Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone – a multidisciplinary patient and service provider perspective

Allen, Archie; Bolton, William; Jalloh, Mohamed Boie; Halpin, Stephen; Jayne, David; Scott, J

doi:10.1080/09638288.2020.1836043

Cited by 13 publications

(5 citation statements)

References 19 publications

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“…Previous studies in Asian countries have found a lack of peer/family support, timely referral, ideal amputations and gender balance in rehabilitation teams (35,36). The RTO stage of the LLA rehabilitation journey is primarily the responsibility of allied health professionals including physiotherapists, PO, occupational therapists, social workers and psychologists working in MDTs with rehabilitation clinicians where available ( 22).…”

Section: Discussion Key Findingsmentioning

confidence: 99%

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

Sayeed

Oakman²,

Stuckey³

2023

Front. Public Health

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ObjectiveTo 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.MethodsA 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.ResultsTwenty-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 “environmental” level had the most identified factors (n = 56) and the “care team” level the least (n = 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.ConclusionsDespite 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.

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Section: Discussion Key Findingsmentioning

confidence: 99%

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

Sayeed

Oakman²,

Stuckey³

2023

Front. Public Health

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“…A systematic literature review [ 21 ] including 77 articles in low- and middle-income countries investigating access to rehabilitation services in particular: use of assistive devices, usage of healthcare services specialised in rehabilitation and consistency to treatment found that coverage of different types of rehabilitation for PWD was poor in many countries but also varied greatly within countries. The shortage of qualified rehabilitation personnel such as physiotherapists, occupational therapists [ 27 ], prosthetists, and orthotists [ 28 ] is a persisting barrier in Sierra Leone and many other African countries. Sierra Leone has in 2019 established its first bachelor’s physiotherapy programme.…”

Section: Discussionmentioning

confidence: 99%

Access to health and rehabilitation services for persons with disabilities in Sierra Leone – focus group discussions with stakeholders

Magnusson

Kebbie

Jerwanska

2022

BMC Health Serv Res

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Background In Sierra Leone persons with disabilities are at higher risk of living in poverty and have poor access to a fragile healthcare and rehabilitation services. The aim was to explore stakeholders’ perceptions of access to health and rehabilitation services for persons with disabilities in Sierra Leone. Methods Seven focus group discussions, including stakeholders working within the field of disability was conducted. Results The subthemes were: continuous stigmatisation of persons with disabilities throughout life; long distances and transportation issues to access health and rehabilitation facilities; financial constraints; infrastructural barriers to healthcare and rehabilitation services and healthcare personnel’s negative attitudes and inadequate knowledge towards persons with disabilities; rehabilitation and healthcare facilities lacking materials to provide quality services; lack of specialised services and rehabilitation personnel for complex rehabilitation and the need for continuous education of new and current rehabilitation personnel. Conclusion Local actors need to take charge and renew efforts made by international organisations by providing trained rehabilitation staff and quality rehabilitation services. Rehabilitation services need to be affordable and transportation costs covered for persons with disabilities to access healthcare and rehabilitation services. Continuous education of the public and health personnel about disability is necessary to reduce negative attitudes towards persons with disabilities.

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“…Also recent data on the number of amputations performed in 2018 in Western Area of Sierra Leone is available. In this area 40 lower limb amputations were performed in public health facilities [12]. Therefore, the possibility exists that the number of people who have been amputated and need a prosthesis may be much higher than is indicated by the PHC.…”

Section: Introductionmentioning

confidence: 99%

Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone – an observational cohort study

et al. 2021

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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 middleincome 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.

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Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone – a multidisciplinary patient and service provider perspective

Cited by 13 publications

References 19 publications

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

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

Access to health and rehabilitation services for persons with disabilities in Sierra Leone – focus group discussions with stakeholders

Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone – an observational cohort study

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