M.S.I. Sayeed1, J. Oakman1, M.P. Dillon2, R. Stuckey1
1La Trobe University, Ergonomics, Safety and Health, Department of Public Health, Bundoora, Australia, 2La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics & Orthotics, Bundoora, Australia
Background: Many people undergo lower limb amputation each year in Bangladesh; approximately 75 per 100,000 population. Most amputations are due to trauma and disproportionately affect young men living in rural areas. Most of these men have limited education and work in labouring type jobs to support themselves and their families. Unfortunately, for these individuals and their families, amputation often has a significant and negative impact on their social and economic situation. Many people experience significant financial strain given the cost of their amputation surgery and hospital stay. As such, amputation increases the risk that families fall into poverty. To reduce the social and economic impact of LLA, it is important that people have access to timely rehabilitation. In Bangladesh, there are significant delays between amputation and rehabilitation in the order of 6.5 years, range 0.3-60 years. Timely rehabilitation is limited due to a range of factors. For example, there are very few rehabilitations centres, mostly located in the major cities. We have little understanding about the level of disability in the period post-amputation and pre-rehabilitation, or changes in peoples’ occupational role and the resultant impact on their financial circumstances. Knowing this could assist identification of those most at risk of falling into poverty and development of appropriate rehabilitation and outreach programs to support people with LLA and their families.
Purpose: To quantify disability, occupation and socioeconomic status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation.
Methods: Between November 2017 and February 2018, participants were interviewed face-to-face for a cross-sectional prospective survey prior to rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Descriptive analysis, cross-tabulation, Chi-square test and Fisher’s exact test were conducted.
Results: Seventy-six individuals participated. The majority had transtibial amputation (61.8%) from trauma (64.5%), were young adults (37.92±12.35 years), married (63.2%), men (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA mobility scored highest in WHODAS (74.61±13.19) and 60.5% did not return to any occupation. Acute healthcare costs negatively impacted their families (89.5%), over 80% becoming impoverished. Nearly 70% of previous income-earners became economically dependent.
Conclusion(s): Most participants experienced significant mobility impairment, did not return to any occupation, and become economically dependent. Potentially this young group could return to productive roles with timely occupational rehabilitation. The stress of managing LLA extends to families, where impoverishment forces changes to earning and dependency roles. Rehabilitation and reduced care-costs post-LLA are urgently required to mitigate the significant disability, occupation and socioeconomic impacts on these individuals and their families.
Implications: The findings in this study potentially have implications for other developing countries. They support implementation of several important strategies to improve occupational rehabilitation and restoration outcomes, including: providing access to cost-accessible and linked acute care and rehabilitation services; providing rehabilitation to upskill this younger participant group to increase community mobility and occupational capacity with specific consideration of each individual’s environmental context; and, providing financial support systems for those with LLA to assist facilitation of occupational and family-role restoration.
Funding, acknowledgements: Not Applicable
Keywords: amputation, disability;, rehabilitation access
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: La Trobe University, Melbourne
Committee: Human Research Ethics Committee
Ethics number: HEC19297
All authors, affiliations and abstracts have been published as submitted.
