Barriers and facilitators to work participation for persons with lower limb amputations in Bangladesh following prosthetic rehabilitation

Background: Lower limb amputation due to workplace injury and motor vehicle accident is common in Bangladesh. Qualitative research may extend our understanding of how physical impairment and other factors, such as cultural norms, family roles and the built environment, facilitate or hinder work participation following lower limb amputation and prosthetic rehabilitation. Objectives: The aim of this study was to explore the experience of people in Bangladesh following lower limb amputation and prosthetic rehabilitation to understand the facilitators and barriers to their work participation. Study Design: Qualitative interviews with thematic analysis. Methods: The Worker Role Interview was used to guide semi-structured interviews in a convenience sample of 10 adults living in Bangladesh following lower limb amputation and prosthetic rehabilitation. Interviews were interpreted, and the themes that emerged were evidenced with first-person quotes. Results: Barriers and facilitators to work participation were synthesised into the following themes: spirituality, attitudes, meaning of work, planning for work participation, traditional gender roles, social support, mobility aids, environmental challenges and ergonomic adaptations. Conclusion: This qualitative approach identified barriers and facilitators to work participation, such as the role of spirituality and the effect of gender roles, that have not been well researched in this population. Being aware of their effects can help clinicians reduce barriers to work participation. Clinical relevance Greater awareness of the barriers and facilitators to work participation, such as the role of spirituality or the effect of gender roles, can assist clinicians to reduce barriers and help facilitate work participation for people living in Bangladesh following lower limb amputation and prosthetic rehabilitation.

Download Full-text

Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa

Prosthetics and Orthotics International ◽

10.1177/0309364618789457 ◽

2018 ◽

Vol 43 (1) ◽

pp. 95-103 ◽

Cited By ~ 2

Author(s):

Ugendrie Naidoo ◽

Liezel Ennion

Keyword(s):

South Africa ◽

Lower Limb ◽

Rural Areas ◽

Lower Limb Amputation ◽

Barriers And Facilitators ◽

Rural Setting ◽

Limb Amputation ◽

Rehabilitation Services ◽

Personal Factors ◽

Persons With Disabilities

Background: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Objective: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. Study Design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. Results: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. Conclusion: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. Clinical relevance Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.

Download Full-text

The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation

Physical Therapy ◽

10.1093/ptj/pzaa091 ◽

2020 ◽

Author(s):

Jennifer Lučarević ◽

Ignacio Gaunaurd ◽

Sheila Clemens ◽

Paulina Belsky ◽

Lauren Summerton ◽

...

Keyword(s):

Lower Limb ◽

Sensory Integration ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Clinical Test ◽

Timed Up And Go ◽

Convenience Sample ◽

The Relationship ◽

Step Turn ◽

Degree Step

Abstract Objective The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. Methods This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. Results Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. Conclusions These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. Impact The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. Lay Summary Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.

Download Full-text

Gait Analysis in Lower-Limb Amputation and Prosthetic Rehabilitation

Physical Medicine and Rehabilitation Clinics of North America ◽

10.1016/j.pmr.2013.09.006 ◽

2014 ◽

Vol 25 (1) ◽

pp. 153-167 ◽

Cited By ~ 19

Author(s):

Alberto Esquenazi

Keyword(s):

Gait Analysis ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Prosthetic Rehabilitation

Download Full-text

Cardiorespiratory fitness and physical strain during prosthetic rehabilitation after lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364619838084 ◽

2019 ◽

Vol 43 (4) ◽

pp. 418-425

Author(s):

Daphne Wezenberg ◽

Rienk Dekker ◽

Frank van Dijk ◽

Willemijn Faber ◽

Lucas van der Woude ◽

...

Keyword(s):

Heart Rate ◽

Cardiorespiratory Fitness ◽

Aerobic Capacity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Prosthetic Rehabilitation ◽

Physical Strain ◽

Individual Level ◽

The Individual

Background: Sufficient cardiorespiratory fitness has been regarded a prerequisite for prosthetic walking. In order to improve cardiorespiratory fitness, adequate strain ought to be placed on the system during training. Objectives: To determine cardiorespiratory fitness at the start and end of inpatient rehabilitation after lower limb amputation and determine the physical strain experienced during conventional prosthetic rehabilitation. Study design: Multicenter prospective cohort study. Methods: Cardiorespiratory fitness was assessed using a peak one-legged cycle exercise test. Physical strain was assessed during a minimum of three full rehabilitation days using heart rate recordings. Physical strain was expressed in the time per day that heart rate exceeded 40% of heart rate reserve. Results: At the start of rehabilitation, peak aerobic capacity was on average 16.9 (SD, 6.5) mL/kg/min ( n = 33). Overall, peak aerobic capacity did not improve over the course of rehabilitation ( n = 23, p = 0.464). Fifty percent of the patients experienced a physical strain level that satisfies minimum criteria for maintaining cardiorespiratory fitness (>40% heart rate reserve for 30 min/day). Conclusion: Cardiorespiratory fitness was low and did not increase during conventional prosthetic rehabilitation. On average, the physical strain during rehabilitation was insufficient to elicit potential improvements in aerobic capacity. Results stress the need for dedicated physical training modules at the individual level. Clinical relevance This study shows that clinicians ought to be aware of the relatively low cardiorespiratory fitness of people who have undergone lower limb amputation and that improvements during rehabilitation are not always obtained. Results stress the need for physical training modules in which intensity is imposed at the individual level.

Download Full-text

The Role of Delirium and Other Risk Factors on Mortality in Elderly Patients with Critical Limb Ischemia Undergoing Major Lower Limb Amputation

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.02.014 ◽

2019 ◽

Vol 60 ◽

pp. 270-278.e2

Author(s):

J.P. Roijers ◽

C.J. Hopmans ◽

T.L. Janssen ◽

P.G.H. Mulder ◽

M.G. Buimer ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Critical Limb Ischemia ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Amputation ◽

Limb Amputation

Download Full-text

Patient satisfaction following lower-limb amputation: the role of gait deviation

Prosthetics and Orthotics International ◽

10.1177/0309364611406169 ◽

2011 ◽

Vol 35 (2) ◽

pp. 225-233 ◽

Cited By ~ 23

Author(s):

Lauren Kark ◽

Anne Simmons

Keyword(s):

Patient Satisfaction ◽

Lower Limb ◽

Functional Ability ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Timed Up And Go ◽

Cross Sectional ◽

High Functioning ◽

Satisfaction Measures

Background: Patient satisfaction is an important measurement in healthcare for administrators, clinicians and patients.Objectives: This study investigated the role of gait deviation in patient satisfaction following lower-limb amputation and prosthesis prescription.Study design: A cross-sectional study was done.Methods: Twenty community-based unilateral lower-limb amputees, 12 transtibial and 8 transfemoral, were recruited from support groups. Participants completed the prosthesis evaluation questionnaire (PEQ) with embedded satisfaction-related questions, the timed-up-and-go test and the six-minute walk test, and also underwent quantitative three-dimensional analysis. Kinematic deviation was summarized using the gait profile score (GPS).Results: Satisfaction levels were generally high (median 80 + /100). Sociodemographic variables did not correlate significantly with any of the satisfaction measures (−0.35 ≤ r ≤ 0.54). Satisfaction correlated strongly with the PEQ scales, particularly ambulation, prosthetic utility, frustration, perceived response and social burden ( r ≥ 0.70). By contrast, the relationships between satisfaction and performance-based outcome measures were not significant (−0.45 ≤ r ≤ 0.43), and the GPS did not correlate with any satisfaction measures (−0.23 ≤ r ≤ 0.15).Conclusions: In this study of high functioning amputees, gait deviation was unimportant to the amputee, while self-reported functional ability and attitudes toward the prosthesis were the strongest correlates of satisfaction following lower-limb amputation.Clinical relevance For the high functioning individuals with lower-limb amputation in this study, gait deviation was not a significant correlate of patient satisfaction. Results suggest that improving self-perceived functional ability and attitudes toward the prosthesis, rather than minimizing gait deviation, will improve patient satisfaction.

Download Full-text

Cycling in people with a lower limb amputation

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00302-3 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Jutamanee Poonsiri ◽

Rienk Dekker ◽

Pieter U. Dijkstra ◽

Juha M. Hijmans ◽

Jan H. B. Geertzen

Keyword(s):

The Netherlands ◽

Median Duration ◽

Lower Limb ◽

Odds Ratio ◽

Lower Limb Amputation ◽

Barriers And Facilitators ◽

Limb Amputation ◽

Future Research ◽

Personal Motivation ◽

Underlying Diseases

Abstract Background To evaluate cycling participation and identify barriers and facilitators related to cycling participation in people with a lower limb amputation (LLA) in the Netherlands. Methods A questionnaire was sent to adults with a LLA between March and August 2019 to obtain information regarding prosthesis, individual’s characteristics, amputation, cycling barriers and facilitators, and prosthetic satisfaction. The questionnaires were distributed via 8 orthopedic workshops, post and were given directly. To find cycling predictors, variables associated with cycling (p < 0.1) were entered into a logistic regression analysis. Non-significant variables were removed manually. Results Participants (n = 207, 71% males) had a mean age of 62.0 ± 13.0 years. The most frequent level of amputation was transtibial (42%), and trauma was the most frequent cause of amputation (43%). After the LLA, 141 participants (68%) cycled for recreation (80%), physical fitness (74%), and transport (50%). In the past six months, cyclists cycled for recreation (79%) and transport (66%). Most cycled less than once a day. Recreational cyclists cycled alone (75%) for a median duration of 45 min or 14 km per ride. Cyclists with a transportation purpose usually cycled to go shopping (80%) or to visit friends (68%), with a median duration of 20 min or five kilometers per ride. Cyclists reported more facilitators (median (IQR) = 5 (3, 7) than non-cyclists 0 (0, 3). The majority of cyclists reported a positive attitude toward cycling (89%) and cycled because of health benefits (81%). A dynamic foot (odds ratio: 5.2, 95% CI 2.0, 13.3) and a higher number of facilitators (odds ratio: 1.3, 95% CI 1.2, 1.5) positively predicted cycling, whereas the presence of other underlying diseases (odds ratio: 0.4, 95% CI 0.2, 0.9) negatively predicted cycling (R2: 40.2%). Conclusion In the Netherlands, the majority of adults cycled after a LLA, mainly for recreational purposes. A dynamic foot, a higher number of facilitators, and no other underlying diseases increases the likelihood of cycling after a LLA. The results suggest that personal motivation and a higher mobility level could be the key to increasing cycling participation. Future research should determine the association between motivation, mobility levels, and cycling with a LLA.

Download Full-text

The influence of balance confidence on social activity after discharge from prosthetic rehabilitation for first lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364611418874 ◽

2011 ◽

Vol 35 (4) ◽

pp. 379-385 ◽

Cited By ~ 23

Author(s):

William C Miller ◽

A Barry Deathe

Keyword(s):

Lower Limb ◽

Social Activity ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Walking Ability ◽

Prosthetic Rehabilitation ◽

Post Discharge ◽

Balance Confidence ◽

Confidence Levels

Background: Community living individuals with lower limb amputation have low balance confidence but the level of balance confidence in the first six months after discharge from prosthetic rehabilitation is not known.Objectives: To determine if balance confidence levels differ after discharge from prosthetic rehabilitation and to determine if balance confidence at discharge predicts social activity at three months post-discharge while controlling for important covariates such as walking ability.Study Design: Prospective study.Methods: Subjects ( n = 65) experiencing their first unilateral transfemoral or transtibial amputation were recruited and followed-up one and three months post-discharge. Measures of balance confidence (Activities-specific Balance Confidence Scale) and walking ability (L Test) collected at discharge were used to predict social activity (Frenchay Activities Index) at follow-up.Results: Despite a 14-second mean improvement in walking ability the mean balance confidence scores did not change significantly between discharge (71.2/100) and at three-month follow-up (69.4/100). Confidence scores and basic walking ability at discharge were the two strongest predictors of three-month social activity. Multiple regression modelling indicated that balance confidence and walking ability explained 64% of the variance (standardized beta = 0.34 and -0.37 respectively) in social activity (adjusted R2 = 39%).Conclusions: Balance confidence after discharge from prosthetic rehabilitation for lower limb amputation is low and scores do not improve over the first three months post-discharge despite improvements in walking ability. Discharge balance scores confidence independently predicts three-month social activity scores.

Download Full-text