6.3 Framework and approach

The guidance is informed by the following international frameworks and underlying practice concepts that underpin evidence-based and best practice person-centred perspectives and approaches:

• The role of health literacy, knowledge and social determinants to the person’s empowerment and health outcomes [5, 9-11] • A biopsychosocial perspective of health as articulated in the World Health Organization (WHO) International Classification of Functioning,

Disability and Health (ICF) [12]. This is the contemporary perspective of health disability and functioning, and was developed through international consensus using elements of both the social and medical perspectives of health. • The United Nations Convention on the Rights of Persons with Disabilities [13] • Person-centredness and person-centred approaches [14-18]. This is different from patient-centred or client-centred. The language in the latter two approaches emphasise the relationship. On the other hand, person-centred acknowledges the person (not position), and the need for empowerment, respect, shared decision making, choice and control. • WHO framework and principles of integrated care and social supports [19, 20] • Post-injury planning approach using the icare

My Plan toolkit [15].

7. The support pathway

There are numerous personal and environmental factors in any person’s life that influence their functioning in terms of their body, activities and participation in life roles. Each adult or young person’s recovery and outcomes from a traumatic injury resulting in limb amputation will be different depending on these contextual factors. The nature of the injury and amputation is just one contributor to the situation. Personal factors are the particular background of an individual’s life and living, such as gender; age; social background; education; personal characteristics such as coping style, habits, attitude and motivation; their health before the injury; and the informal (unpaid) supports available to them. Key learnings from the research and the biopsychosocial model of functioning (ICF), show that these factors critically influence the person’s progress and outcomes. These contextual factors can be a barrier and hinder progress, or they can be a facilitator and positively influence the person’s functioning and progress along the pathway [12, 21, 22].

Environmental factors arise from the person’s physical, social and attitudinal environment. Some of the environmental factors influencing the person’s progress may relate to the ‘system’ (e.g. Medicare, Workers Insurance, Lifetime Care and Support, National Disability Insurance Scheme [NDIS]), including the policies and structures for funding treatment, rehabilitation and care; the range and type of services provided; the attitude and approach of organisations and service providers; the timing of services, products and technology; and the physical environment (natural and built).

The guidance on the support pathway is informed by the research evidence, and the working party members’ contextual, expert and experiential knowledge [1, 2, 23]. The information, recommendations and best practice notes in the guidance indicate the most appropriate approach and supports that should be provided. However, people’s needs, and the context and timing of support will vary. Subsequent sections describing the pathway provide a general description of the person’s context, what the issues and concerns might be at various times after the amputation, and the services and supports that facilitate progress.

The support pathway is adapted from the My Plan toolkit [15]. The pathway comprises three phases: Recovery, Participation and Maintaining lifestyle and health (refer to Figure 1). A person may experience a life event (e.g. becoming a parent, changing jobs, experiencing a co-occurring health condition) that changes the supports they require and so may move between phases in either direction.