Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review

Wijekoon, Ashan; Jayawardana, Subashini; Milton-Cole, Rhian; Chandrathilake, KRM; Amy, Jones; Cook, Sophie; Morrison, Edward R.; Sobolev, Boris

doi:10.1016/j.apmr.2023.02.009

Cited by 8 publications

(4 citation statements)

References 47 publications

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“…Findings from both sets of data were integrated to inform the development of a future CBPR intervention for the underlying population. We defined CBPR as an exercise-based rehabilitation intervention practiced in the community or at the home of the participant [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

“…These include present health conditions, provision of informal (family) and formal (health care provider) support, availability of and access to rehabilitation resources, prosthetic function, physical fitness, personal attitude, and knowledge or awareness of the condition [ 9 , 16 - 19 ]. Moreover, engaging in PA as part of a physical rehabilitation program is more beneficial than performing PA alone, as physical rehabilitation programs further seek to improve chronic pain [ 20 ] and balance [ 21 ], and increase cardiopulmonary endurance [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study

Wijekoon,

Gamage Dona,

Jayawardana

et al. 2024

JMIR Rehabil Assist Technol

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Background Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. Objective This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. Methods This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Results Based on the quantitative survey findings, scores for both physical ( P <.001) and psychological ( P <.001) well-being and participation in walking ( P =.004) and vigorous-intensity activities ( P <.001) were significantly lower among veterans than among controls. A “sedentary” classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonres...

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study

Wijekoon,

Gamage Dona,

Jayawardana

et al. 2024

JMIR Rehabil Assist Technol

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“…5 Continuous engagement in physical rehabilitation has proven to be effective in improving physical health outcomes following LLA. 6 However, rehabilitation opportunities for Sri Lankan veterans were limited to postinjury referrals for hospital-based rehabilitation, typically spanning a duration of 4-6 weeks, until their eventual reintegration into the community. 5 Previous investigations have revealed a significant diminution of their quality of life, both in terms of physical and mental outcomes, compared with a demographically similar population without amputation.…”

Section: Original Researchmentioning

confidence: 99%

Prevalence of physical health comorbidities and long-term functional outcomes among community-reintegrated veterans following lower limb amputation in Sri Lanka

Wijekoon,

Gamage Dona,

Jayawardana

2023

BMJ Mil Health

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IntroductionLower limb amputation (LLA) poses significant health challenges, including physical health comorbidities (PHCs) and functional limitations. Military veterans, who typically undergo traumatic LLA at a young age, endure these challenges for an extended period. Understanding the extent of these challenges is vital to designing tailored and feasible postamputation care for them. In this study, we evaluated the prevalence of PHCs and long-term functional outcomes among community-reintegrated veterans following LLA in Sri Lanka.MethodsA comparative cross-sectional study was conducted in five districts in Sri Lanka. Prevalence of PHCs and functional outcomes were compared between community-reintegrated veterans with war-related traumatic LLA and a matched able-bodied cohort. Data on PHCs were collected from participants’ medical records and through a self-administered questionnaire. Timed-Up-and-Go (TUG) and 2 min walk test (2MWT) were used to compare functional outcomes between the groups. Veterans’ functional level was identified using the K-level classification.ResultsVeterans were active prosthetic users who had undergone LLA >10 years ago. Sixty-six (77.6%) veterans reported experiencing phantom limb pain. A significantly higher prevalence of diabetes mellitus (34.2%), hypertension (22.4%), knee osteoarthritis (18.8%), knee pain (20%) and back pain (69.4%) was observed among veterans compared with the able-bodied group (p<0.05). Veterans demonstrated significantly lower levels of functional mobility (2MWT: mean (SD): 113.6 (14.8); increased risk of falling (TUG): mean (SD): 10.6 (1.8)) compared with able-bodied individuals (150.8 (11.9) and 7.2 (0.9), respectively, p<0.001). The majority of the veterans belonged to the K3 functional level (71.8%).ConclusionsThe higher prevalence of PHCs and impaired functional outcomes underscores the multifaceted health challenges faced by veterans with LLA living in low-resource community settings with limited access to rehabilitation. These findings provide insights into the unique rehabilitation needs of individuals with similar backgrounds, informing the design and implementation of tailored rehabilitation interventions.

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“…9 Além disto, o ajuste e uso da prótese também é um relevante aspecto na reabilitação de pessoas com amputação, já que o ajuste correto no processo de protetização reflete no aumento da mobilidade e independência, 10 o qual pode representar ganhos às capacidades físicas e contribuir para a melhora de aspectos psicológicos, 11,12 como a autoestima, o bem-estar, a autoconfiança e a qualidade de vida. 7,8 A qualidade de vida, como um constructo multifatorial e subjetivo, pode ser associada a domínios como, estado geral de saúde, aspectos físicos e psicossociais, função emocional, níveis de dor, satisfação com a vida e sensação de bem-estar, 13 que refletem a percepção que o indivíduo possui sobre si. 14 Neste sentido, vale ressaltar algumas das relações encontradas que refletem na qualidade de vida dessa população, como a imagem corporal 15 e comprometimento funcional.…”

Section: Introductionunclassified

Atividade física, ajuste à prótese e condição de saúde de pessoas com amputação de membro inferior

Lima,

Castro,

Weber

et al. 2023

Acta Fisiátr.

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Objetivo: Relacionar atividade física, características demográficas e clínicas, ajuste à prótese e condições de saúde relacionada à qualidade de vida de adultos com amputações de membro inferior. Método: Participaram do estudo 70 indivíduos com amputações de membro inferior de ambos os sexos. Os dados foram coletados por meio de ficha para caracterização dos participantes, do Physical Activity Scale for Individual with Physical Disabilities (PASIPD), da Trinity Amputation and Prosthesis Experience Scales–Revised (TAPES-R) e do Short Form Health Survey (SF-12). Os dados foram analisados por meio de estatística descritiva e inferencial visando correlações, comparações e associações. Foi adotado p menor ou igual a 0,05. Resultados: Os resultados demonstraram que os participantes tiveram gasto energético de 26,93 MET h/d e maiores médias de condições de Saúde Relacionado à Qualidade de Vida no domínio saúde mental, ainda apresentaram maiores médias relacionados ao Ajuste à Prótese no domínio Social (3,56) com Grau de Ajuste acima da média (6,42). Conclusão: Os participantes do estudo apresentaram bom nível de atividade física, bom ajuste à prótese, boa saúde física e mental, melhor adaptação à amputação e participação. Além disso, também foi observado uma pior relação na adaptação entre pessoas com amputação acima do joelho, quando comparadas às amputações abaixo do joelho.

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Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review

Cited by 8 publications

References 47 publications

Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study

Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study

Prevalence of physical health comorbidities and long-term functional outcomes among community-reintegrated veterans following lower limb amputation in Sri Lanka

Atividade física, ajuste à prótese e condição de saúde de pessoas com amputação de membro inferior

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