SURVEY OF COMMUNITY-BASED PHYSICAL REHABILITATION PRACTICE AND SERVICE PROVISION FOR ADULTS FOLLOWING LOWER LIMB AMPUTATION IN THE UNITED KINGDOM

A. Wijekoon^1,2, S. Jayawardana¹, S. Morrison², K. Sheehan²

¹Faculty of Medicine, University of Colombo, Department of Allied Health Sciences, Colombo, Sri Lanka, ²Faculty of Life Sciences and Medicine, King's College London, Department of Population Health Sciences, London, United Kingdom

Background: Continuous follow-up in the community along with physical rehabilitation improves recovery and preserves independence among people with lower limb amputation (LLA). However, community-based physical rehabilitation (CBPR) is a limited or unavailable service in most developing countries. Understanding the current practise and service provision in an established setting would inform the design of a similar service in developing countries.

Purpose: To determine the current CBPR practice and service provision for adults following LLA in the United Kingdom (UK).

Methods: A UK-wide web-based cross-sectional descriptive survey of therapy service managers and physiotherapists working in the field of community-based rehabilitation of adults following LLA was conducted. Questions for the survey were informed by the existing literature and designed to provide data on clinical practise and service provision in the community for adults following LLA. The Survey was distributed via direct emails to rehabilitation centres, through professional bodies, and by advertising on social media platforms.

Results: In total, 33 respondents completed the survey, consisting of 7 therapy service managers and 26 physiotherapists, who were geographically spread across the UK. Rehabilitation services were designed as centre-based care, along with home visits as required. Delivery of CBPR is led by physiotherapists and occupational therapists with input from physicians, nurses, and prosthetists. The number of physiotherapists involved in CBPR from each centre varied from 2–8, and the number of patients who received CBPR varied from 50 to 300. The most common reason for referral to CBPR was to provide a physiotherapy programme (80.8%), which was delivered for up to 2 years with a frequency of twice a week. The majority of the centres provided longer-term follow-up and care after discharge from the physiotherapy programme (71.4%). The main components of the physiotherapy programme included: prosthetic training (88.5%), lower limb muscle strengthening (84.6%), gait training (84.6%), education on stump management (84.6%), core muscle strengthening (80.8%), and balance training (76.9%). Sixteen (61.5%) physiotherapists stated that they follow British Association of Chartered Physiotherapists in limb Absence Rehabilitation (BACPAR) guidelines when designing the rehabilitation programme. On average, physiotherapists provided 7–20 visits to patients, and the length of a session varied from 30 (11.5%) to 90 (7.7%) minutes. Most assessed outcomes were mobility (100%), balance (96.2%), activities of daily living (92.3%), quality of life (88.5), functional independence (84.6%), and pain (84.6%). According to many of the respondents, adherence to CBPR among the patients was satisfactory (38.5%) or average (26.9%).

Conclusions: CBPR in the form of centre-based care and home visits is a common practice in the UK, led primarily by physiotherapists. Potential population received a multifaceted physiotherapy programme with longer-term access to follow-up and care. There were similarities in programme format, content, staffing, outcome assessment, and follow-up across the country.

Implications: This survey identified important information regarding the structure, content, and organisation of the CBPR programmes for adults following LLA in the UK, which will inform the designing and implementation of similar programmes in developing countries.

Funding acknowledgements: This study was supported by Commonwealth Scholarship Commission funded by UK government (Scholar Identification Number: LKCN-2019-464)

Keywords:
Lower limb amputation
Community-based rehabilitation
Disability

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

Did this work require ethics approval? Yes

Institution: King's College London

Committee: Research Ethics Committee

Ethics number: LRS-21/22-29150