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Ladkhedkar PS, Akhuj A, Fating T, Gulrandhe P, Ambekar A. Rehabilitation Following Above-Knee Amputation in a Pediatric Osteosarcoma Patient: A Case Report. Cureus 2023; 15:e50859. [PMID: 38259366 PMCID: PMC10801109 DOI: 10.7759/cureus.50859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
The earliest stages of osteosarcomas are primitive mesenchymal cells. It generally occurs close to the long bones' metaphysis and typically affects the long bones, such as the arm and leg. This case report underscores the pivotal role of physiotherapy in the rehabilitation of a 14-year-old male diagnosed with osteosarcoma, who underwent above-knee amputation. The structured six-week rehabilitation program, encompassing passive, active-assisted, and active exercises for the affected limb, alongside strength training for unaffected joints, produced notable gains in the pain rating scale and the lower-extremity functional scale in just 15 days. These outcomes underscore the significance of early and targeted physiotherapy interventions in optimizing functional outcomes and quality of life for young patients with osteosarcoma after surgery.
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Affiliation(s)
- Pooja S Ladkhedkar
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditi Akhuj
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Purva Gulrandhe
- Department of Community Health Physiotherapy, International Institute of Health Management Research (IIHMR) University, Jaipur, IND
| | - Aditi Ambekar
- Department of Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Parker K, MacDonald S, Henley S, Rutledge K, McLean K, Taylor K, Lee Kirby R. Residual limb support devices on wheelchairs for people with transtibial amputations: A scoping review and survey of rehabilitation professionals in Nova Scotia. Prosthet Orthot Int 2023; 47:387-398. [PMID: 36595289 DOI: 10.1097/pxr.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/08/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To determine what research evidence exists for the use of residual limb supports (RLSs) for people with transtibial amputations and to describe clinicians' use of such supports in Nova Scotia. METHODS Scoping review of published and gray literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews as a guide and an anonymous online and paper-based clinician survey. RESULTS We identified 22 publications meeting criteria for review. Seventeen (77%) of the publications were practice guidelines or systematic reviews about care of people with lower-limb amputations, 4 (18%) involved research about the design of stump supports, and 1 (5%) researched the use of supports. Generally, the use of RLSs was recommended (e.g., to prevent contractures, control edema, and to provide comfort), but many authors acknowledged that the evidence was weak, and additional evidence in support of these treatment goals could not be found. We received 44 survey responses from health care professionals involved with the care of people with transtibial amputations in Nova Scotia. Of the 43 health care professionals who responded to the question "… what percent of patients/clients with transtibial amputations do you estimate receive stump supports …," the mean (standard deviation) was 86.1% (21.1). The most common reasons for recommending a stump support were to prevent knee contracture (38 [86.4%]), and to prevent swelling (13 [29.5%]). CONCLUSIONS Most clinicians who provide services to people with amputations in Nova Scotia believe that RLSs have benefits such as the prevention of contractures, the reduction of edema, and improved patient comfort. However, there is little high-quality research evidence to support their use. There is a need to perform the necessary research or to modify practice guidelines.
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Affiliation(s)
- Kim Parker
- Assistive Technology Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Siobhan MacDonald
- Assistive Technology Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Shalyn Henley
- Assistive Technology Program, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Kallen Rutledge
- Library Services, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Katie McLean
- Library Services, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Kristy Taylor
- Occupational Therapy, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Ronald Lee Kirby
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Nova Scotia, Canada
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Frossard L, Conforto S, Aszmann OC. Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:950481. [PMID: 36189016 PMCID: PMC9397676 DOI: 10.3389/fresc.2022.950481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Laurent Frossard
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Correspondence: Laurent Frossard
| | | | - Oskar C. Aszmann
- Bionic Laboratory of Extremity Reconstruction and Department of Plastic & Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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Anderst W, Fiedler G, Onishi K, McKernan G, Gale T, Paulus P. Within-subject effects of standardized prosthetic socket modifications on physical function and patient-reported outcomes. Trials 2022; 23:299. [PMID: 35413866 PMCID: PMC9006565 DOI: 10.1186/s13063-022-06205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background Among the challenges of living with lower limb loss is the increased risk of long-term health problems that can be either attributed directly to the amputation surgery and/or prosthetic rehabilitation or indirectly to a disability-induced sedentary lifestyle. These problems are exacerbated by poorly fit prosthetic sockets. There is a knowledge gap regarding how the socket design affects in-socket mechanics and how in-socket mechanics affect patient-reported comfort and function. The objectives of this study are (1) to gain a better understanding of how in-socket mechanics of the residual limb in transfemoral amputees are related to patient-reported comfort and function, (2) to identify clinical tests that can streamline the socket design process, and (3) to evaluate the efficacy and cost of a novel, quantitatively informed socket optimization process. Methods Users of transfemoral prostheses will be asked to walk on a treadmill wearing their current socket plus 8 different check sockets with designed changes in different structural measurements that are likely to induce changes in residual limb motion, skin strain, and pressure distribution within the socket. Dynamic biplane radiography and pressure sensors will be used to measure in-socket residual limb mechanics. Patient-reported outcomes will also be collected after wearing each socket. The effects of in-socket mechanics on both physical function and patient-reported outcomes (aim 1) will be assessed using a generalized linear model. Partial correlation analysis will be used to examine the association between research-grade measurements and readily available clinical measurements (aim 2). In order to compare the new quantitative design method to the standard of care, patient-reported outcomes and cost will be compared between the two methods, utilizing the Wilcoxon-Mann-Whitney non-parametric test (aim 3). Discussion Knowledge on how prosthetic socket modifications affect residual bone and skin biomechanics itself can be applied to devise future socket designs, and the methodology can be used to investigate and improve such designs, past and present. Apart from saving time and costs, this may result in better prosthetic socket fit for a large patient population, thus increasing their mobility, participation, and overall health-related quality of life. Trial registration ClinicalTrials.gov NCT05041998. Date of registration: Sept 13, 2021.
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Affiliation(s)
- William Anderst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Goeran Fiedler
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA.
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Gina McKernan
- Human Engineering Research Laboratory, University of Pittsburgh, Pittsburgh, USA
| | - Tom Gale
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Paige Paulus
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
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Charlton K, Murray C, Boucaut R, Berndt A. Facilitating manual wheelchair skills following lower limb amputation using a group process: A nested mixed methods pilot study. Aust Occup Ther J 2021; 68:490-503. [PMID: 34318937 PMCID: PMC9290744 DOI: 10.1111/1440-1630.12759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/03/2022]
Abstract
Introduction The manual wheelchair skills training programme is used to structure teaching manual wheelchair use for people following injury or disability. This pilot study aimed to explore the outcomes of introducing a group wheelchair skills training programme on skill performance, confidence and frequency of wheelchair use for people with lower limb amputation in a rehabilitation setting from the perspective of participants and group facilitators. Method This pilot study used a two‐phase mixed methods nested design. Eleven people with lower limb amputations received a minimum of two 45‐min wheelchair skills sessions, using the Wheelchair Skills Training Program, delivered in a mix of group and one‐to‐one sessions. In phase one, wheelchair skill performance, confidence and frequency were measured using the Wheelchair Skills Test Questionnaire‐Version 5.0, goal achievement was measured through the Functional Independence Measure and Goal Attainment Scale. These measures were repeated in phase two. Nested within phase two was qualitative data collection. Interviews were conducted with eight participants and a focus group held with three programme facilitators, to gather their perceptions of the training process. Descriptive statistics were used to analyse and report quantitative data and thematic analysis was used to combine qualitative data from the two participant groups. Results Post intervention, the mean Wheelchair Skills Test Questionnaire score increased in performance (42.3 ± 13.4), confidence (33.9 ± 20.7) and frequency (33.9 ± 27.3). Goal Attainment was achieved or exceeded by 91% of all participants. Four themes were developed from qualitative data including, “motivators driving learning,” “delivery methods, structure and profile of the Wheelchair Skills Training Program,” “managing risk and safety” and “confidence in wheelchair use.” Conclusions The pilot study found that The Wheelchair Skills Training Program can improve wheelchair performance, confidence and frequency to support enhanced safety, independence and quality of life for people with lower limb amputations.
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Affiliation(s)
- Kimberly Charlton
- Central Adelaide Local Health Network, Department of Health and Wellbeing, South Australian Government, Hampstead Rehabilitation Centre, Lightsview, South Australia, Australia.,Allied Health Science and Human Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carolyn Murray
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Rose Boucaut
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
| | - Angela Berndt
- Allied Health and Human Performance, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia
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Likens AD, Kent JA, Sloan CI, Wurdeman SR, Stergiou N. Stochastic Resonance Reduces Sway and Gait Variability in Individuals With Unilateral Transtibial Amputation: A Pilot Study. Front Physiol 2020; 11:573700. [PMID: 33192576 PMCID: PMC7604354 DOI: 10.3389/fphys.2020.573700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Sub-threshold (imperceptible) vibration, applied to parts of the body, impacts how people move and perceive our world. Could this idea help someone who has lost part of their limb? Sub-threshold vibration was applied to the thigh of the affected limb of 20 people with unilateral transtibial amputation. Vibration conditions tested included two noise structures: pink and white. Center of pressure (COP) excursion (range and root-mean-square displacements) during quiet standing, and speed and spatial stride measures (mean and standard deviations of step length and width) during walking were assessed. Pink noise vibration decreased COP displacements in standing, and white noise vibration decreased sound limb step length standard deviation in walking. Sub-threshold vibration positively impacted aspects of both posture and gait; however, different noise structures had different effects. The current study represents foundational work in understanding the potential benefits of incorporating stochastic resonance as an intervention for individuals with amputation.
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Affiliation(s)
- Aaron D Likens
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States
| | - Jenny A Kent
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States.,Feinberg School of Medicine, Physical Medicine and Rehabilitation, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, United States
| | - C Ian Sloan
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States
| | - Shane R Wurdeman
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States.,Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, United States
| | - Nick Stergiou
- Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, United States.,Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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O'Banion LA, Dirks R, Farooqui E, Kaups K, Qumsiyeh Y, Rome C, Davis J. Outcomes of major lower extremity amputations n dysvascular patients: Room for improvement. Am J Surg 2020; 220:1506-1510. [PMID: 32891397 DOI: 10.1016/j.amjsurg.2020.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Dysvascular patients account for >80% of major amputations in the US. We sought to determine if early mobilization and discharge disposition decreased post-operative hospital length of stay (PO-LOS) and expedited independent ambulation. METHODS A retrospective review of dysvascular patients undergoing major amputations was performed. Primary outcomes included PO-LOS, discharge disposition, and days to ambulation. RESULTS 130 patients were included. Patients evaluated by Physical Therapy (PT) within 1 day of formal amputation had decreased PO-LOS (5.6 vs 6.5 days, p = 0.029). Patients discharged to rehab had a shorter PO-LOS (4 days) than those discharged to SNF or home (8 and 5 days, respectively; p = 0.008). Time to ambulation was shorter for patients discharged to rehab (109 days vs home = 153 days; SNF = 175 days; p = 0.033). CONCLUSION Modifiable factors, including early PT and rehab placement, decreased PO-LOS and expedited time to ambulation. A need exists for a standardized multidisciplinary team approach to improve outcomes.
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Affiliation(s)
- Leigh Ann O'Banion
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Rachel Dirks
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Emaad Farooqui
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Krista Kaups
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Yazen Qumsiyeh
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - Cambia Rome
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
| | - James Davis
- UCSF Department of Surgery, 2823 Fresno St, 1st Floor Surgery, Fresno, CA, 93721, USA.
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Soft Tissue Contouring at the Time of Osseointegrated Implant Reconstruction for Lower Extremity Amputation. Ann Plast Surg 2020; 85:S33-S36. [PMID: 32187066 DOI: 10.1097/sap.0000000000002329] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients with lower extremity amputations using a classic socket prosthesis face many challenges related to the socket-limb interface. The adaptation of osseointegration has allowed for the attachment of a prosthesis directly to bone, eliminating this interface and providing mechanical benefits. Contrary to the socket prosthesis, the osseointegrated prosthesis requires reducing and minimizing the soft tissue envelope. Studies have shown that patients who have undergone placement of these implants have high rates of reoperation for soft tissue redundancy. The purpose of our study was to evaluate complication rates and need for revisional surgery using our technique of soft tissue closure around the prosthesis at the time of implant placement. METHODS An institutional review board-approved, retrospective chart review was performed on all patients who underwent implantation of an osseointegrated prosthesis for lower extremity amputation with concomitant plastic surgery closure at our institution during a 2-year period from June 2017 to June 2019. Patient demographics, health status descriptors, operative data, length of admission, and rates of postoperative complications were gathered from the electronic medical record and coded into a HIPAA-compliant database. Specific outcomes tracked included minor and major infection, osteomyelitis, implant failure, hematoma, seroma, delayed wound healing, and rates of reoperation and readmission. RESULTS There were a total of 14 patients who underwent osseointegrated implant placement with concomitant plastic surgical coverage of the prosthesis during the study period. The average patient age was 50 years (range, 26-70 years), and average body mass index was 32.2 kg/m (range, 19.7-44.8 kg/m). Average follow-up time was 28 weeks (range, 10-73 weeks). There were 2 cases of local infection resolved with a course of oral antibiotics. There were no instances of infection requiring procedural intervention or hospital admission, nor any cases of osteomyelitis. Two patients required outpatient surgery for exchange of implant abutment, one required revision of a prosthesis for hardware loosening, and one required targeted muscle reinnervation of a sciatic nerve neuroma. There were no patients who required revisional surgery for soft tissue redundancy and no cases of delayed wound healing. CONCLUSIONS Adequate planning of incisions and soft tissue contouring is important in the care of osseointegrated patients. Plastic surgery involvement can decrease soft tissue complications and lead to improved patient outcomes.
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Pedras S, Vilhena E, Carvalho R, Pereira MG. Quality of Life Following a Lower Limb Amputation in Diabetic Patients: A Longitudinal and Multicenter Study. Psychiatry 2020; 83:47-57. [PMID: 31652411 DOI: 10.1080/00332747.2019.1672438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Lower limb amputation (LLA) leads to several emotional and physical sequelaes that have a negative impact on individuals` life. The objectives of this study were: 1) to analyze the relationship between emotional reactions (anxiety, depression and traumatic stress symptoms) and functionality level, before and after a LLA due to diabetic foot ulcer, and mental/physical quality of life; and 2) to analyze the mediator role of social support between emotional reactions and mental/physical quality of life. Method: A multicenter, longitudinal study with four time assessments: before the surgery, one month, six months, and ten months after surgery, including 206 individuals hospitalized with diabetic foot ulcer indicated for a LLA. The instruments used were the following: Revised Impact of Event Scale; Barthel Index; Hospital Anxiety and Depression Scale and SF-36. Results: Anxiety symptoms before surgery and depression symptoms one month after surgery contribute to Mental Component Score (MCS) ten months after surgery. The level of functionality before and one month after surgery, traumatic stress symptoms one month after surgery as well as satisfaction with social support six months after surgery contribute to the Physical Component Score (PCS), ten months after surgery. Social support was a mediator between traumatic stress symptoms one month after surgery and PCS ten months after surgery. Conclusion: Identifying risk variables and the extent to which and when they affect mental/physical quality of life, will help to develop appropriate psychological interventions to promote quality of life in this population.
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Mduzana LL, Visagie S, Mji G. Suitability of 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for the Eastern Cape, South Africa: A qualitative study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:396. [PMID: 30135914 PMCID: PMC6093117 DOI: 10.4102/sajp.v74i1.396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/19/2017] [Indexed: 11/03/2022] Open
Abstract
Background Major lower limb amputation has a severe impact on functional mobility. Mobility can be salvaged with a prosthesis, but this is not always the best option. It is often difficult to decide whether to refer someone for a prosthesis or not. A prosthetic screening tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' was developed and is used for prosthetic prescription in parts of the Western Cape province of South Africa. Objectives This study aimed to explore the suitability of the tool 'Guidelines for Screening of Prosthetic Candidates: Lower Limb' for use in the Eastern Cape province of South Africa. Method A qualitative study was conducted with conveniently sampled occupational therapists (OTs) (n = 10), physiotherapists (PTs) (n = 12) and prosthetists (n = 6) in government employment in the Buffalo City Metro Municipality. Participants were trained in the use of the tool and used it for four weeks with patients. Their experiences of the tool were assessed through three focus group discussions with emergent themes being identified during inductive data analysis. Findings Participants indicated that the tool could assist with prosthetic prescription, goal setting, communication and teamwork. They thought that the tool was multidisciplinary in nature, comprehensive and practical. Findings showed a lack of teamwork in this study setting. Resistance to change and a lack of time might also hamper implementation of the tool. Conclusion The tool can assist with managing the backlog for prostheses and to guide prosthetic prescription in the Eastern Cape province. Clinical implications A prosthesis can help to salvage functional mobility after lower limb amputation. However, not all people who had above knee amputation manage to walk with a prosthesis. The tool reported on in this article provides information that can guide prosthetic prescription and rehabilitation goals.
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Affiliation(s)
- Luphiwo L Mduzana
- Department of Rehabilitation Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa
| | - Surona Visagie
- Centre for Rehabilitation Studies, University of Stellenbosch, South Africa
| | - Gubela Mji
- Centre for Rehabilitation Studies, University of Stellenbosch, South Africa
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