{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:38:15Z","timestamp":1760146695050,"version":"build-2065373602"},"reference-count":43,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T00:00:00Z","timestamp":1733270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cognition plays a major role in prosthetic rehabilitation success. The ability to identify patients who may have difficulty understanding and adapting to the rehabilitation process is beneficial for clinicians and patients to allow for targeted and appropriate therapy. The research aim was to codesign a process that facilitates routine cognitive screening into the amputee inpatient journey. Methods: A convenience sample of sixteen medical and allied health practitioners from one local health district undertook a codesign process over 10 months from March to November 2023. A combination of virtual and face-to-face data collection occurred. Each of the codesign meetings was audio recorded, following which transcription occurred. Transcripts were reviewed using thematic analysis-based techniques to capture themes and consensus within the group. Results: Two pathways were established for use within one local health district, allowing clinicians to measure the cognition of patients in both inpatient and outpatient settings either before or after they underwent amputation. The newly established pathways provide step-by-step guidance for clinicians, such as how to address contraindicators for testing and providing guidance for subsequent neuropsychological testing. The Montreal Cognitive Assessment (MoCA), both paper based and electronic based, was selected as the cognitive screening tool for implementation. Conclusions: Utilizing codesign as a method for generating a cognitive screening pathway for amputees was successful. The pathways generated should be reviewed for suitability for application in other health settings.<\/jats:p>","DOI":"10.3390\/jcm13237378","type":"journal-article","created":{"date-parts":[[2024,12,4]],"date-time":"2024-12-04T06:38:25Z","timestamp":1733294305000},"page":"7378","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Results of a Codesign Process: A Cognition Screening Pathway for Inpatient and Outpatient Settings for Patients Who Are Facing or Have Undergone Lower Limb Amputation"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5343-8263","authenticated-orcid":false,"given":"Erinn","family":"Dawes","sequence":"first","affiliation":[{"name":"School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia"},{"name":"Illawarra Shoalhaven Local health District, Illawarra Transitional Aged Care Service, Block E Port Kembla Hospital, Warrawong, NSW 2502, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyndel","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vida","family":"Bliokas","sequence":"additional","affiliation":[{"name":"School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3975-4427","authenticated-orcid":false,"given":"Val","family":"Wilson","sequence":"additional","affiliation":[{"name":"South West Sydney Nursing and Midwifery Research Alliance, The Ingham Institute, 1 Cambell Street, Liverpool, NSW 2170, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E2249950","DOI":"10.1001\/jamanetworkopen.2022.49950","article-title":"Predisposing and Precipitating Factors Associated with Delirium: A Systematic Review","volume":"6","author":"Ormseth","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/ap.12191","article-title":"Cognitive screening following stroke: Are we following best evidence-based practice in Australian clinical settings?","volume":"51","author":"Stolwyk","year":"2016","journal-title":"Aust. Psychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"6215","DOI":"10.1007\/s10072-022-06280-9","article-title":"Infectious diseases and cognition: Do we have to worry?","volume":"43","author":"Letenneur","year":"2022","journal-title":"Neurol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1017\/S1041610220004056","article-title":"Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis","volume":"34","author":"Barchielli","year":"2022","journal-title":"Int. Psychogeriatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.3233\/JAD-200811","article-title":"An Operational Definition of \u2018Abnormal Cognition\u2019 to Optimize the Prediction of Progression to Dementia: What Are Optimal Cut-Off Points for Univariate and Multivariate Normative Comparisons?","volume":"77","author":"Huizenga","year":"2020","journal-title":"J. Alzheimer\u2019s Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ejphar.2004.02.046","article-title":"Neuropsychology of cognitive ageing, minimal cognitive impairment, Alzheimer\u2019s disease, and vascular cognitive impairment","volume":"490","author":"Lindeboom","year":"2004","journal-title":"Eur. J. Pharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e273","DOI":"10.1002\/gps.4787","article-title":"The Brief Memory and Executive Test (BMET): A cognitive screening tool to detect and differentiate vascular cognitive impairment and Alzheimer\u2019s disease","volume":"33","author":"Hollocks","year":"2018","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1002\/gps.5136","article-title":"Cognitive screening instruments to identify vascular cognitive impairment: A systematic review","volume":"34","author":"Ghafar","year":"2019","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_9","first-page":"1","article-title":"A Systematic Review of Cognitive Screening for Mild Cognitive Impairment","volume":"1","author":"Lonie","year":"2010","journal-title":"Mind Brain J. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1093\/arclin\/acx021","article-title":"Cognitive Screening Tests Versus Comprehensive Neuropsychological Test Batteries: A National Academy of Neuropsychology Education Paper\u2020","volume":"32","author":"Glen","year":"2017","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1002\/gps.4539","article-title":"Montreal Cognitive Assessment and Mini-Mental State Examination reliable change indices in healthy older adults","volume":"32","author":"Kopecek","year":"2017","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.pmr.2014.09.006","article-title":"Pediatric limb differences and amputations","volume":"26","author":"Le","year":"2015","journal-title":"Phys. Med. Rehabil. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"50","DOI":"10.2337\/dc18-1380","article-title":"Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population","volume":"42","author":"Geiss","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"973","DOI":"10.3233\/BMR-181148","article-title":"Comparison of the demographic and clinical characteristics, functional status and quality of life of lower extremity amputees to identify the reason for undergoing amputation","volume":"31","year":"2018","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/j.1445-5994.2012.02758.x","article-title":"Diabetes as a risk factor for dementia and mild cognitive impairment: A meta-analysis of longitudinal studies","volume":"42","author":"Cheng","year":"2012","journal-title":"Intern. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1017\/S1355617713001483","article-title":"Magnitude of cognitive dysfunction in adults with type 2 diabetes: A meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains","volume":"20","author":"Palta","year":"2014","journal-title":"J. Int. Neuropsychol. Soc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.apmr.2018.07.436","article-title":"Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation","volume":"100","author":"Desmond","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","first-page":"100216","article-title":"On understanding and measuring the cognitive load of amputees for rehabilitation and prosthetic development","volume":"4","author":"Rackerby","year":"2022","journal-title":"Arch. Rehabil. Res. Clin. Transl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1080\/09638288.2020.1803999","article-title":"A qualitative study exploring individuals\u2019 experiences living with dysvascular lower limb amputation","volume":"44","author":"MacKay","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_20","unstructured":"NSW Agency for Clinical Innovation (2017). ACI Care of the Person Following Amputation: Minimum Standards of Care."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1097\/PXR.0000000000000169","article-title":"Cognitive screening in persons with an amputation: A retrospective medical record audit","volume":"46","author":"Dawes","year":"2022","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Dawes, E., Bliokas, V., Hewitt, L., and Wilson, V. (2024). An investigation of allied health and medical clinicians\u2019 viewpoint on prosthetic rehabilitation and cognition. Disabil. Rehabil., 1\u20138.","DOI":"10.1080\/09638288.2024.2346234"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e3222211","DOI":"10.17061\/phrp3222211","article-title":"Co-creation, co-design, co-production for public health\u2014A perspective on definitions and distinctions","volume":"32","author":"Vargas","year":"2022","journal-title":"Public Health Res. Pract."},{"key":"ref_24","unstructured":"Dawes, E., Hewitt, L., Bliokas, V., and Wilson, V. Learning from Experience. Reflections on Using the Codesign Process with Medical and Allied Health Clinicians, J. Physiother., (under review)."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1080\/01634372.2018.1559906","article-title":"Looking Back to Move Forward: The Value of Reflexive Journaling for Novice Researchers","volume":"62","author":"Meyer","year":"2019","journal-title":"J. Gerontol. Soc. Work"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zelenko, O., Gomez, R., and Kelly, N. (2021). Research co-design: Meaningful collaboration in research. How to Be a Design Academic, CRC Press.","DOI":"10.1201\/9780429351693-20"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/j.1532-5415.2006.00667.x","article-title":"Detection of Delirium by Bedside Nurses Using the Confusion Assessment Method","volume":"54","author":"Lemiengre","year":"2006","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"458","DOI":"10.21275\/ART20178695","article-title":"Delirium and it\u2019s Risk Factors among Elderly Patients","volume":"6","author":"Umesh","year":"2017","journal-title":"IJSR"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.apmr.2016.06.012","article-title":"Association Between Montreal Cognitive Assessment Scores and Measures of Functional Mobility in Lower Extremity Amputees After Inpatient Rehabilitation","volume":"98","author":"Frengopoulos","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.apmr.2017.09.003","article-title":"MoCA Domain Score Analysis and Relation to Mobility Outcomes in Dysvascular Lower Extremity Amputees","volume":"99","author":"Frengopoulos","year":"2018","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/ageing\/26.4.295","article-title":"Age-associated cognitive decline in healthy old people","volume":"26","author":"Starr","year":"1997","journal-title":"Age Ageing"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.gaitpost.2022.12.012","article-title":"Association between measures of cognitive function on physical function in novice users of a lower limb prosthesis","volume":"100","author":"Omana","year":"2023","journal-title":"Gait Posture"},{"key":"ref_34","unstructured":"(2023, April 05). MoCA Cognition Digital Tools. Available online: https:\/\/mocacognition.com\/digitaltools."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e079254","DOI":"10.1002\/alz.079254","article-title":"The Validity of the Thai Electronic Version of the Montreal Cognitive Assessment (MoCA)","volume":"19","author":"Hemrungrojn","year":"2023","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3233\/JAD-170896","article-title":"Comparing the Electronic and Standard Versions of the Montreal Cognitive Assessment in an Outpatient Memory Disorders Clinic: A Validation Study","volume":"62","author":"Berg","year":"2018","journal-title":"J. Alzheimers Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/WAD.0000000000000333","article-title":"A comparison of electronic and paper versions of the montreal cognitive assessment","volume":"33","author":"Wallace","year":"2019","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1097\/WAD.0000000000000069","article-title":"Comparison of an electronic and paper-based Montreal Cognitive Assessment Tool","volume":"29","author":"Snowdon","year":"2015","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.eurger.2016.11.002","article-title":"A comparative study of the use of three cognitive function screening tests on rehabilitation wards for older people","volume":"8","author":"Vassallo","year":"2017","journal-title":"Eur. Geriatr. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3037","DOI":"10.1080\/09638288.2023.2240231","article-title":"An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation: A Canadian perspective","volume":"46","author":"Sureshkumar","year":"2024","journal-title":"Disabil. Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.apmr.2004.06.072","article-title":"Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations","volume":"86","author":"Dillingham","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/BF03325220","article-title":"Predictors for institutionalization and prosthetic ambulation after major lower extremity amputation during an eight-year follow-up","volume":"21","author":"Remes","year":"2009","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1136\/bmjqs-2019-009570","article-title":"Use and reporting of experience-based codesign studies in the healthcare setting: A systematic review","volume":"29","author":"Green","year":"2020","journal-title":"BMJ Qual. 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