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S. O'Driscoll1, N. Bergin1, L. Collins1, E. Murphy1, E. O'Connor1, C.A. Barth2,1, C. Sharma3, C. O'Sullivan1
1UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland, 2International Committee of the Red Cross (ICRC), Geneva, Switzerland, 3International Committee of the Red Cross (ICRC), New Delhi, India
Background: It is estimated that over 30 million people in need of a prosthesis reside in low income countries (BMJ, 2019), yet the research on rehabilitation amongst this population is limited. People with disability have poorer health outcomes, lower education achievements and higher poverty rates than people without disabilities (WHO, 2011). The density of rehabilitation practitioners in low and lower-middle income countries is below 10 per 1 million of the population (Gimigliano et al. 2017).
The last review of the literature addressing rehabilitation for people with amputation in low and lower-middle income countries was published by Staats in 1996. Since then, it is reasonable to believe there has been changes in the causes, rates and management of people with amputation, considering both the increased use of motor vehicles and the ever-increasing burden of diabetes in low and lower-middle income countries.
The last review of the literature addressing rehabilitation for people with amputation in low and lower-middle income countries was published by Staats in 1996. Since then, it is reasonable to believe there has been changes in the causes, rates and management of people with amputation, considering both the increased use of motor vehicles and the ever-increasing burden of diabetes in low and lower-middle income countries.
Purpose: This systematic review examines the characteristics of rehabilitation interventions, the outcome of rehabilitation and the effectiveness of rehabilitation in improving outcomes post-amputation in low and lower-middle income countries.
Methods: In order to guide this review, the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was used. Four electronic databases were comprehensively searched (October 2019) for randomised controlled trials, non-randomised control trials, cohort and cross-sectional studies investigating rehabilitation interventions post-amputation in low and lower-middle income countries. The Effective Public Health Practice Project Tool assessed quality of included studies.
Results: Fourteen studies (660 participants) were included. Interventions addressed lower limb (n=12), upper limb (n=1), or both (n=1) amputations. Two studies were rated as strong in quality, five moderate and seven rated as weak. In addition to usual prosthetic care, physiotherapy and mirror therapy improved outcomes for people with amputations. Best evidence synthesis provides level II evidence for supporting a functional physiotherapy programme to improve mobility and the use of mirror therapy to reduce pain. Level III evidence supports the use of a PCAST prosthetic socket in transtibial amputation.
Conclusion(s): A functional-based physiotherapy programme and mirror therapy improved outcomes for people with lower limb amputation in low and lower-middle income countries. Further high-quality research using multiple domain measures of rehabilitation interventions is required.
Implications:
- Researchers from low and lower-middle income countries appear to be underrepresented in published rehabilitation literature, indicating a need to promote and support further research in these settings.
- Mirror therapy can reduce phantom limb pain and residuum pain in people with amputations.
- Exercise based interventions such as lower limb strengthening, weight bearing exercise and coordination tasks improve functional mobility with a prosthesis.
- The pressure-cast (PCAST) prosthesis socket for transtibial amputation may be suitable for use in low and lower-middle income countries.
Funding, acknowledgements: Research unfunded.
Keywords: Amputation, Rehabilitation, Low and lower-middle income country
Topic: Disability & rehabilitation
Did this work require ethics approval? No
Institution: University College Dublin, Ireland
Committee: Undergraduate Research Ethics Committee
Reason: Systematic Review
All authors, affiliations and abstracts have been published as submitted.
