FUNCTIONAL OUTCOME IN FIRST TIME LOWER LIMB PROSTHETIC USERS AT ALEPPO PHYSICAL REHABILITATION CENTER (ALEPPO-PRC): 2020 -2022

A. Hlal¹, S. Berhanu¹

¹International Committee of the Red Cross, Physical Rehabilitation Program, Aleppo, Syria

Background: Rehabilitation of persons with lower limb amputation strives to improve their quality of life. Thus, evidence based functional outcome rehabilitation is a crucial part of the rehabilitation. There is considerable evidence and valid tools to measure functional outcome of service users with lower limb amputation . However, there are limited number of studies regarding service users (SUs) that use prosthesis for the first time.

Purpose: The purpose of this study is to assess the improvements in functional outcomes in first time lower limb prosthetic SUs at Aleppo-PRC using three functional outcome measures.

Methods: A retrospective survey was conducted using secondary data. Forty-two subjects that received prosthesis between January 2020 and August 2022 were included in the study.
Three main outcome measuring tools were used to analyses the improvements. Two minutes walking test (2MWT), one leg standing, and timed up and go (TUG) tests were used. Pre and post prosthetic outcome measures used, and the difference was calculated. Crude odds ratio was also calculated to compare variables. Other factors such as the use of mobility aids were also considered in the study.
The total mean scores of the three outcome measures were converted into percentages and used to compare the result.

Results: The results showed that children performed better than adults in the three functional outcome measures. The outcome measures improved in children by 43%, in adults by 23%, in SUs with traumatic causes by 36%, and in pathological causes only by 4%. With regards to the level of amputation, people with transtibial amputation (TTA) showed better improvement compared to people with transfemoral amputation (TFA). SUs with TFA showed better results with walking aids compared with prostheses. This study showed better improvements in short stumps (46%) and long/medium (37%). However, the short stumps are all TTA. SUs with TTA performed much better than SUs with TFA. TTA improved in average by 39% while TFA showed deterioration by 12%.
Crude odds ratio was calculated for each of the functional tests. Results showed that children are 1.2 and 64 times more likely to improve in 2MWT and TUG test, respectively, than adults. Females were 4 times more likely to improve their 2MWT scores than males, while males were 1.8 more likely to improve than females in TUG. The level of amputation; TT amputees score 13.8 times higher than TF amputees for the 2MWT and 41.6 higher for the TUG test. Traumatic causes are 2.4 and 7 times more likely to show improvements compared to pathologic causes for 2MWT and TUG tests respectively. One leg standing didn’t show any significant difference in an odds ratio.

Conclusions: Causes of amputation, level of amputation, and age have an influence on successful rehabilitation outcome in people with amputation using prostheses for the first time. It significantly shows the importance of conserving the knee joint in lower limb amputation.

Implications: Evidence based practice in hospital settings allows for a relevant multidisciplinary approach between the surgical and physical rehabilitation professionals centered on the best functional outcomes for patients.

Funding acknowledgements: International Committee of the Red Cross

Keywords:
Lower limb amputation
Functional outcome measures
Rehabilitation

Topics:
Disability & rehabilitation
Disability & rehabilitation
Service delivery/emerging roles

Did this work require ethics approval? No

Reason: This report on ICRC retrospective survey was conducted using secondary data; therefore, did not require an ethical approval.