{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:22:17Z","timestamp":1774459337431,"version":"3.50.1"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify barriers and enablers for return to occupation (RTO) for people with lower limb amputation (LLA) in East, South, and Southeast Asian developing countries from the perspective of rehabilitation professionals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A convenience sample of rehabilitation professionals working in Asian developing countries participated in online in-depth interviews between September 2021 and February 2022. Interview transcripts were analyzed and thematically coded to the modified Health Care Delivery System Approach (HCDSA) framework. COREQ guidelines were followed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-eight interviewees from 13 countries shared their experiences of factors related to RTO for people with LLA. Identified factors described barriers and facilitators for RTO at all four HCDSA framework levels. The \u201c<jats:italic>environmental<\/jats:italic>\u201d level had the most identified factors (<jats:italic>n<\/jats:italic> = 56) and the \u201c<jats:italic>care team<\/jats:italic>\u201d level the least (<jats:italic>n<\/jats:italic> = 31). Common environmental RTO challenges included cultural attitudes to women; lack of rural\/remote services; inadequate numbers and regulation of rehabilitation professionals; inappropriate prosthesis; limited government support for rehabilitation, and reliance on charitable models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite varied cultural, religious, and geographical characteristics, consistent factors impacting RTO were identified within these thirteen countries. Identified barriers to RTO underline the need for improvements throughout service systems from the acute-care focus on saving life without consideration of RTO, the rehabilitation focused primarily on mobility, to the lack of occupational rehabilitation services and supporting policy in these countries. These interlinked factors at different levels of healthcare service systems reinforce the importance of systems approaches to best utilize limited resources toward improving RTO in this region.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1039279","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T06:20:35Z","timestamp":1677738035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Rehabilitation professionals' perspectives of factors influencing return to occupation for people with lower limb amputation in East, South, and Southeast Asian developing countries: A qualitative study"],"prefix":"10.3389","volume":"11","author":[{"given":"Md Shapin Ibne","family":"Sayeed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodi","family":"Oakman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rwth","family":"Stuckey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1177\/0309364620934322","article-title":"Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation","volume":"44","author":"Stuckey","year":"2020","journal-title":"Prosthet Orthot Int."},{"key":"B2","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1007\/s10926-018-9757-y","article-title":"Factors influencing functional outcomes and return-to-work after amputation: a review of the literature","volume":"28","author":"Darter","year":"2018","journal-title":"J Occup Rehabil."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1633","DOI":"10.1080\/09638280902736346","article-title":"Factors affecting measures of activities and participation in persons with mobility impairment","volume":"31","author":"Wee","year":"2009","journal-title":"Disabil Rehabil."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.2522\/ptj.20120162","article-title":"The meaning of occupation, occupational need, and occupational therapy in a military context","volume":"93","author":"Brown","year":"2013","journal-title":"Phys Ther."},{"key":"B5","volume-title":"Asian Development Outlook 2021","author":"Asian","year":"2021"},{"key":"B6","unstructured":"List of developing countries\n            DFATAustralia\n          2018"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4025","DOI":"10.1080\/09638288.2021.1994025","article-title":"Influential factors for access to and participation in rehabilitation for people with lower limb amputation in East, South, and Southeast Asian developing countries: a scoping review","volume":"17","author":"Sayeed","year":"2021","journal-title":"Disabil Rehabil"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21203\/RS.3.RS-489964\/V1","article-title":"Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation. (LLA) and pre-rehabilitation: a cross-sectional study.","volume":"5","author":"Sayeed","year":"2021","journal-title":"Res Sq"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1080\/09638288.2018.1544671","article-title":"Characterisation of persons with lower limb amputation who attended a tertiary rehabilitation centre in Bangladesh","volume":"42","author":"Imam","year":"2020","journal-title":"Disabil Rehabil."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7189\/jogh.12.04083","article-title":"Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: an exemplar study across three clinics in Cambodia","volume":"12","author":"Dickinson","year":"2022","journal-title":"J Glob Health."},{"key":"B11","first-page":"1164","article-title":"Measuring disability and inclusion in relation to the 2030 agenda on sustainable development","volume":"4","author":"Madans","year":"2017","journal-title":"Disabil Glob South"},{"key":"B12","volume-title":"Building a Better Delivery System: A new Engineering\/Health Care Partnership","author":"Reid","year":"2005"},{"key":"B13","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1177\/0309364613513824","article-title":"Priorities in lower limb prosthetic service delivery based on an international survey of prosthetists in low- and high-income countries","volume":"39","author":"Wyss","year":"2015","journal-title":"Prosthet Orthot Int."},{"key":"B14","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1093\/occmed\/kqy091","article-title":"Return to work after occupational and non-occupational lower extremity amputation","volume":"68","author":"Journeay","year":"2018","journal-title":"Occup Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"29","DOI":"10.35680\/2372-0247.1237","article-title":"Healthcare providers versus patients' understanding of health beliefs and values","volume":"4","author":"Kennedy","year":"2017","journal-title":"Patient Exp J."},{"key":"B16","unstructured":"Template for rehabilitation information collection2019"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12955-016-0406-X\/TABLES\/4","article-title":"Stakeholders' perceptions of rehabilitation services for individuals living with disability: a survey study","volume":"14","author":"Darzi","year":"2016","journal-title":"Health Qual Life Outcomes."},{"key":"B18","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1177\/0309364619863617","article-title":"Professionals' perspectives of prosthetic and orthotic services in Tanzania, Malawi, Sierra Leone and Pakistan","volume":"43","author":"Magnusson","year":"2019","journal-title":"Prosthet Orthot Int."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1080\/09638288.2017.1300331","article-title":"Living as a person using a lower-limb prosthesis in Nepal","volume":"40","author":"J\u00e4rnhammer","year":"2018","journal-title":"Disabil Rehabil."},{"key":"B20","doi-asserted-by":"publisher","first-page":"4734","DOI":"10.1080\/09638288.2020.1822935\/SUPPL_FILE\/IDRE_A_1822935_SM4734.DOC","article-title":"The vicious cycle of functional neurological disorders: a synthesis of healthcare professionals' views on working with patients with functional neurological disorder","volume":"3","author":"Barnett","year":"2020","journal-title":"Disabil Rehabil"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/9781118715598.ch21","article-title":"\u201cCOREQ","author":"Booth","year":"2014","journal-title":"Guidelines for Reporting Health Research: A User's Manual"},{"key":"B22","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1177\/030802266903201219","article-title":"Rehabilitation of lower limb amputees","volume":"117","author":"Ida","year":"2015","journal-title":"Period Biol."},{"key":"B23","doi-asserted-by":"publisher","article-title":"Asian Development Outlook","year":"2019","DOI":"10.22617\/FLS190070-3"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: The RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am J Public Health."},{"key":"B25","unstructured":""},{"key":"B26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/1468-0009.00206","article-title":"Improving the quality of health care in the United Kingdom and the united states: a framework for change","volume":"79","author":"Ferlie","year":"2001","journal-title":"Milbank Q."},{"key":"B28","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s10926-011-9295-3","article-title":"Prevention and management of work disability in Asia Pacific: challenges and opportunities","volume":"21","author":"Feuerstein","year":"2011","journal-title":"J Occup Rehabil."},{"key":"B29","unstructured":"Disability and the Muslim Perspective: An Introduction for Rehabilitation and Health Care Providers\n            HasnainR\n            ShaikhLC\n            ShanawaniH\n          2008"},{"key":"B30","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1177\/0269215511410731","article-title":"Beyond the body image: a qualitative study on how adults experience lower limb amputation","volume":"26","author":"Senra","year":"2011","journal-title":"Clin Rehabil."},{"key":"B31","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1177\/0309364611407108","article-title":"Environmental barriers, activity limitations and participation restrictions experienced by people with major limb amputation","volume":"35","author":"Gallagher","year":"2011","journal-title":"Prosthet Orthot Int."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1080\/09638288.2016.1189608","article-title":"Patient experience after lower extremity amputation for sarcoma in England: a national survey","volume":"39","author":"Furtado","year":"2017","journal-title":"Disabil Rehabil."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-021-06447-8","article-title":"Physical rehabilitation financing in Iran: a policy analysis using Kingdon's multiple streams","volume":"21","author":"Shahabi","year":"2021","journal-title":"BMC Health Serv Res."},{"key":"B34","doi-asserted-by":"publisher","first-page":"RC09","DOI":"10.7860\/JCDR\/2016\/20316.8417","article-title":"Living with amputation: Anxiety and depression correlates","volume":"10","author":"Bhutani","year":"2016","journal-title":"J Clin Diagnostic Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1177\/0309364617698520","article-title":"A qualitative study of the challenges of providing pre-prosthetic rehabilitation in rural South Africa","volume":"42","author":"Ennion","year":"2018","journal-title":"Prosthet Orthot Int."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09638288.2020.1836043","article-title":"Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone\u2014A multidisciplinary patient and service provider perspective","author":"Allen","year":"2020","journal-title":"Disabil Rehabil."},{"key":"B37","article-title":"Rehabilitation: Essential along the Continuum of Care","volume-title":"Disease Control Priorities: Improving Health and Reducing Poverty","author":"Mills","year":"2018"},{"key":"B38","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.mpsur.2010.01.017","article-title":"Amputation and rehabilitation","volume":"28","author":"Marshall","year":"2010","journal-title":"Surgery."},{"key":"B39","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1093\/PTJ\/PZAA008","article-title":"Effectiveness of an evidence-based amputee rehabilitation program: a pilot randomized controlled trial","volume":"100","author":"Gailey","year":"2020","journal-title":"Phys Ther."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph17124291","article-title":"Differences in rehabilitation needs after stroke: a similarity analysis on the icf core set for stroke","volume":"17","author":"Perin","year":"2020","journal-title":"Int J Environ Res Public Health."},{"key":"B41","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1016\/j.jclinepi.2013.02.003","article-title":"GRADE guidelines: 15. Going from evidence to recommendation\u2014Determinants of a recommendation's direction and strength","volume":"66","author":"Andrews","year":"2013","journal-title":"J Clin Epidemiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/S0140-6736(10)61507-3","article-title":"Health and health-care systems in southeast Asia: diversity and transitions","volume":"377","author":"Chongsuvivatwong","year":"2011","journal-title":"Lancet."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.3233\/WOR-211064","article-title":"Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation: a cross-sectional study","volume":"73","author":"Sayeed","year":"2022","journal-title":"Work"},{"key":"B44","unstructured":"Asia: A Geopolitical Reconfiguration113\n            BuzanB\n          Polit \u00e9trang\u00e8re772012"},{"key":"B45","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1080\/17483107.2016.1188170","article-title":"Assistive technology in resource-limited environments: a scoping review","volume":"12","author":"Matter","year":"2017","journal-title":"Disabil Rehabil Assist Technol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s10339-012-0466-8","article-title":"Assistive\/rehabilitation technology, disability, and service delivery models","volume":"13","author":"Adya","year":"2012","journal-title":"Cogn Process."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph17114139","article-title":"Physical rehabilitation needs in the brics nations from 1990 to 2017: Cross-national analyses using data from the global burden of disease study","volume":"17","author":"Jesus","year":"2020","journal-title":"Int J Environ Res Public Health."},{"key":"B48","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s10926-010-9284-y","article-title":"Occupational rehabilitation policy and practice in the Philippines: Initiatives and challenges","volume":"21","author":"Olavides-Soriano","year":"2011","journal-title":"J Occup Rehabil."},{"key":"B49","unstructured":"2010"},{"key":"B50","doi-asserted-by":"publisher","first-page":"60","DOI":"10.36803\/ijpmr.v5i01.201","article-title":"Rehabilitation, physical, and rehabilitation medicine and community based rehabilitation\u2014A comment to the debate towards a differentiated view of PRM on rehabilitation system, services and training of rehabilitation professionals","volume":"5","author":"Gutenbrunner","year":"2016","journal-title":"IndoJPMR."},{"key":"B51","doi-asserted-by":"publisher","first-page":"39","DOI":"10.5463\/DCID.v22i3.110","article-title":"The Community based rehabilitation programme of the university of the Philippines Manila, college of allied medical professions","volume":"22","author":"Magallona","year":"2011","journal-title":"Disabil CBR Incl Dev."},{"key":"B52","doi-asserted-by":"publisher","first-page":"369","DOI":"10.5281\/zenodo.887089","article-title":"Strengths and limitations of qualitative and quantitative research Methods","volume":"3","author":"Almeida","year":"2017","journal-title":"Eur J Educ Stud."},{"key":"B53","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1111\/mono.12296","article-title":"More than just convenient: the scientific merits of homogeneous convenience samples","volume":"82","author":"Jager","year":"2017","journal-title":"Monogr Soc Res Child Dev."},{"key":"B54","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1080\/10790268.2019.1565707","article-title":"Living with spinal cord injury in Mongolia: a qualitative study on perceived environmental barriers","volume":"43","author":"Dorjbal","year":"2019"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1039279\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T06:20:43Z","timestamp":1677738043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1039279\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,2]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2023.1039279"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1039279","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,2]]},"article-number":"1039279"}}