Prosthetic use by persons with unilateral above knee amputation in the Western Cape

[摘要] ENGLISH SUMMARY : Background: Walking with an above knee prosthesis places high physical demands on a person. People with an above knee amputation tend to use their prosthesis less frequently compared to people with a below knee amputation. Within the Western Cape's Public Health Sector, guidelines for pre-prosthetic rehabilitation services and prosthetic prescription are well developed and practised. However, once a prosthesis has been obtained, access to, and use of, prosthetic rehabilitation services seem limited. Furthermore, little is known about prosthetic use and mobility once the person has received an above knee prosthesis.Aim: To determine prosthetic mobility and prosthetic use of people with unilateral above knee amputation who have received their prosthesis from the Western Cape Government.Methods: The study used a quantitative, descriptive study design. The study population included all adults who had received a first prosthesis from the Orthotic and Prosthetic Centre in the Western Cape between 1 June 2011 and 31 December 2014. 43 people participated in the study. Data was collected through telephone interviews. An adapted version of the Prosthetic Profile of the Amputee (PPA) was completed. The original tool was tested for validity and reliability, but in a different context, with a different population. Data was captured on an Excel spreadsheet. Descriptive and some inferential analysis, with the Ci square- test, were done.Results: The majority of the 43 study participants were older than 50 years (77%), and men (79%). Vascular conditions (47%), followed by diabetes (23%), caused the highest number of amputations. More than half of participants waited longer than a year before receiving their prosthesis, however, it had no clinical or statistically significant impact on prosthetic use. Thirty five participants (81%) used their prostheses at least once a week and eighteen (42%) used it daily. A statistically significant effect (p=0.000) was found between prosthetic rehabilitation and prosthetic walking distance. Seventeen, less than half of participants, that received prosthetic rehabilitation, reported that they could walk for longer distances. Two (5%) participants could walk 1 000 or more steps without having to rest, however, more than half (56%) were limited to less than 200 steps. Of the prosthetic users, twenty six (74%) could walk indoors without assistive devices. On outdoor, uneven terrain, twenty six (74%) needed one or two elbow crutches, where nine (26%) did not rely on any hand held assisted devices across all terrains. Less than half (44%) of the participants felt the prosthesis completely met their expectations.Conclusion: The majority of the study participants used their prosthetic leg; although limitations were experienced in frequency of wear and mobility, such as walking distances and the need for additional hand held assisted devices. Initial expectations of what the prosthesis will offer were not often met. The results highlight the lack of prosthetic rehabilitation and also the benefit of prosthetic rehabilitation on mobility. It is recommended that access to rehabilitation is improved, from pre-prosthetic which could shorten waiting time to prosthesis, through to prosthetic rehabilitation, to improve mobility outcomes. It is also recommended that emphasis is placed on education at the pre-prosthetic phase, to determine realistic goals for the prosthetic phase.

[发布机构] Stellenbosch University