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

Pienaar, Elzbeth (2018-03)

Thesis (MHumanRehabSt)--Stellenbosch University, 2018.

Thesis

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.

AFRIKAANSE OPSOMMING : Agtergrond: Dit verg meer fisiese inspanning van ‘n persoon om met ‘n bo-knie prostese te loop. Mense met ‘n bo-knie amputasie is geneig om hul prosteses minder te dra in vergelyking met die wat ‘n onder-knie amputasie gehad het. Riglyne vir pre-prostetiese rehabilitasie en die voorskryf van prosteses is goed ontwikkel en word prakties toegepas in die Wes Kaap se Publieke Gesondheidsektor. Dit wil egter voorkom asof daar minder toegang tot en of gebruik van prostetiese rehabilitasie dienste is. Daar is ook min inligting beskikbaar oor die gebruik van en mobilitiet met bo-knie prosteses in die Wes Kaap. Doel: Om die mobiliteit en prostetiese gebruik van mense met ‘n bo-knie amputasie wat hul prostese ontvang het deur die Wes Kaap Publieke Gesondheids Sektor te evalueer. Metode: ’n Kwantitatiewe, beskrywende studie is gedoen. Die studie populasie het bestaan uit individue met ‘n bo-knie amputasie wat tussen 1 Junie 2011 en 31 Desember 2014 hul eerste prostese ontvang het vanaf die Wes Kaapse ‘Orthotic and Prosthetic Centre’. Drie en veertig mense het aan die navorsing deelgeneem. Die data is versamel deur middel van telefoon onderhoude waar ‘n aangepaste bestaande vraelys ‘Prosthetic Profile of the Amputee (PPA)’ beantwoord is. Die oorspronklike vraelys was getoets vir betroubaarheid en geldigheid, maar in ‘n ander konteks ten opsigte van kultuur en populasie. Versamelde data was in Excel opgesom en beskrywende analise is gedoen. Die Chi`square toets is gebruik om vas te stel of veranderlikes `n statisties beduidende verhouding met mekaar het. Resultate: Meeste van die deelnemers was manlik (79%) en ouer as 50 (77%). Meeste amputasies was gedoen as gevolg van vaskulêre probleme (47%) en diabetes (23%). Meer as die helfde van deelnemers het langer as ‘n jaar gewag voor prostese ontvang is, die wag periode, het egter nie ‘n statistiese of klinisie impak op prostetises gebruik gemaak nie. Vyf en dertig (81%) deelnemers het hul prostese ten minste een keer per week gebruik en agtien (42%) het dit daagliks gebruik. `n Statisties beduidende verhouding (p=0.000) was gevind tussen prostetiese rehabilitasie en stap afstand met die prostese. Deelnemers wat prostetiese rehabilitasie ontvang het, kon langer afstande loop met die prostese. Sewentien deelnemers, minder as die helfde, het egter prostetiese rehabilitasie ontvang. Slegs twee deelnemers kon 1 000 tree of meer loop sonder om te rus en meer as helfde deelnemers (56%) kon nie meer as 200 treë op ‘n slag loop nie. Van die deelnemers wat die prostese gebruik het, kon ses en twintig (74%) binnehuis loop sonder die hulp van krukke. Ses en twintig (74%) deelnemers het een of twee krukke nodig gehad om op ongelyke grond te loop, waar nege (26%), kon loop sonder krukke oor alle terreine. Minder as die helfde (44%) van die deelnemers het gevoel dat die prostese volkome aan hul verwagtinge voldoen het. Slotsom: Meeste van die deelnemers het hul prosteses gebruik, alhoewel baie beperkinge ondervind het soos beperkte loop afstande en die afhanklikheid van krukke. Verwagtinge van prostese was dikwels nie gevul nie. Die resultate dui daarop dat prostetiese rehabilitasie ‘n positiewe impak het op mobiliteit, asook dat daar beperkte toegang tot prostetiese rehabilitasie is. Beter toegang tot rehabilitasie word dus voorgestel; vanaf pre-prostetiese rehabilitasie, om die wag tydperk tussen amputasie en prostese te verkort, tot prostetiese rehabilitasie, om mobilitiet te verbeter. Dit word ook voorgestel dat meer inligting gegee word gedurende pre-prostetiese rehabilitasie om realistiese doelwitte te skep vir prostese fase.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103619
This item appears in the following collections: