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Prosthetic and Orthotic Services in Developing Countries
Jönköping University, School of Health Science, HHJ. Prosthetics and Orthotics. Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to generate further knowledge about prosthetic and orthotic services in developing countries. In particular, the thesis focused on patient mobility and satisfaction with prosthetic and orthotic devices, satisfaction with service delivery, and the views of staff regarding clinical practice and education.

Methods: Questionnaires, including QUEST 2.0, were used to collect self-reported data from 83 patients in Malawi and 139 patients in Sierra Leone. In addition, 15 prosthetic/orthotic technicians in Sierra Leone and 15 prosthetists/orthotists in Pakistan were interviewed.

Results: The majority of patients used their prosthetic or orthotic devices (90% in Malawi, and 86% in Sierra Leone), but half of the assistive devices in use needed repair. Approximately one third of patients reported pain when using their assistive device (40% in Malawi and 34% in Sierra Leone). Patients had difficulties, or could not walk at all, with their prosthetic and/or orthotic device in the following situations; uneven ground (41% in Malawi and 65% in Sierra Leone), up and down hills (78% in Malawi and 75% in Sierra Leone), on stairs (60% in Malawi and 66% in Sierra Leone). Patients were quite satisfied or very satisfied with their assistive device (mean 3.9 in Malawi and 3.7 in Sierra Leone out of 5) and the services provided (mean 4.4 in Malawi and 3.7 in Sierra Leone out of 5), (p<0.001), but reported many problems (418 comments made in Malawi and 886 in Sierra Leone). About half of the patients did not, or sometimes did not, have the ability to access services (71% in Malawi and 40% in Sierra Leone). In relation to mobility and service delivery, orthotic patients and patients using above-knee assistive devices in Malawi and Sierra Leone had the poorest results. In Sierra Leone, women had poorer results than men. The general condition of devices and the ability to walk on uneven ground and on stairs were associated with both satisfaction of assistive devices and service received. Professionals’ views of service delivery and related education resulted in four themes common to Sierra Leone and Pakistan: 1) Low awareness and prioritising of prosthetic and orthotic services; 2) Difficulty managing specific pathological conditions and problems with materials; 3) The need for further education and desire for professional development; 4) Desire for improvements in prosthetic and orthotic education. A further two themes were unique to Sierra Leone; 1) People with disabilities have low social status; 2) Limited access to prosthetic and orthotic services.

Conclusion: High levels of satisfaction and mobility while using assistive devices were reported in Malawi and Sierra Leone, although patients experienced pain and difficulties when walking on challenging surfaces. Limitations to the effectiveness of assistive devices, poor comfort, and limited access to follow-up services and repairs were issues that needed to be addressed. Educating prosthetic and orthotic staff to a higher level was considered necessary in Sierra Leone. In Pakistan, prosthetic and orthotic education could be improved by modifying programme content, improving teachers’ knowledge, improving access to information, and addressing issues of gender equality.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences, Jönköping University, Sweden , 2014. , 129 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 56
Series
The Swedish Institute for Disability Research, ISSN 1650-1128 ; 66
Keyword [en]
Assistive device, Convention of Rights of Persons with Disabilities, disability, low-income countries, mobility, orthosis, prosthesis, satisfaction, QUEST
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-24973ISBN: 978-91-85835-55-3 (print)OAI: oai:DiVA.org:hj-24973DiVA: diva2:754830
Public defence
2014-11-07, Forum Humanum, Hälsohögskolan i Jönköping, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2014-10-13Bibliographically approved
List of papers
1. Malawian prosthetic and orthotic users' mobility and satisfaction with their lower limb assistive device
Open this publication in new window or tab >>Malawian prosthetic and orthotic users' mobility and satisfaction with their lower limb assistive device
2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 4, 385-391 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate patients’ mobility and satisfaction with their lower limb prosthetic or orthotic device and related service delivery in Malawi and to compare groups of patients regarding type and level of device and demographics.

METHODS: Questionnaires were used to collect self-report data from 83 patients.

RESULTS: Ninety percent of prostheses or orthoses were in use by patients, but approximately half of these needed repair. Thirty-nine percent reported pain when using their assistive device. The majority of patients were able to rise from a chair (77%), move around the home (80%), walk on uneven ground (59%) and travel by bus or car (56%). However, patients had difficulties walking up and down hills (78%) and stairs (60%). In general, patients were quite satisfied with their assistive device (mean of 3.9 out of 5) and very satisfied with the service provided (mean of 4.4 out of 5). Access to repairs and servicing were rated as most important, followed by durability and follow-up services. Lack of finances to pay for transport was a barrier to accessing the prosthetic and orthotic centre.

CONCLUSION: Patients were satisfied with the assistive device and service received, despite reporting pain associated with use of the device and difficulties ambulating on challenging surfaces.

National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Health Sciences
Identifiers
urn:nbn:se:hj:diva-20686 (URN)10.2340/16501977-1117 (DOI)
Available from: 2013-02-25 Created: 2013-02-25 Last updated: 2017-12-06Bibliographically approved
2. Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study
Open this publication in new window or tab >>Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study
2014 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 5, 438-446 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. Methods: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). Results: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. Conclusion: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

Keyword
prosthesis; orthosis; assistive device; Sierra Leone; satisfaction; disability; rehabilitation.
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-23662 (URN)10.2340/16501977-1780 (DOI)000336472300009 ()24658314 (PubMedID)2-s2.0-84902984683 (Scopus ID)
Available from: 2014-03-31 Created: 2014-03-31 Last updated: 2017-12-05Bibliographically approved
3. Experiences of providing prosthetic and orthotic services in Sierra Leone - the local staff's perspective
Open this publication in new window or tab >>Experiences of providing prosthetic and orthotic services in Sierra Leone - the local staff's perspective
2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 24, 2111-2118 p.Article in journal (Refereed) Published
Abstract [en]

In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. Purpose: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff’s perspective. Method: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. Results: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. Conclusions: The findings illustrated traditional beliefs about the causes of disability and that the public’s attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

Keyword
Africa, assistive device, assistive technology, developing country, low-income country, orthotic, prosthetic, Sierra Leone
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-19390 (URN)10.3109/09638288.2012.667501 (DOI)
Available from: 2012-09-10 Created: 2012-09-10 Last updated: 2017-12-07Bibliographically approved
4. Prosthetist/Orthotist Educational Experience & Professional Development in Pakistan
Open this publication in new window or tab >>Prosthetist/Orthotist Educational Experience & Professional Development in Pakistan
2009 (English)In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, Vol. 4, no 6, 385-392 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To explore areas in which the education at the Pakistan Institute of Prosthetic & Orthotic Science (PIPOS) could be improved or supplemented to facilitate clinical practice of graduates. To describe educational opportunities PIPOS graduates have had since their graduation and explore their further educational needs.

METHOD: 15 graduates from PIPOS participated in semi-structured interviews. A qualitative content analysis was applied to the transcripts.

FINDINGS: Respondents indicated a need to upgrade the education at PIPOS. This should include upgrading of resources such as literature and internet access as well as providing staff with the opportunity to further their own education. Females experienced inequality throughout their education but were supported by management. Upon entering the workforce graduates reported that they were supported by senior staff but experienced difficulties in determining appropriate prescriptions. They further indicated that a multidisciplinary approach to patient care is lacking. Graduates knowledge of workshop management was identified as a problem when entering the workforce. Limited awareness of the prosthetics and orthotics profession by both the general community and the medical community was also identified as a problem. If offered the opportunity to continue their studies the respondents would like to specialize. "Brain drain" was noted as a risk associated with post graduate education. Interaction from international collaborators and networking within the country was desired.

CONCLUSION: The education at PIPOS meets a need in the country. Graduates indicated that P&O services for Pakistan can be better provided by modifying program content, upgrading teachers' knowledge, improving access to information and addressing issues of gender equality. PIPOS graduates have had limited opportunities for professional development and have a desire for further education.

Keyword
Pakistan, prosthetist, orthotist, education, professional development
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-10308 (URN)10.3109/17483100903024634 (DOI)19817652 (PubMedID)
Available from: 2009-09-09 Created: 2009-09-09 Last updated: 2014-10-13Bibliographically approved

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