Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

Barth, Cornelia Anne; Wladis, Andreas; Blake, Catherine; Bhandarkar, Prashant; Perone, Sigirya Aebischer; O’Sullivan, Cliona

doi:10.1136/bmjopen-2021-049533

Cited by 12 publications

(8 citation statements)

References 45 publications

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“…The population of people with limb-loss in Cambodia is relatively young in comparison to most high-income countries, with people experiencing their amputations at a younger age [ 25 ], which was reflected in this cohort, with no participants aged over 60. Almost all had amputations due to trauma, and were highly active, walking an average of 4492 steps per day which is in line with recommendations for moderate-to-vigorous physical activity (MVPA) for people without physical disabilities [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study

Diment

Nguon²,

Seng³

et al. 2022

J NeuroEngineering Rehabil

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Background After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. Methods Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24–60 years old and 3–43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. Results Participants averaged 4470 steps/day (743–7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5–17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman’s rho rs = 0.59, and rs = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (rs = 0.49). A longer residual limb correlated with better community participation (rs = 0.56) and comfort (rs = 0.56). Self-reported community participation did not correlate with a person’s activity level (rs = 0.13), or their prosthesis comfort (rs = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (rs = 0.37). A simple 0–10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. Conclusion Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.

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Section: Discussionmentioning

confidence: 99%

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study

Diment

Nguon²,

Seng³

et al. 2022

J NeuroEngineering Rehabil

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“…The total number of clients has reduced, though their age profile has increased ( Figure 5 top). The ageing of existing clients, and entry of new older clients with amputations most commonly due to illness as observed by Barth et al [ 22 ], appears to be outweighing the entry of new young clients into the service. This will impact the complexity of patient management and the ability of the government and NGOs to deliver the same interventions within existing timeframes.…”

Section: Discussionmentioning

confidence: 99%

“…Future work might investigate the declining number of people accessing prosthetics services in the last decade, and whether this is due to the existing population reaching their life expectancy, standardised prosthetic devices lasting longer or no longer meeting the needs of an emerging middle class who then choose to access services elsewhere, or people experiencing more difficulty in accessing services due to reducing financial support. Further consideration of dimensions including sex should be made, noting that female clients are in a clear minority in this and similar data sets [ 19 , 20 , 22 ]. Findings might enhance our recommendations for improving the equity and diversity of the service.…”

Section: Discussionmentioning

confidence: 99%

“…The International Committee of the Red Cross (ICRC, Geneva) established a standardised digital patient management system (PMS) which offers an opportunity to identify and compare context-specific needs for prosthetics services at repeated time points, with homogeneous client demographics, standardised clinical data and outcome information. This data set has been used to study the demographics of people accessing ICRC physical rehabilitation services across 14 countries [ 21 ], and the demographics specifically of people with amputations in 5 countries [ 22 ].…”

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confidence: 99%

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Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: An exemplar study across three clinics in Cambodia

et al. 2022

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Background Prosthetic service development and delivery rely on data describing population needs. These needs are context-specific, but most existing data come from high-income countries or small geographic areas, which are often not comparable. This study analysed routinely collected digital patient record data at multiple time points to provide insights into characteristics of people accessing Cambodian prosthetic services. Methods We investigated trends in birth year, sex, year and reason for limb absence, and prosthesis type, over three decades. Then, we observed data from 2005 and 2019 indicating how the population actively accessing prosthetics services has changed. Results Temporal trends in prosthetics service user demographics corresponded with events in Cambodia’s socio-political history. The predominant historical reason for limb absence prior to 2000 was weapon trauma during and following conflict. Since 2000, this was replaced by non-communicable disease and road accidents. Transtibial remained the most prevalent amputation level but transfemoral amputation had higher incidence for people with limb loss from road accidents, and people with limb loss due to disease were older. These observations are important as both transfemoral and older-aged groups experience particular rehabilitation challenges compared to the young, transtibial group. Conclusions The study shows how standardised, routinely collected data across multiple clinics within a country can be used to characterise prosthetics service user populations and shows significant changes over time. This indicates the need to track client characteristics and provides evidence for adapting services according to population dynamics and changes in patient need.

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“…This is similar to the results expressed by Barth et al where Traumatic amputations happened in 73.4%. 16 In 2017, 57.7 million people were living with limb amputation due to traumatic causes worldwide.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Anxiety in Amputees Owed to Traumatic & Non-Traumatic Causes in Quetta

Baqi

Shaikh

Zia³

et al. 2022

Ann Pak Inst Med Sci

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Objective: To find out the causes and factors of anxiety among amputees suffering from traumatic and non-traumatic causes. Methodology: This descriptive cross-sectional study was conducted in Quetta from the month of May 2018 to July 2018. This study included those clients with amputations as a result of Traumatic & non-traumatic causes and the data was collected from them. This study involved a total of 54 participants. All amputees who visited the three Physical Rehabilitation Centre were included during data collection process. A structured adopted questionnaire using the Hospital Anxiety and Depression Scale (HADS) according to the inclusion & exclusion criteria & then tabularized and analyzed by applying Chi square test. Results: This study involved a total of 54 participants of whom 7(13%) were females and 47(87%) males. Among amputees 36(66.7 %), amputations were due to Traumatic injuries and 18(33.3%) were due to non-traumatic amputations. In traumatic, the majority was due to RTA with 25(46.3 %) and in non-traumatic causes diabetes stood first with 13(24.1%) amputation. Traumatic are more anxious than non-traumatic. There is a significant relationship between marital status and anxiety level (p-value 0.047). Statistically significant relationships between amputation and anxiety level were noticed, p value=0.049. Conclusion: Amputation has a significant association with anxiety level. Traumatic experiences make people feel more anxious than non-traumatic ones. Socio-demographics has association with levels of anxiety. It is recommended to do regular or annual screening of these patients following amputation.

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Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

Cited by 12 publications

References 45 publications

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study

Learning about the changing needs for prosthetics service provision from routinely collected digital centre management data: An exemplar study across three clinics in Cambodia

Determinants of Anxiety in Amputees Owed to Traumatic & Non-Traumatic Causes in Quetta

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