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P. Moreau1, S. Ismail2, E. Tauveron1, S. Herfat3,1
1La Fondation Médecins Sans Frontières, Paris, France, 2Médecins Sans Frontières, Amman, Jordan, 3University of California San Francisco, San Francisco, United States
Background: Access to assistive technologies is estimated by WHO to reach only 5-15% of the population in need. Decades of conflict in the Middle East has increased the amputee population, and resources to provide integrative rehabilitation care and prosthetics are limited. While opportunities exist for lower limb amputees from local organizations or NGOs, upper limb amputee patients have fewer to no chances to receive adapted care. In the last decade, existing groups working in humanitarian settings have been developing upper limb prosthetics using 3D scanning and printing technologies. However, too few of them integrated their solution within a comprehensive clinical care system.
Purpose: In Amman, Jordan, Médecins Sans Frontières (MSF) is providing reconstructive surgery to patients from across the Middle East; among them, patients suffering upper limb difference. Since 2017, MSF developed 3D prostheses and multidisciplinary rehabilitation care focusing on below elbow and partial hand devices. Patients are offered adapted care and follow-up depending on their needs and environment.
Methods: Prior to initiating rehabilitation including occupational therapy and physiotherapy, each enrolled patient underwent clinical assessments to identify their specific needs (using the Individually Prioritized Problem Assessment) and to assess completion of daily activities (using the Orthotic Prosthetic Users Survey [OPUS] - Upper Limb Activity section and the Children Amputee Prosthetic Project - Functional Status Inventory survey). 3D surface scans of the residual and contralateral limbs were acquired and used to design the socket and prosthesis. Devices are passive and delivered with various activity-specific adaptation tools. All devices are 3D printed locally using various polymer materials. Rehabilitation is tailored to address specific patient requests to perform previously-defined activities. After delivery of the prosthetic devices, patients continue rehabilitation and receive follow-up. After 3 months from the initial encounter, clinical assessments were re-administrated in addition to completing a satisfaction survey from the OPUS.
Results: Since summer 2017, 60 patients were treated (37 below elbow, 3 above elbow and 20 partial hand limb loss). Nearly half (48%) are from the local community while the rest come from other Middle Eastern countries. Half are pediatric cases and 65% are traumatic amputation cases.
Among the below elbow amputee cohort, patients were using their prosthetic 6h52m/day (mean; N=12) and decreased their difficulty to perform their selected activities by 52.6% (N=14) after 3 months of rehabilitation. Other scores showed an overall improvement in performing daily activities by 33.3% (N=14). User satisfaction with their devices was 95.4% after 3 months (N=14).
Among the below elbow amputee cohort, patients were using their prosthetic 6h52m/day (mean; N=12) and decreased their difficulty to perform their selected activities by 52.6% (N=14) after 3 months of rehabilitation. Other scores showed an overall improvement in performing daily activities by 33.3% (N=14). User satisfaction with their devices was 95.4% after 3 months (N=14).
Conclusions: This program demonstrates the feasibility of developing and providing 3D prosthetics and comprehensive multidisciplinary care to the upper limb difference patient population in Low- and Middle-income countries. Overall, this MSF project has positively impacted the daily life of the studied cohort.
Implications: Similar projects could be suggested in other humanitarian settings. Although, technical and clinical training requirements, the need for experienced clinicians, and long-term access to patients are key challenges to address prior to establishing a new project. Development of local capabilities is essential to increase access to care for upper limb amputee patients.
Funding acknowledgements: This Project is funded by MSF and MSF The Foundation donors.
Keywords:
upper-limb loss
humanitarian setting
3D technology
upper-limb loss
humanitarian setting
3D technology
Topics:
Orthopaedics
Disaster management
Innovative technology: robotics
Orthopaedics
Disaster management
Innovative technology: robotics
Did this work require ethics approval? No
Reason: This research fulfilled the exemption criteria set by the MSF Ethics Review Board (ERB) and thus did not require MSF ERB review.
All authors, affiliations and abstracts have been published as submitted.
