O&P clinicians spend their careers determining and fitting the most appropriate devices for each individual patient. But even if they do that perfectly, the patient’s success may be out of their hands.
Studies show that medical care accounts for just 10-20 percent of health outcomes. The rest are influenced by social determinants of health, which include socioeconomic factors, environmental conditions, food security, and social networks.1
“If their psychosocial needs are not addressed, we don’t know if their outcomes with that prosthesis are going to be optimal,” says Mona Patel, LCSW, founder and executive director, San Antonio Amputee Foundation.
Even though addressing these challenges may be outside of the O&P clinician’s scope, being able to recognize them and pointing patients toward resources for help can be invaluable, experts say.
“Clinicians have such an opportunity to be a key part of the patient’s entire recovery process,” Patel says. “They can have a bigger impact than only providing mobility for them.”
There are lots of ways to help identify these potential issues and connect patients with resources. We spoke to clinicians, social workers, and patient advocates who have found their own ways. Here are some of their stories.
Giving Patients a Place to Feel Safe
Patel suffered for seven years after her right leg was smashed in a crash with a drunk driver. As she prepared to have her 25th surgery, she decided that enough was enough. “I thought to myself, there has to be a better quality of life,” she says. She decided to do research and figure out what life might be like with an amputation. Unfortunately, at the time, there was no support group for people with amputations in San Antonio.
“I had 1,000 questions and I couldn’t find anyone to talk to,” she says. Eventually, she found one woman willing to share her experiences of living with a transfemoral amputation. The woman answered Patel’s questions about pregnancy, motherhood, and life, and Patel became convinced that a life with a transtibial amputation would be better than a life with pain.
“Her encouragement of what life could look like gave me the confidence to proceed with amputation surgery,” Patel says. Along with that decision, Patel also decided that that she would make it easier for people with amputations to connect.
“I vowed that once I got back on my feet, I would start a support group because I thought surely there had to be other people like me in San Antonio that need the same type of guidance and support,” Patel says. Next year will mark the 30th anniversary of that group.
“I’ve seen people walk into our support group feeling completely defeated,” she says. “Then they spend two hours talking to others who have been on that same journey and found ways to live fulfilling lives.You literally can see the shift in their whole being. It’s the connection with other people, community is vital.”
Patel was so inspired by the work that she dedicated her social work career to it. She used her experience in social work to work in an O&P clinic to help support patients. Her job was helping connect the patients to the resources they needed. She worked directly with patients to help address their individual needs and worries. She always recommended they join a peer support group and often asked someone who might have the same type of amputation to speak to them directly to answer questions. For some, she helped them find resources to help pay for their high out-of-pocket insurance costs.
At times, she might gently recommend they talk to a mental health therapist to help them address their very normal, but intense, feelings about life with an amputation.
As the patients started to feel better mentally and physically, their hope for the future grew and their outcomes improved, Patel says.
“Hope increases their motivation,” she says. “They work harder in physical therapy and are able to communicate better with their prosthetist about what’s working and not working instead of just being apathetic in an appointment.”
She wishes that all O&P offices would have either a social worker or a peer advocate on staff to help their patients. She would love to see clinicians try to take on some of that work as well, she says.
“Life following amputation is so much more than a physical experience. I understand that clinicians have a certain job to do, but time in a patient care room can serve as a critical opportunity to try to understand where the gaps are to help that patient have the best overall outcomes beyond just the clinical ones.”
A Comprehensive Approach
Clinicians at the University of California, San Francisco (UCSF) have long recognized that barriers in a patient’s personal life can directly influence clinical outcomes. Identifying and addressing these barriers, however, often depends on asking the right questions.
According to Matthew Garibaldi, MS, CPO, director, Orthotic and Prosthetic Centers in the Department of Orthopaedic Surgery at UCSF, many of these challenges can be mitigated once they are clearly understood.
“We ask detailed questions about a patient’s life and background to understand the full picture and optimize their care,” Garibaldi says. He recently presented on this topic at the 2026 Academy Annual Meeting & Scientific Symposium in a session titled “Considering Social Determinants of Health to Elevate O&P Care and Outcomes.”
Garibaldi’s work aligns with a broader UCSF initiative focused on identifying social determinants of health, which are nonmedical factors that can influence health outcomes. These determinants are assessed early in the care process through a brief set of targeted questions designed to uncover modifiable barriers.
The screening process typically takes less than five minutes and is conducted during the patient’s initial evaluation. While the information gathered does not usually alter the clinical course of treatment, Garibaldi says that in certain cases it can have a profound impact.
“If a significant barrier is uncovered, it can be very meaningful to address it before the treatment process begins,” he says.
The screening focuses on four key domains: transportation, education, employment and insurance status, and social or community support. Insights into any of these areas can influence where care is delivered, how information is communicated, and even which device is ultimately prescribed.
Transportation
Transportation challenges can significantly affect a patient’s ability to adhere to care plans. Patients who rely on public transit or travel long distances may be more likely to miss follow-up appointments. Others may face financial strain associated with frequent travel.
“When transportation is a barrier, we may pause care and redirect the patient to a clinic that is more accessible,” Garibaldi notes. “Patients are often very appreciative, and improved access increases their likelihood of success.”
Education
Understanding a patient’s educational background helps clinicians tailor communication effectively. While most patients can follow standard written instructions, some may face literacy challenges or language barriers.
“If we had not asked, we might assume they could follow written instructions when, in reality, they cannot,” Garibaldi says.
In such cases, clinicians adapt by providing verbal guidance, offering instructional videos, or engaging translation services when needed.
Employment and Insurance
Assumptions about a patient’s employment or insurance status can lead to gaps in care. Even patients who appear stable may be experiencing job loss, insurance lapses, or financial hardship.
“These are assumptions we make based on what we see in front of us,” Garibaldi explains. “But circumstances can change quickly.”
By proactively assessing financial and insurance status, clinicians can connect patients with hospital resources, including insurance specialists, before initiating treatment, he says.
Social and Community Support
A patient’s support system plays a critical role in successful outcomes, particularly in O&P care. Patients living alone or without assistance may struggle with device use or adherence.
“It is very important to know whether patients have someone who can help them,” Garibaldi says. “We have seen cases where patients were not using their device simply because they lacked support at home.”
Identifying these gaps allows care teams to adjust expectations, provide additional training, or explore alternative solutions, he says.
In some cases, responses to screening of social determinants of health may delay or temporarily halt treatment. Garibaldi views this as a necessary and constructive step.
“Sometimes we cannot move forward until we resolve these barriers,” he says. “Often we can address them, but when we cannot, it leads to an important conversation with the patient about next steps.”
Ultimately, these brief but targeted questions underscore a broader principle: Comprehensive care extends beyond clinical interventions.
“By understanding the context of a patient’s daily life, clinicians can deliver more effective, equitable, and patient-centered care,” he says. 
Assessments at the start of treatment are also done at Progressive O&P, New York, says Patient Advocate Melissa Antonucci, LCSWR. Progressive’s office conducts a psychosocial assessment, which is a set of questions that helps the clinicians get a sense of what patients’ lives were like prior to their amputations.
“We want to know how active they were, what their life looked like, what were they doing, were they working—were they traveling?” she says. “The goal is always to make the patient feel empowered and regain their independence.”
This helps everyone get a clear picture of the goals and needs for the patient, she says. These psychosocial factors are tied to all aspects of a patient’s life, she adds. She, along with the clinicians, try their best to support patients along the way.
“They need to go through a grieving process, but we also want to address the positive things and how we can keep them going mentally because it can be very easy to stay down in the dumps.”
Taking the First Step to Listen
Whenever there is a future patient for Leimkuehler Orthotic-Prosthetic Center, Ohio, Josh Green is usually one of the first in the office to meet them.
Green, an amputee care and outreach coordinator, will often talk with them just before their surgery, if it’s planned, or right after. His official job is to fit the limb protectors and drop off shrinkers. Unofficially, he’s there to answer questions and give them hope. The ice is always broken when they see he has an amputation too.
“Most people are going through a bout of depression or have a fear of the unknown,” Green says. “So, I like to just give them a general timeline of things and let them know that we will get them back up and hopefully back to the things they enjoyed.”
Green, who was born without a knee joint in his right leg, had an amputation when he was four years old to have a more active life. While he doesn’t remember much of what life was like before his amputation, he can certainly identify with the nervousness and fear the patients are going through and help walk them through the process of what’s coming.
When he meets patients, he always brings information about his support group so, if they want, they can reach out and start asking questions immediately.
“I wish every hospital would include mental health resources in their discharge papers,” he says. “They have all of these instructions about physical therapy, occupational therapy, wound care, and this and that. But there’s usually nothing about the mental side of healing.”
Right after an amputation, patients have to wait a while before they can be fitted for their devices, and that time period can be mentally devastating, he says. “They’ve got two months of healing, and if they didn’t talk to anybody, then they just worry themselves to death,” he says.
At his support group, patients get their questions answered about everything from recovery timelines, insurance, and device technology. They get hope from one another and it’s a much-needed improvement to the doom and gloom they might find on online chats, Green says. Right now, they have a Facebook group with more than 5,000 members. They also have an in-person meeting once a month, which is also accessible online for people who can’t make the trip.
Listening really is key, says Bryan Sculthorpe, CPO, a clinician who works with Green at Leimkuehler Orthotic-Prosthetic Center. He’s noticed a difference since he started using an artificial intelligence tool to record appointments and organize notes. Now, instead of focusing on taking notes, he’s able to have a one-on-one conversation with his patients and knows that he can look over the notes generated afterward.
“I remember a lot more information, and then that open conversation just flows better,” he says. Those conversations help, he says, but if he finds that a patient seems to be struggling, he’s seen a benefit from referring them to a physical medicine and rehabilitation physician.
“I find that referral is really powerful because it takes a holistic approach to their health management…. Their outlook is much less on the prosthesis itself. They’re thinking about that person’s activities of daily living.”
Sculthorpe says he’s seen a big change in patients after they’ve started attending the support group Green runs too. “It’s all they’re talking about,” he says. “They feel so much better about their situation just knowing that it’s not just them.” They also get a lot more information from the group and, with that information, they’re able to have a deeper conversation during appointments.
Unfortunately, Green says, some patients won’t reach out on their own. Even though the support group and other referrals have been found to work, many patients choose to suffer in silence instead of asking for help. For those who don’t go to his support group, he’s made videos on 200 of the most common questions asked by people with amputations. That way, patients can get accurate answers to their questions.
Even with the videos, Green says it’s still important for patients to make connections in the community. He recommends that all O&P clinics have a patient advocate, who will be the first to reach out and build those bridges.
“Many people aren’t willing to take the first step,” Green says. “I’m usually reaching out to people two to three times before they get back to me. I don’t wait for them to come to me. I’m proactive and go to them.”
Making a Personal Connection
Sometimes the best way to help a patient is to make a personal connection, says Steve Halloran, CFo, orthotic fitter and prosthetic peer advisor, Mountain Orthotic & Prosthetic Services, New York.
Their offices once had a peer support group, but their rural locations made it difficult for many people to attend. The small group they did have stopped coming after COVID. That doesn’t stop Halloran from reaching out individually, he says. He is one of the first in the office to make a connection by attending shrinker evaluations.
“I can talk to people about the reality of being an amputee and answer any early questions and kind of keep them on track to hopefully get them a good outcome.”
He has a transtibial amputation from a motor vehicle accident. His device makes it easier to make that connection, he says.
“As an amputee talking to an amputee, I have a little extra card that the prosthetist or a doctor does not necessarily have. I can come right out and ask these direction questions like ‘how’s your head,’” he says.
When Halloran started out in his position, he took a course on how to be a peer advisor. Once he learned the basics, the rest came naturally to him. He’s learned that the most important thing he can do is to listen.
“Which was not easy for me in the beginning because I like to talk,” he laughs. “But that is the thing. You’re letting them get everything off their chests.”
While not all of Mountain Orthotic & Prosthetic Services’ four offices have a peer advisor, they do all have someone clinicians can reach out to and ask to connect with a patient.
“Each location has an established amputee that’s good at talking to people and we can lean on,” Halloran says. “It’s all people we can trust, and they have enough head on their shoulders to know when to listen and know when to talk.”
Sometimes the patients will bring up issues that are beyond his capability to help. For example, spouses call him and say that the patient has been very depressed.
In those cases, he’ll try to connect them with other professionals.
“I’ll usually talk to the patient and ask them if I can talk to their doctor,” he says. “If they’re a veteran, I’ll get in touch with the VA and have somebody reach out to them.”
While he knows he can’t always help the patient, at the very least, he can be the person who listens and assists them to find the help they need.
“Sometimes it’s way out of my scope,” he says. “But what are you going to do? Are you going to say it’s out of my scope? No, you’re going to do something.” And that, our sources agree is the key—knowing when to listen and being ready to provide outside resources when necessary.
Maria St. Louis-Sanchez can be contacted at msantray@yahoo.com.
Reference
Hood, C. M., K. P. Gennuso, G. R. Swain, and B. B. Catlin. 2016. County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2):129-35.
Asad/stock.adobe.com; aubriella/stock.adobe.com; Monika Jurczyk/stock.adobe.com
