Figure 3 - uploaded by Liezel Ennion
Content may be subject to copyright.
Source publication
Background:
Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional o...
Context in source publication
Similar publications
Considering the scenarios of cities as results of spatial production forms, especially of its streets, the general objective of the investigation is to evaluate relations between guidelines determined by the public administration and perception of urban road axis by the population. Supported byspecific theoretical background and multiple methodolog...
Local communities participation in CPEC: The case of Balochistan
Abstract
While active participation of beneficiary communities in development initiatives is often considered critical, its value however, cannot be empirically determined without a good measure of the level of community participation. The objective of this study was to determine the level of community participation in the implementation of projec...
Villages are given a great opportunity to manage their own governance and to develop the infrastructure to enhance the welfare and life quality of their communities. In 2015 all villages in Indonesia have received village funds from State Budget (APBN). Village funds management needs the community involvement. However, most villagers are apathetic....
While recognizing that community participation stimulates local self-reliance and reduced dependency on outside agencies, it is also appreciated that a number of factors influence participation. This study was conducted to determine the demographic factors that influence community participation by using empirical data collected from a sample of 326...
Citations
... Other studies have found barriers to access among South Africans depending on state funded orthotic and prosthetic services because of services being centralized in metropolitan areas, a shortage of material and service providers, long distances, transport challenges, and financial challenges. 23,24 The need for additional devices among children using AFOs was supported by current findings. Especially positive was the finding that despite the children being able to ambulate independently some of them had wheelchairs. ...
... 1,4 Previous South African studies have found that transport costs prevented people from accessing O&P services in a timely manner. 23 Limitations Because the population size was not known, no sample size calculation was done. This hampers the internal validity of the results. ...
Background
Ankle foot orthoses (AFOs) improve ankle-foot stability and alignment. They might reduce the burden of care because they facilitate independent function. However, AFO use can add additional stressors such as adherence to wearing schedules and aiding with donning that might increase caregiver burden.
Objectives
The study aimed to quantify the burden experienced by family caregivers of children wearing AFOs in South Africa and to determine if there is a difference in the burden experienced by caregivers of children who have AFOs and those waiting for AFOs.
Study design
A cross-sectional survey was done in 4 South African provinces.
Methods
One hundred and twenty-three caregivers were identified through consecutive sampling. They completed the Burden Scale for Family Caregivers between March and June 2023. Descriptive and comparative analysis (χ ² test and Pearson correlation coefficient) were done.
Results
Eighty-three (67.48%) children had an AFO, whereas 40 (32.52%) needed one. The mean caregiver burden score for caregivers of children with AFOs was 21.82/60 (standard deviation 6.49), and for caregivers of children needing AFOs was 24.60 (standard deviation 5.63). Most family caregivers (69; 83.13%) of children with AFOs and children needing AFOs (32; 80.00%) experienced no to mild levels of burden. The difference in burden experienced by the 2 groups was not statistically significant ( P = 0.671082).
Conclusions
Caregivers of children who can walk and use AFOs experience low to moderate levels of burden. AFOs did not reduce the caregiver burden statistically. However, clinically the burden experienced by caregivers was reduced.
... Only 23 of the studies adequately described why participants selected for the study were appropriate to answer the research question. Many studies used convenience sampling approaches which may have led to samples with little variation, which do not represent the characteristics of target population [35,43,49,51,[53][54][55]59,66,68,70,73]. ...
... Subtheme 1.4-Fulfilment of roles. The subtheme of role fulfilment is linked to 'participation in important activities', and was discussed in 13 papers [13,35,40,41,43,44,46,49,62,66,67,71,72]. Fulfilment of a role such as a parent, spouse or valued member of the community, was described as an important outcome following lower limb amputation. ...
... An additional third subtheme has been developed describing the importance of prosthetic componentry which enables participation. 64,66,67,72,73,37,[42][43][44]49,53,56,58]. Participants described wanting a leg that was waterproof so they could go fishing, or a flexible ankle so they could lift objects at work. ...
Background
Little is known about which outcome domains characterise meaningful recovery following prosthetic rehabilitation and should be measured. Our previous qualitative work developed a conceptual model of outcome domains which are meaningful to patients. This qualitative synthesis aims to develop that model by exploring views and experiences of recovery captured in the limb loss literature, and use these to produce a second iteration of the model describing outcome domains of importance following prosthetic rehabilitation from the patient’s perspective.
Methods
Systematic searches were conducted using CINAHL, Psychinfo and Web of Science from 2011 to early 2023. Studies with a qualitative design focusing on views and experiences of lower limb prosthetic users were eligible for inclusion. Quality was assessed using the CASP tool. ‘Best Fit’ framework synthesis was used to synthesise the evidence and develop the conceptual model.
Results
40 studies were included, describing the experiences of 539 participants. Data supported the pre-existing conceptual model and led to development of four of the five domains. The newly named ECLIPSE model describes meaningful outcome domains as 1) Being able to participate in important activities and roles, 2) Participating in the way I want to, 3) My prosthesis works for me, 4) If I am in pain, I can manage it, and 5) I am able to accept my new normal. Studies came from 15 countries showing good coverage of high-income settings. Few participants from low-and-middle-income countries were included, it is unclear if the ECLIPSE model describes outcome domains of importance in these settings.
Conclusions
This synthesis provides a rigorous foundation for understanding outcome domains of importance following lower limb prosthetic rehabilitation from the patient’s perspective. The ECLIPSE model is an accessible representation of recovery which could direct rehabilitation programmes, as well as inform the evaluation of prosthetic care through the selection of outcome measures.
... 9 Several studies investigate the barriers and challenges related to the application of prosthesis in the adult population with limb loss. [10][11][12] Although these experiences and challenges can be different in children and adolescents with limb loss, concerns about their level of activity, participation in games, cultural variations, 13 and their life experiences with lower-limb prosthesis have not been investigated. Thus, this qualitative study explores the lived experience of children and adolescents with limb loss who use lower-limb prosthesis. ...
... The technique of taking notes was used because of the challenges associated with interviewing young children, including verbal limitations. 10 Another way to overcome the limitations of interviewing young children is to use shadow data. 15,16 This information was obtained from an interview with someone who knows the participant well. ...
... To get acquainted with the content, the researcher studied and reviewed these texts several times. 10 After each interview, each transcript was analyzed, and the codes were extracted. From this content, keywords reflecting experiences regarding the capabilities, limitations, and challenges of children and adolescents with LLL concerning prosthesis use, as well as the experiences and challenges of their parents and their prosthetists, were identified. ...
Purpose
Children's and adolescents' level of activity, the type of activity, and other features are special to them and can result in unique experiences with lower-limb prosthesis. The specific objective of this study was to explore the lived experience of children and adolescents with lower-limb loss (LLL) who used a prosthesis.
Methods
We used a descriptive qualitative study design and in-depth, semistructured, face-to-face interviews. Accordingly, 35 participants, including children and adolescents with LLL who used a prosthesis, their parents, and prosthetists, were interviewed. The collected data were analyzed thematically.
Results
One hundred sixty-eight codes about the experiences of children, parent(s), and prosthetists were extracted from the transcripts and categorized into 32 subthemes. Finally, 7 broad themes including suitability, provoke reactions, intrinsic nature, infrastructures, the school, availability, and parenting role were extracted.
Conclusion
The experiences of children and adolescents with lower-limb prosthesis are specific as each may face unique challenges and deal with different difficulties. In this study that has been conducted in a developing country, the main challenges faced by children using lower-limb prosthesis and their parents are the prosthetic components, social reactions, long distance, and costs of services. Moreover, designing a more natural prosthesis and gait training for children with LLL were the most important issues faced by prosthetists. However, close relationships with friends and family members, and children’s amazing ability to adapt can aid in facilitating prosthetic management.
... The organisation of the Norwegian health care system is an advantage to the patients because rehabilitation and prosthesis expenses are free of charge. Thus, there is probably a decreased transferability to low-income countries [21], or to countries with a personal health insurance-based system. The study does not suggest transferability for patients with disability caused by other factors than amputation, due to the technical perspective of a prosthesis. ...
Background:
Living with a lower limb amputation influences multiple facets of life due to altered function. Individuals achieve a varied level of function post amputation, depending on several variables like age, level of function prior to amputation, and available personal and environmental resources. Releasing the potential to live life to the fullest despite a disability is important to the individual.
Objectives:
The primary objective of this study is to identify barriers and facilitators for function which lower limb amputees experience in their lives several years after amputation, from the amputee's perspective. This knowledge can contribute to further development of the clinical pathway for lower limb amputees in a Norwegian rehabilitation hospital.
Methods:
The study has a descriptive and exploratory qualitative design with a phenomenological hermeneutical approach. Semistructured, individual interviews were conducted for data collection. Thematic analysis inspired by Braun and Clarke was used for data analysis. The sample consisted of eight transfemoral amputees (70 ± 6.9 (58-77 years)) living in the southern part of Norway. Average time since amputation was 11 years.
Results:
The results have been categorised into two main themes with subthemes: (1) facilitators: personal resources, a well-fitted prosthesis, rehabilitation, social network, balance in activity/rest, and accessibility and (2) barriers: walking distance, poorly fitted prosthesis, pain, comorbidities, climate/terrain/falling, reduced local competence on amputation, and pandemic.
Conclusion:
Lower limb amputees experience barriers in their everyday life, but they also develop strategies to cope with their disability. Clinical implications can include increased nutritional guidance, structural psychological mapping and follow-up, structured follow-ups over a significant period of time, and extended use of digital consultation.
... Previous studies on LLA in SA majorly focused on the burden, indications and outcomes. 12,13,16,23 The only existing study that assessed LLA knowledge was a quantitative study conducted amongst patients who were about to be amputated or had just been amputated 12 and was not focused on prevention. Qualitative data helps to better understand the phenomenon of interest. ...
... In addition, individual factors such as residual limb condition, financial instability for follow-up and purchase of required materials and even environmental factors all impact prosthetic services. 23 Therefore, healthcare providers must be mindful of the promises offered and may consider more feasible options based on the resources at their disposal and the financial condition of the people. ...
Background: South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery.
Aim: This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention.
Setting: Nqamakwe, a rural community in the Eastern Cape province of South Africa.
Method: This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed and translated, and an inductive approach was used for thematic analysis.
Results: A total of 15 individual interviews were conducted. Of those, 13 were persons with DM, five with LLA, including one with bilateral LLA. There was a gap in knowledge on foot self-examination as a measure of preventing LLA amongst persons with DM. The attitude of persons without LLA was mostly fearful and their fears centred around perioperative death, risk for contralateral amputation, loss of limb and independence. Consent to LLA procedure was a last resort and only when pain levels were unbearable. Family support and information on rehabilitation services and assistive devices also fostered consent to LLA surgery.
Conclusion: There is a need for awareness creation and adequate health education for persons living with DM on LLA and its prevention measures, especially foot care practices. Also, health education programmes for persons living with DM in rural areas should address the various misperceptions of LLA to reduce delays.
Contribution: The article revealed gaps in knowledge on LLA and its prevention among individuals living with diabetes as well as areas of concerns that may potentially delay acceptance when LLA is inevitable. Findings from our study may assist primary health care providers to determine important issues to be addressed during routine and pre-operative patient education.
... This is in line with existing literature showing that access to an appropriate LLP positively influences functionality and quality of life among users living in similar settings. 20 Although not all the changes reported were significant, it is interesting to notice that measurements collected at follow-up seem to indicate that participants witnessed improvements in most functional outcomes both objectively, as shown by the increased AMP score and decrease L test times, and subjectively, as indicated by greater adjustment to limitations, functional satisfaction, and reduced perception of activity restriction on the TAPES. However, general levels of adjustment to the LLP, aesthetic and overall satisfaction, and number of hours wearing an LLP per day all decreased, albeit not always significantly, at follow-up. ...
Background:
Many people with amputations who live in low-resourced settings struggle to access the workshops where qualified prosthetists provide appropriate care. Novel technologies such as the thermoplastic Confidence Socket are emerging, which could help facilitate easier access to prosthetic services.
Objectives:
The objective of this study was to evaluate the satisfaction and the performance of transtibial prosthesis featuring the Confidence Socket.
Study design:
This is a longitudinal repeated-measures design study.
Methods:
A convenience sample of 26 participants who underwent transtibial amputation were fitted with the Confidence Socket. The performance of the socket was evaluated after a follow-up period between 1 month and 6 months using the L test of functional mobility and the amputee mobility predictor. Satisfaction with the prosthesis was measured using the Trinity Amputation and Prosthetic Experience Scales and purposefully designed 7-point Likert scales.
Results:
Ten of the 26 participants returned for follow-up. Perceived activity restriction and L test times improved significantly at follow-up, but the self-reported satisfaction with the Confidence Socket was lower at follow-up compared with that after fitting.
Conclusions:
The Amparo Confidence Socket represents a potentially viable alternative to improve access to appropriate prosthesis in Kenya, but some aspects of users' self-reported satisfaction should be further investigated.
... In this study, it was shown that discrimination appeared to impact on various lived experiences, including support post amputation, to preserve or find employment, to preserve family relationships, to establish intimate relationships, to obtain respectful recognition from the wider community and to participate in their community. This appears to be similar to a growing body of qualitative research exploring the experiences of individuals with lower limb absence, who described that the key function of wearing a lower prosthesis was to appear 'non' or 'less-disabled' and capable of being able to work, as the use of crutches would highlight their disability and affect being able to gain employment (Ennion & Manig 2019;Kam et al. 2015;Ramstrand et al. 2021;Stuckey et al. 2020). In these studies that focussed on lower limb absence, it was shown that prosthesis use was related to increased self-worth and value in terms of being able to engage in society, which was compared to increased dependence on other people prior to http://www.ajod.org ...
... In these studies that focussed on lower limb absence, it was shown that prosthesis use was related to increased self-worth and value in terms of being able to engage in society, which was compared to increased dependence on other people prior to http://www.ajod.org Open Access prosthesis use (Ennion & Manig 2019;Ramstrand et al. 2021). This perhaps links to the concept of 'prosthetically enabled identities' developed through a qualitative synthesis process (Murray & Forshaw 2013) and highlights the role of prosthesis in regaining identities, adjusting to limb loss and enabling new identities (Järnhammer et al. 2018). ...
Background: The impact of upper limb absence on people’s lived experiences remains severely under-explored, particularly in African countries, with implications for policy and service design.
Objectives: explore the lived experiences of people with upper limb absence (PWULA) living in Uganda.
Method: informed by preliminary work, we designed a qualitative study employing semi-structured interviews to understand the experience of living with upper limb absence in Uganda. Seventeen adults with upper limb absence were individually interviewed and their interviews analysed utilizing thematic analysis.
Results: seven themes illustrating the impact on the individual’s life after amputation were identified and categorized into (1) living and adapting to life, (2) productivity and participation and (3) living within the wider environment. This paper presents three main findings: 1) PWULA need psychological and occupational support services which are not available in Uganda, 2) PWULA want to work but face multiple barriers to employment and limited support, this is combined with complex parenting and caring responsibilities, 3) the local Ugandan culture and social structures affect in both positive and negative ways the everyday life of PWULA.
Conclusion: This paper contributes the lived experiences of PWULA in Uganda which are lacking in the literature. PWULA face ableism and hardship underpinned by a lack of formal support structures and policies, which may in turn exacerbate the impact of upper limb absence on multiple facets of life.
... In addition, without access to proper protheses, people develop secondary conditions, which will increase the impact of their disability [5]. It is known that prostheses in general positively affect the quality of life [3,6,7]. ...
Background
There is a huge unmet global need for affordable prostheses. Amputations often happen in Sierra Leone due to serious infections, complex wounds, traffic accidents and delayed patient presentation to the hospital. However, purchasing a prosthesis is still beyond reach for most Sierra Leonean amputees.
Method
We applied computer-aided design (CAD) and computer-aided manufacturing (CAM) to produce low-cost transtibial prosthetic sockets. In February and March 2020, eight participants received a 3D printed transtibial prosthesis in the village of Masanga in Tonkolili district, Sierra Leone. Research was performed using questionnaires to investigate the use, participants’ satisfaction, and possible complications related to the prostheses. Questionnaires were conducted prior to production of the prosthesis and five to six weeks after fitting the prosthesis. A personal short-term goal was set by the participants.
Findings
Competitively priced and fully functional prostheses were produced locally. After six weeks, all participants were still wearing the prosthesis and six of the eight participants reached their personal rehabilitation goals. Using their prostheses, all participants were no longer in need of their crutches.
Interpretation
We have come a step closer to the production of low-cost prostheses for low-and middle-income countries (LMICs). The goal of our project is to perform long-term follow-up and to refine our concept of 3D printed prostheses for LMICs to provide practical solutions for a global health need unmet to date.
Funding
€ 15,000 was collected during a crowdfunding campaign in collaboration with the Dutch Albert Schweitzer Fund. Internship allowance for MvdS was obtained from the University of Twente. 3D-scanner, 3D-printer, and printing material were donated by Ultimaker BV and Shining 3D.
... A lack of available and affordable transport was another frequently cited barrier to accessing rehabilitation services, especially for rural patients, who have fewer transport options, longer distances to travel and higher transport costs. These transport barriers are mirrored in findings from South African and Malawian studies [29,30]. Gender was also found to be a barrier, with women having reduced access because of the need to find childcare when accessing services. ...
Purpose: The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018.
Materials and methods: A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11).
Results: Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services.
Conclusions: A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery.
... 51 Even those who obtain a prosthesis may be limited by travel costs associated with maintenance. 52 Although designs and programs have been created to address these needs, there is a lack of outcome data in the literature regarding the use of prosthetics in resource-limited environments. 53 One study from South Africa reported that only 42% of patients with a prosthesis used it daily and only 30% could walk at least 500 steps. ...
Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location.
Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations.
All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery.
Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation.
