Prevalence of physical health comorbidities and long-term functional outcomes among community-reintegrated veterans following lower limb amputation in Sri Lanka

INTRODUCTION

Lower limb amputation (LLA) poses significant health challenges, including physical health comorbidities (PHCs) and functional limitations. Military veterans, who typically undergo traumatic LLA at a young age, endure these challenges for an extended period. Understanding the extent of these challenges is vital to designing tailored and feasible postamputation care for them. In this study, we evaluated the prevalence of PHCs and long-term functional outcomes among community-reintegrated veterans following LLA in Sri Lanka.

METHODS

A comparative cross-sectional study was conducted in five districts in Sri Lanka. Prevalence of PHCs and functional outcomes were compared between community-reintegrated veterans with war-related traumatic LLA and a matched able-bodied cohort. Data on PHCs were collected from participants' medical records and through a self-administered questionnaire. Timed-Up-and-Go (TUG) and 2 min walk test (2MWT) were used to compare functional outcomes between the groups. Veterans' functional level was identified using the K-level classification.

RESULTS

Veterans were active prosthetic users who had undergone LLA >10 years ago. Sixty-six (77.6%) veterans reported experiencing phantom limb pain. A significantly higher prevalence of diabetes mellitus (34.2%), hypertension (22.4%), knee osteoarthritis (18.8%), knee pain (20%) and back pain (69.4%) was observed among veterans compared with the able-bodied group (p<0.05). Veterans demonstrated significantly lower levels of functional mobility (2MWT: mean (SD): 113.6 (14.8); increased risk of falling (TUG): mean (SD): 10.6 (1.8)) compared with able-bodied individuals (150.8 (11.9) and 7.2 (0.9), respectively, p<0.001). The majority of the veterans belonged to the K3 functional level (71.8%).

CONCLUSIONS

The higher prevalence of PHCs and impaired functional outcomes underscores the multifaceted health challenges faced by veterans with LLA living in low-resource community settings with limited access to rehabilitation. These findings provide insights into the unique rehabilitation needs of individuals with similar backgrounds, informing the design and implementation of tailored rehabilitation interventions.

Effectiveness and Equity in Community-Based Rehabilitation on Pain, Physical Function, and Quality of Life After Unilateral Lower Limb Amputation: A Systematic Review

OBJECTIVES

To synthesize evidence for (1) the effectiveness of exercise-based rehabilitation interventions in the community and/or at home after transfemoral and transtibial amputation on pain, physical function, and quality of life and (2) the extent of inequities (unfair, avoidable differences in health) in access to identified interventions.

DATA SOURCES

Embase, MEDLINE, PEDro, Cinahl, Global Health, PsycINFO, OpenGrey, and ClinicalTrials.gov were systematically searched from inception to August 12, 2021, for published, unpublished, and registered ongoing randomized controlled trials.

STUDY SELECTION

Three review authors completed screening and quality appraisal in Covidence using the Cochrane Risk of Bias Tool. Included were randomized controlled trials of exercise-based rehabilitation interventions based in the community or at home for adults with transfemoral or transtibial amputation that assessed effectiveness on pain, physical function, or quality of life.

DATA EXTRACTION

Effectiveness data were extracted to templates defined a priori and the PROGRESS-Plus framework was used for equity factors.

DATA SYNTHESIS

Eight completed trials of low to moderate quality, 2 trial protocols, and 3 registered ongoing trials (351 participants across trials) were identified. Interventions included cognitive behavioral therapy, education, and video games, combined with exercise. There was heterogeneity in the mode of exercise as well as outcome measures employed. Intervention effects on pain, physical function, and quality of life were inconsistent. Intervention intensity, time of delivery, and degree of supervision influenced reported effectiveness. Overall, 423 potential participants were inequitably excluded from identified trials (65%), limiting the generalizability of interventions to the underlying population.

CONCLUSIONS

Interventions that were tailored, supervised, of higher intensity, and not in the immediate postacute phase showed greater promise for improving specific physical function outcomes. Future trials should explore these effects further and employ more inclusive eligibility to optimize any future implementation.

Care seeking in Sri Lanka: one possible explanation for low childhood mortality

This paper examines care-seeking practices of mother caretakers with children less than five years of age in a rural district of Sri Lanka. The study was carried out from June to September 1998, documenting care-seeking practices of mother caretakers in a population of 2248 children in 60 villages. Of the five targeted diseases in the IMCI programme (Integrated Management of Childhood Illnesses) that were the focus of the study, acute respiratory infections (82.0%) and diarrhoea (14.8%) were predominant. Although malnutrition was highly prevalent it was not recognised by mother caretakers as an illness. Findings show that in 65.0% of illness episodes in children the mother caretakers sought outside care and treatment. Caretakers sought treatment from both private and public sectors with the majority seeking care in the private sector. Care seeking of mother caretakers was driven by symptomology. Young children with higher perceived severity and high-risk symptoms were brought to provider care more frequently, although a large percentage of episodes with low-risk symptoms were also brought for outside care. Care seeking was similar across socio-economic groups. The study points out that high care seeking of mother caretakers in Sri Lanka, particularly for illnesses with acute high-risk symptoms and signs, is a plausible explanation for the low level of childhood mortality despite the prevalence of a high rate of malnutrition.

Thalassaemia control in developing countries--the Sri Lankan perspective

Beta thalassaemia is a Mendelian recessive disorder. The economic and social cost of the disease is high due to patients' life long need for monthly blood transfusions and treatment with desferrioxamine, an iron chelating agent. Wider availability of cheaper drugs is on the horizon. If there is no concomitant reduction in the number of new thalassaemia major births, there will be a cumulative increase in numbers requiring treatment. The frequency and severity, and the economic and social costs of thalassaemia, support the case for the introduction of a carrier screening and counselling program in Sri Lanka. A three-pronged plan emphasising professional, political and public education in outlined.