Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation

Pasquina, Colonel Paul F.; Carvalho, Antonio J.; Sheehan, Terrence P.

doi:10.1001/journalofethics.2015.17.6.stas1-1506

Cited by 47 publications

(18 citation statements)

References 38 publications

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“…In HICs, treatment for limb loss focuses on the physical and psychosocial effects of amputation and usually includes the provision of a prosthesis to improve mobility (Wurdeman, Stevens & Campbell 2017). Prosthesis usage is associated with higher levels of employment, higher QOL and reduced secondary health issues (Pasquina, Carvalho & Sheehan 2015), although patients…”

Section: Introductionmentioning

confidence: 99%

Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Kaeppler

Hetherington

Donnelley

et al. 2021

African Journal of Disability

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Background: The rise of diabetes and traumatic injury has increased limb loss-related morbidity in low- and middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL ) and function has not been quantified.Objectives: Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees.Method: A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use.Results: Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p = 0.068).Conclusion: Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.

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Section: Introductionmentioning

confidence: 99%

Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Kaeppler

Hetherington

Donnelley

et al. 2021

African Journal of Disability

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“…Although the findings demonstrate the potential value of early receipt of a prosthesis with associated decrease in healthcare costs, age is a risk factor with increased comorbidities. 11 , 29 Furthermore, in the United States, as adults reach the age of 65 yrs, they qualify for Medicare insurance.…”

Section: Discussionmentioning

confidence: 99%

“…However, as costs of treatment for chronic conditions and health care in the United States have continually increased over the past decades, several studies have reported the significance of access to rehabilitation services for restoration of mobility and independence postamputation. 11 , 28 , 29 …”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

Miller

Paul

Forthofer

et al. 2020

Am J Phys Med Rehabil

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“…Amputees encounter multiple challenges during their recovery, rehabilitation, and reintegration into their homes and communities. Learning and adopting new strategies for basic mobility, personal hygiene, and activities of daily living with a prosthesis is difficult (6). Complicating this process, the residual limb (RL) naturally goes through a period of volume fluctuation post amputation that impacts fit (7).…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of an Adjustable Transfemoral Prosthetic Interface Accommodating Volume Fluctuation: Case Study

2016

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The socket-limb interface is vital for functionality and provides stability and mobility for the amputee. Volume fluctuation can lead to compromised fit and function. Current socket technology does not accommodate for volume fluctuation. An adjustable interface may improve function and comfort by filling this technology gap. The purpose of this study was to compare the effectiveness of the standard of care (SOC) ischial ramus containment to an adjustable transfemoral prosthetic interface socket in the accommodation of volume fluctuation. A prospective experimental case study using repeated measures of subjective and performance outcome measures between socket conditions was employed. In the baseline volume condition, the adjustable socket improved subjective and performance measures 19% to 37% over SOC, whereas the two-minute walk test demonstrated equivalence. In the volume loss condition, the adjustable socket improved all subjective and performance measures 22% to 93%. All aggregated data improved 16% to 50% compared with the SOC. In simulated volume gain, the SOC socket failed, while the subject was able to complete the protocol using the adjustable socket. In this case study, the SOC socket was inferior to the comparative adjustable transfemoral amputation interface in subjective and performance outcomes. There is a lack of clinical trials and evidence comparing socket functional outcomes related to volume fluctuation.

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Ethics in Rehabilitation: Access to Prosthetics and Quality Care Following Amputation

Cited by 47 publications

References 38 publications

Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

Comparative Effectiveness of an Adjustable Transfemoral Prosthetic Interface Accommodating Volume Fluctuation: Case Study

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