation wound attributed to diabetes in the previous 12 months was recruited from a primary care setting in Singapore. Semi-structured audio recorded one-to-one interviews with a duration of 45\u201360 min each were conducted between September 2018 and January 2019. The interviews were transcribed verbatim and analysed using IPA.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S146342362000064X_as4\">\n\t    <jats:title>Findings:<\/jats:title>\n\t    <jats:p>The essential meaning of the phenomenon \u2018the lived experiences for patients with DLEA and post-amputated wound\u2019 can be interpreted as \u2018struggling for \u201cnormality\u201d\u2019 which encompasses four domains of sense making: physical loss disrupted normality, emotional impact aggravated the disrupted normality, social challenges further provoked the disrupted normality, and attempt to regain normality. The study highlights the complex physical and psychosocial transition facing patients after DLEA before post-amputation wound closure. In primary care, an amputation, whether minor or major, is a life-altering experience that requires physical healing, emotional recovery, and social adaptation to regain normality. Patients living with DLEA and a post-amputation wound may benefit from an interdisciplinary team care model to assist them with physical and psychosocial adjustment and resume normality.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s146342362000064x","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T08:32:02Z","timestamp":1608107522000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":25,"title":["Struggling for normality: experiences of patients with diabetic lower extremity amputations and post-amputation wounds in primary care"],"prefix":"10.1017","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-6203","authenticated-orcid":false,"given":"Xiaoli","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling Jia","family":"Goh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-2195","authenticated-orcid":false,"given":"Evelyn","family":"Chew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8557-6222","authenticated-orcid":false,"given":"Bernadette","family":"Bartlam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"S146342362000064X_ref42","first-page":"26","article-title":"Managing patients following a lower limb amputation","volume":"29","author":"Price","year":"2015","journal-title":"JCN"},{"key":"S146342362000064X_ref46","doi-asserted-by":"crossref","unstructured":"Rybarczyk, Szymanski and Nicholas (2000) Limb amputation. In Robert FG and Timothy ER, editors. Handbook of rehabilitation psychology. Washington: American Psychological Association, 29\u201347.","DOI":"10.1037\/10361-002"},{"key":"S146342362000064X_ref13","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-1146"},{"key":"S146342362000064X_ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-015-0926-9"},{"key":"S146342362000064X_ref45","unstructured":"Roosa, T , Robin, O , Elias, M , Ana, D and George, AW (2020) International Health Care System Profiles: Singapore, The Commonwealth Fund. Retrieved 15 October 2020 from https:\/\/www.commonwealthfund.org\/international-health-policy-center\/countries\/singapore"},{"key":"S146342362000064X_ref52","first-page":"39","article-title":"Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology","volume":"1","author":"Smith","year":"2004","journal-title":"Qualitative Research in Psychology"},{"key":"S146342362000064X_ref31","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12474"},{"key":"S146342362000064X_ref48","doi-asserted-by":"crossref","first-page":"694LP","DOI":"10.2337\/dc13-1212","article-title":"Health-related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: the eurodiale study","volume":"37","author":"Siersma","year":"2014","journal-title":"Diabetes Care"},{"key":"S146342362000064X_ref7","doi-asserted-by":"publisher","DOI":"10.1590\/S0104-11692007000200021"},{"key":"S146342362000064X_ref57","doi-asserted-by":"publisher","DOI":"10.1177\/0309364614556838"},{"key":"S146342362000064X_ref6","doi-asserted-by":"publisher","DOI":"10.1177\/1708538118797544"},{"key":"S146342362000064X_ref36","doi-asserted-by":"crossref","first-page":"215824401667137","DOI":"10.1177\/2158244016671376","article-title":"Being in-between: the lived experience of becoming a prosthesis user following the loss of a leg","volume":"6","author":"Norlyk","year":"2016","journal-title":"SAGE Open"},{"key":"S146342362000064X_ref18","doi-asserted-by":"publisher","DOI":"10.3109\/09638280903295417"},{"key":"S146342362000064X_ref16","doi-asserted-by":"publisher","DOI":"10.14614\/EXPERAMP.2.54"},{"key":"S146342362000064X_ref33","doi-asserted-by":"publisher","DOI":"10.3402\/dfa.v4i0.21288"},{"key":"S146342362000064X_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.15215"},{"key":"S146342362000064X_ref54","doi-asserted-by":"publisher","DOI":"10.1123\/apaq.26.3.236"},{"key":"S146342362000064X_ref44","unstructured":"Road to Recovery (2016) Ministry of Health Health Hub. Retrieved 23 January 2018 from https:\/\/www.healthhub.sg\/live-healthy\/1283\/road-to-recovery"},{"key":"S146342362000064X_ref40","doi-asserted-by":"crossref","unstructured":"Pietkiewicz and Smith (2014) A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Czasopismo Psychologiczne Psychological Journal 20, 7\u201314. doi: 10.14691\/CPPJ.20.1.7.","DOI":"10.14691\/CPPJ.20.1.7"},{"key":"S146342362000064X_ref37","doi-asserted-by":"publisher","DOI":"10.3402\/qhw.v8i0.21891"},{"key":"S146342362000064X_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7135.903"},{"key":"S146342362000064X_ref11","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2014.885993"},{"key":"S146342362000064X_ref53","doi-asserted-by":"publisher","DOI":"10.1177\/2049463714541642"},{"key":"S146342362000064X_ref30","doi-asserted-by":"publisher","DOI":"10.5172\/conu.2011.39.1.20"},{"key":"S146342362000064X_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2009.02802.x"},{"key":"S146342362000064X_ref58","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9566.00191"},{"key":"S146342362000064X_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2003.07.009"},{"key":"S146342362000064X_ref5","unstructured":"Butcher, Z and Corbett, G (2014) EWMA Position Paper: Managing Wounds as a Team, J Wound Care. Retrieved 26 March 2020 from www.markallengroup.com"},{"key":"S146342362000064X_ref39","doi-asserted-by":"publisher","DOI":"10.1136\/ebnurs-2018-103017"},{"key":"S146342362000064X_ref1","doi-asserted-by":"publisher","DOI":"10.1177\/0309364619882126"},{"key":"S146342362000064X_ref43","doi-asserted-by":"publisher","DOI":"10.1097\/JPO.0b013e3181571108"},{"key":"S146342362000064X_ref51","volume-title":"Interpretive phenomenological analysis: theory, method and research","year":"2009"},{"key":"S146342362000064X_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.10.003"},{"key":"S146342362000064X_ref23","doi-asserted-by":"publisher","DOI":"10.1080\/2000625X.2018.1452513"},{"key":"S146342362000064X_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2009.07.005"},{"key":"S146342362000064X_ref41","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2005.12.011"},{"key":"S146342362000064X_ref35","unstructured":"Neal, O , Schnetter CA, Wallston KA, Wells N, Dietrich M and Heflinger CA (2007) The development of the normalization assessment measure."},{"key":"S146342362000064X_ref50","doi-asserted-by":"publisher","DOI":"10.1080\/09638280410001662996"},{"key":"S146342362000064X_ref56","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2013.11.076"},{"key":"S146342362000064X_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.dhjo.2017.03.004"},{"key":"S146342362000064X_ref17","doi-asserted-by":"publisher","DOI":"10.1177\/1359105305051433"},{"key":"S146342362000064X_ref25","doi-asserted-by":"publisher","DOI":"10.1002\/nur.4770090306"},{"key":"S146342362000064X_ref20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0092943"},{"key":"S146342362000064X_ref49","first-page":"1","article-title":"Functional capacity of elderly with lower-limb amputation after prosthesis rehabilitation: a longitudinal study","volume":"14","author":"Silva","year":"2019","journal-title":"Disability and Rehabilitation: Assistive Technology"},{"key":"S146342362000064X_ref2","doi-asserted-by":"publisher","DOI":"10.1177\/2010105816663521"},{"key":"S146342362000064X_ref27","unstructured":"Linette Lai (2015) Singapore \u2018has 2nd-highest proportion of diabetics\u2019, Health News & Top Stories - The Straits Times, The straitstime. Retrieved 21 January 2018 from https:\/\/www.straitstimes.com\/singapore\/health\/hospital-data-shows-one-in-5-diabetics-who-had-lower-limb-amputation-died-within-a"},{"key":"S146342362000064X_ref34","unstructured":"National Healthcare Group Polyclinics (no date). Retrieved 30 April 2020 from https:\/\/www.nhgp.com.sg\/About_Us\/"},{"key":"S146342362000064X_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2012.02.011"},{"key":"S146342362000064X_ref32","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-87462-3"},{"key":"S146342362000064X_ref29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2010.03256.x"},{"key":"S146342362000064X_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12593"},{"key":"S146342362000064X_ref38","doi-asserted-by":"publisher","DOI":"10.3109\/09638288.2013.833311"},{"key":"S146342362000064X_ref14","first-page":"16","article-title":"When a diabetic foot ulcer results in amputation: a qualitative study of the lived experience of 15 patients","volume":"60","author":"Foster","year":"2014","journal-title":"Ostomy\/Wound Management"},{"key":"S146342362000064X_ref47","doi-asserted-by":"publisher","DOI":"10.1177\/0269215511410731"},{"key":"S146342362000064X_ref22","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1622797"},{"key":"S146342362000064X_ref4","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2019.1597177"},{"key":"S146342362000064X_ref21","doi-asserted-by":"publisher","DOI":"10.1080\/09638280410001708869"},{"key":"S146342362000064X_ref55","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2016.05.011"}],"container-title":["Primary Health Care Research &amp; Development"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S146342362000064X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T08:32:45Z","timestamp":1608107565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S146342362000064X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":58,"alternative-id":["S146342362000064X"],"URL":"https:\/\/doi.org\/10.1017\/s146342362000064x","relation":{},"ISSN":["1463-4236","1477-1128"],"issn-type":[{"value":"1463-4236","type":"print"},{"value":"1477-1128","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]},"assertion":[{"value":"\u00a9 The Author(s) 2020","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e63"}}