Rehabilitation outcome following war-related transtibial amputation in Kosovo

Prevalence and Spatial Patterns of Major Limb Loss in the Acholi Sub-Region of Uganda

There is a widely reported yet poorly understood preponderance of major limb loss in Northern Uganda, caused in large part by prolonged civil war. Access to rehabilitation services is extremely limited, and there is no understanding of how many people have major limb loss, nor how many have had access to medical or rehabilitative services. This research represents the first prevalence study of disability and major limb loss in the Acholi sub-region of Northern Uganda, as well as a novel evaluation of spatial patterns in cases of major limb loss. We conservatively estimate that there are c. 10,117 people with major limb loss in Acholi (c. 0.5% of the population) who require long-term rehabilitation services, as well as c. 150,512 people with other disabilities (c. 8.2% of the population). We also demonstrate that people with major limb loss are spread throughout the region (as opposed to clustered in specific locations) and are disproportionately male, older, and less well educated than the general population. This research demonstrates a clear inadequacy in both the supply and service delivery models of rehabilitation services for those with major limb loss in the study area and provides much-needed insight into the challenges that must be addressed for an effective system to be put in place.

Patient-reported Outcome Measures following Traumatic Lower Extremity Amputation: A Systematic Review and Meta-analysis

BACKGROUND

Outcomes after traumatic major lower extremity amputation (MLEA) have focused on surgical complications, despite the life-altering impact on patients. With advances in the surgical management of MLEA, a heightened need for consistent reporting of patient-centered outcomes (PCO) remains. This meta-analysis assesses articles for the prevalence and methods of PCO reporting among traumatic MLEA studies.

METHODS

An electronic database search was completed using Ovid MEDLINE for studies published between 2000 and 2020. Studies were included that reported any outcome of traumatic MLEA. Weighted means of outcomes were calculated when data were available. The prevalence of PCO was assessed in the categories of physical function, quality of life (QOL), psychosocial, and pain. Trends in PCO reporting were analyzed using Pearson's chi-squared test and analysis of variance when appropriate.

RESULTS

In total, 7001 studies were screened, yielding 156 articles for inclusion. PCO were evaluated in 94 (60.3%) studies; 83 (53.2%) reported physical function and mobility outcomes, 33 (21.2%) reported QOL and satisfaction measures, 38 (24.4%) reported psychosocial data, and 43 (27.6%) reported pain outcomes. There was no change in prevalence of PCO reporting when comparing 5-year intervals between 2000 and 2020 (P = 0.557).

CONCLUSIONS

Optimization of function and QOL following traumatic MLEA has become a cornerstone of surgical success; however, only 60% of studies report PCO, with no trend over the last two decades suggesting improvement. As healthcare progresses toward patient-centered care, this inconsistent means of reporting PCO calls for improved inclusion and standardization of instruments to assess function, QOL, and other patient-focused measures.

Physiological cost index and comfort walking speed in two level lower limb amputees having no vascular disease

Background:

The Physiological Cost Index (PCI) was introduced by MacGregor to estimate the energy cost in walking of healthy people, also it has been reported for persons with lower limb amputation, walking with prosthesis.

Objective:

To assess energy cost and walking speed in two level lower limb amputation: transfemoral and transtibial amputation and to determine if the age and prosthetic walking supported with walking aids have impact on energy cost and walking speed.

Methods:

A prospective cross sectional study was performed in two level lower limb amputees with no vascular disease who were rehabilitated at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo. The Physiological Cost Index (PCI) was assessed by five minutes of continuous indoor walking at Comfort Walking Speed (CWS).

Results:

Eighty three lower limb amputees were recruited. It is shown relevant impact of level of amputation in PCI (t=6.8, p<0.001) and CWS (T=487, p<0.001). The great influence of using crutches during prosthetic walking in PCI (ANOVA F= 39.5 P < 0.001) and CWS (ANOVA F=32.01, P <0.001) has been shown by One Way ANOVA test. The correlation coefficient (R) showed a significant correlation of age with PCI and CWS in both groups of amputation.

Conclusions:

Walking with transfemoral prosthesis or using walking aids during prosthetic ambulation is matched with higher cost of energy and slower walking speed. Advanced age was shown with high impact on PCI and CWS in both groups of amputees.