Original Research

Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Ericka P. von Kaeppler, Alexander Hetherington, Claire A. Donnelley, Syed H. Ali, Corin Shirley, Sravya T. Challa, Emily Lutyens, Billy T. Haonga, Saam Morshed, Jan Andrysek, David W. Shearer
African Journal of Disability | Vol 10 | a839 | DOI: https://doi.org/10.4102/ajod.v10i0.839 | © 2021 Ericka P. von Kaeppler, Alexander Hetherington, Claire A. Donnelley, Syed H. Ali, Corin Shirley, Sravya T. Challa, Emily Lutyens, Billy T. Haonga, Saam Morshed, Jan Andrysek, David W. Shearer | This work is licensed under CC Attribution 4.0
Submitted: 23 December 2020 | Published: 07 September 2021

About the author(s)

Ericka P. von Kaeppler, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Alexander Hetherington, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Claire A. Donnelley, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America, United States
Syed H. Ali, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Corin Shirley, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Sravya T. Challa, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Emily Lutyens, LegWorks, Inc., Buffalo, United States of America
Billy T. Haonga, Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
Saam Morshed, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
Jan Andrysek, LegWorks, Inc., Buffalo, United States of America; and, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
David W. Shearer, Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America


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Abstract

Background: The rise of diabetes and traumatic injury has increased limb loss-related morbidity in low- and middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL ) and function has not been quantified.

Objectives: Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees.

Method: A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use.

Results: Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p < 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p < 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p < 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p = 0.068).

Conclusion: Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.


Keywords

low- and middle-income countries; transfemoral amputation; above-knee prosthesis; quality of life; functional status; Tanzania

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