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Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi

Magnusson, Lina LU and Ahlström, Gerd LU (2017) ISPO 2017 World Congress
Abstract (Swedish)

BACKGROUND
People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. Few studies have investigated overall satisfaction with prostheses fabricated using low-cost technology. Evidence-based recommendations for prosthetic and orthotic services in low-income countries are needed in order to more effectively provide services. Detailed analysis of variables which influence patient satisfaction with assistive devices are therefore of significance to investigate for improving of clinical rehabilitation practice.

AIM
The aims were to investigate similarities and differences between Sierra Leone and... (More)

BACKGROUND
People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. Few studies have investigated overall satisfaction with prostheses fabricated using low-cost technology. Evidence-based recommendations for prosthetic and orthotic services in low-income countries are needed in order to more effectively provide services. Detailed analysis of variables which influence patient satisfaction with assistive devices are therefore of significance to investigate for improving of clinical rehabilitation practice.

AIM
The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants’ mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients’ satisfaction with assistive devices and associated services in the entire study group from these two low-income countries.

METHOD
This is a cross-sectional survey study in two low-income countries with correlative and comparative design. Questionnaires, including QUEST, were answered by a total of 222 patients in Sierra Leone and Malawi.

RESULTS
Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7–3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p<.001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The significant association with satisfaction with assistive device was pain, general condition of the device, ability to walk on uneven ground/roads, ability to walk on stairs, and ability to get in and out of a car. The significant association with satisfaction with service was general condition of the device, ability to walk on uneven ground, ability to pay for costs associated with receiving the service appliances, accommodation, travel, and ability to walk on stairs.

DISCUSSION
Implications of the results is that the design and manufacture of prostheses and orthoses using low-cost technology needs be improved, specifically towards appropriate dimensions, increased comfort, and increasing the ability of patients to ambulate on challenging surfaces with their assistive device, as well as increasing patients’ ability to walk long distances with reduced pain. Increased or simulated ankle joint range of motion, careful dynamic alignment, more optimal dimensioning of assistive devices, and better training could facilitate the desired improvements. Access to repairs and follow-up services were important to participants, and should be addressed both by professionals operating within the rehabilitation field and policymakers, as it has the potential to improve mobility and satisfaction levels as well as reduce pain. The quality of assistive devices and service delivery could be enhanced by addressing the education level of staff.
CONCLUSION
Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device.
More than half of the assistive devices were in need of repair. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.

REFERENCES
Magnusson L, Ahlström G. Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi. Submitted for publication 2016.
Magnusson L. Prosthetic and Orthotic Services in Developing Countries. Doctoral Thesis. School of Health Sciences: Dissertation Series No 56. 2014. ISBN 978-91-85835-55-3 Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24973
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author
organization
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ISPO 2017 World Congress
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0772801b-24ed-4fc0-8164-8939b44059e3
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2017-06-18 22:53:44
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@misc{0772801b-24ed-4fc0-8164-8939b44059e3,
  abstract     = { <br>
BACKGROUND <br>
People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. Few studies have investigated overall satisfaction with prostheses fabricated using low-cost technology. Evidence-based recommendations for prosthetic and orthotic services in low-income countries are needed in order to more effectively provide services. Detailed analysis of variables which influence patient satisfaction with assistive devices are therefore of significance to investigate for improving of clinical rehabilitation practice.<br>
<br>
AIM <br>
The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants’ mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients’ satisfaction with assistive devices and associated services in the entire study group from these two low-income countries. <br>
<br>
METHOD  <br>
This is a cross-sectional survey study in two low-income countries with correlative and comparative design. Questionnaires, including QUEST, were answered by a total of 222 patients in Sierra Leone and Malawi. <br>
<br>
RESULTS <br>
Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7–3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p&lt;.001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The significant association with satisfaction with assistive device was pain, general condition of the device, ability to walk on uneven ground/roads, ability to walk on stairs, and ability to get in and out of a car. The significant association with satisfaction with service was general condition of the device, ability to walk on uneven ground, ability to pay for costs associated with receiving the service appliances, accommodation, travel, and ability to walk on stairs.<br>
<br>
DISCUSSION <br>
Implications of the results is that the design and manufacture of prostheses and orthoses using low-cost technology needs be improved, specifically towards appropriate dimensions, increased comfort, and increasing the ability of patients to ambulate on challenging surfaces with their assistive device, as well as increasing patients’ ability to walk long distances with reduced pain. Increased or simulated ankle joint range of motion, careful dynamic alignment, more optimal dimensioning of assistive devices, and better training could facilitate the desired improvements. Access to repairs and follow-up services were important to participants, and should be addressed both by professionals operating within the rehabilitation field and policymakers, as it has the potential to improve mobility and satisfaction levels as well as reduce pain. The quality of assistive devices and service delivery could be enhanced by addressing the education level of staff.<br>
CONCLUSION<br>
Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. <br>
More than half of the assistive devices were in need of repair. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.<br>
<br>
REFERENCES <br>
Magnusson L, Ahlström G. Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi. Submitted for publication 2016.<br>
Magnusson L. Prosthetic and Orthotic Services in Developing Countries. Doctoral Thesis. School of Health Sciences: Dissertation Series No 56. 2014. ISBN 978-91-85835-55-3 Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24973 <br>
 },
  author       = {Magnusson, Lina and Ahlström, Gerd},
  language     = {eng},
  month        = {05},
  title        = {Patients’ Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi},
  year         = {2017},
}