The influence of environmental and personal factors on participation of lower-limb prosthetic users in low-income countries: prosthetists’ perspectives

Abstract

There are unique environmental and personal components that can influence activity and participation of lower-limb (LL) prosthetic users in low-income countries (LICs). These components are often overlooked in the design of prosthetic devices and provision of prosthetic services. Continuity of care, condition of the post-surgical residuum, outdoor environments of common occupations, aesthetics and durability of prostheses, and user comfort should all be considered when providing prosthetic rehabilitation to adults with LL amputations in LICs to promote activity and participation. Results of our study can inform the practice of prosthetists in LICs by highlighting their contributions in enabling participation for LL prosthetic users. Our results can also inform the design of durable and comfortable prostheses and the provision of more appropriate prosthetic rehabilitation to LL prosthetic users in LICs to facilitate and optimize participation.

Users’ Satisfaction with Prosthetic and Orthotic Assistive Devices in the Lao People’s Democratic Republic: A Cross-sectional Study

“…Overall, respondents were ambivalent about their level of satisfaction in terms of service delivery. Reasons for this were related to well-documented health service demand-and supply-barriers, including accessibility (e.g., poor road access, lack of transportation), acceptability (e.g., long waits, differing languages) and upfront cost of transportation and opportunity costs ( Matsen, 1999;Lawthers et al, 2003;Samuelsson and Wressle, 2008;Bosmans et al, 2009;Magnusson et al, 2013;Lee, 2014Lee, , 2014bBorg and Östergren, 2015;Kam et al, 2015;Weerasinghe et al, 2015).The rehabilitation sector is particularly under-resourced and this almost inevitably affects the quality of care that clients receive (Akkhavong et al, 2014). Low levels of satisfaction with access to repairs probably relate to the aforementioned demand-and supply-side barriers, and the fact that over 50% of respondents had devices in need of repair.…”

Suitability of ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ for the Eastern Cape, South Africa: A qualitative study

“…While feasible, reliable and valid, the AMP was developed in a well-resourced setting (Gailey et al 2002 ). Services, environments and prosthetic components (Andrysek 2010 ; Kam et al 2015 ; Wyss et al 2015 ) differ between well-resourced and poorer-resourced settings. In poorer-resourced settings, diverse natural environments, seasonal changes and climate extremes as well as occupations that require strenuous physical activity, such as farming, necessitate that prosthetic components enable function in physically demanding circumstances (Kam et al 2015 ).…”

“…Services, environments and prosthetic components (Andrysek 2010 ; Kam et al 2015 ; Wyss et al 2015 ) differ between well-resourced and poorer-resourced settings. In poorer-resourced settings, diverse natural environments, seasonal changes and climate extremes as well as occupations that require strenuous physical activity, such as farming, necessitate that prosthetic components enable function in physically demanding circumstances (Kam et al 2015 ). Indeed, the simpler prosthetic components often used in developing countries (Kam et al 2015 ) require higher levels of physical conditioning and strength to use, and do not support the functional requirements of strenuous activities (Andrysek 2010 ; Wyss et al 2015 ).…”

“…Distances, a lack of transport, financial constraints and a shortage of healthcare hamper rehabilitation in poorly resourced settings (Kam et al 2015 ). South African studies describe little (Fredericks & Visagie 2013 ; Godlwana, Stewart & Musenge 2015 ) or no rehabilitation post-amputation (Ennion & Rhoda 2016 ).…”

“…The residual limb should be free of wounds, with healthy skin and firm soft tissue (Roberts et al 2006 ). Challenges with the shape and skin condition of the residual limb are often experienced in developing countries (Kam et al 2015 ), making these important factors to take into consideration during prosthetic prescription.…”