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Wen P.-S.1, Randolph M.2, Elbaum L.2, De La Rosa M.3
1Florida International University, Department of Occupational Therapy, Miami, United States, 2Florida International University, Physical Therapy, Miami, United States, 3Florida International University, Social Work, Miami, United States
Background: The 2010 earthquake in Haiti brought to light the inconceivable poverty in Haiti and the lack of medical and rehabilitation infrastructure needed in the recovery from a natural disaster. A lack of resources and management of prosthetic rehabilitation limited all interventions available for that population to focus on reducing physical limitations and providing artificial limbs. In our previous study conducted in Port-Au-Prince, we evaluated the status of individuals with lower extremity prosthetic devices and found that psychosocial adjustment lagged significantly behind physical adjustment. Studies show that individuals with traumatic amputations in low income countries are more likely to experience poor long term outcomes considering the contextual barriers and sociocultural exclusion. After the earthquake the inherent gender inequalities in the Haitian culture became more evident because of unequal access to resources for women as documented in several studies. A greater understanding of the role of gender differences as a possible factor for physical and psycho-social adjustment for prosthesis users in this cultural environment is needed. A rehabilitation plan tailored to the indigenous culture is required to have the best outcomes after a natural disaster.
Purpose: The purpose of this study was to investigate the gender differences in psychosocial and physical outcomes in unilateral lower extremity prosthesis users after the 2010 earthquake in Haiti.
Methods: In collaboration with a large non-profit organization in Port-Au-Prince, Haiti, 140 unilateral lower extremity prosthesis users over the age of 18 were recruited for this study from October 2011 to May 2012. The questionnaires used were the Trinity Amputation and Prosthesis Experience Scales (TAPES) and the Locomotor Capabilities Index (LCI). These questionnaires were translated into Haitian Creole and administered verbally by a well trained staff because of the high rate of illiteracy in Haiti. We conducted descriptive statistics, Chi-square and multiple regression analyses using SPSS version 18.
Results: The mean age of the participants was 34.85 ± 11.97 years, and approximately 50% of them had trans-tibial amputations. Seventy-two of the participants were women (51.4%), and 68 were men (48.6%). Men showed significantly better physical capacity (less activity restriction) than women in both the activity restriction domain of the TAPES and the Advanced LCI (p .01), but no gender difference was found in the basic LCI (p = .06). Both genders reported more difficulty in psychosocial adjustment. After controlling for strenuous physical ability and phantom pain, we found that Haitian women showed better psychosocial adjustment than men.
Conclusion(s): Relief efforts after a natural disaster should include a comprehensive rehabilitation plan that addresses gender differences in the indigenous culture to improve physical and psychosocial adjustments to limb loss.
Implications: Given the gender difference in psychosocial adjustment found in this study, it is critical to include interventions that address psychosocial adjustment such as self-efficacy training adapted to the gender roles of the indigenous culture.
Funding acknowledgements: This project was supported in part by NIH Grant R01-3P20MD002288-04S1.
Topic: Globalisation: health systems, policies & strategies
Ethics approval: Approved by IRB of University and non-profit organization in compliance with Haitian Health Ministry
All authors, affiliations and abstracts have been published as submitted.
