Amputee rehabilitation (FS-02)

Integrating evidence into lower limb prosthetic rehabilitation in today's world

Gillian Margaret Johnson (New Zealand), Lonwabo Godlwana (South Africa), Prasath Jayakaran (United Kingdom), Hemakumar Devan (New Zealand), Sara Drum (Ethiopia)

Focused symposium

Monday 4 May 2015, 10:45-12:15, Hall 405

Integrating evidence into lower limb prosthetic rehabilitation in today's world

Johnson G.M. 1, Godlwana L. 2, Jayakaran P. 3, Devan H. 1, Drum S. 4

1University of Otago, Centre for Health, Activity and Rehabilitation, School of Physiotherapy, Dunedin, New Zealand, 2University of the Witwatersrand, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, Johannesburg, South Africa, 3Brunel University, School of Health Sciences and Social Care,, London, United Kingdom, 4Physical Rehabilitation Programme, International Committee of the Red Cross (ICRC), Addis Ababa, Ethiopia

Learning objectives

  1. To discuss the importance of undertaking patient-led participation and quality of life measures at the pre-operative stage in individuals about to undergo a lower limb amputation.
  2. To outline the deficits in balance performance in persons with a lower limb amputation secondary to vascular complications and, the biomechanical features attributed to low back pain in persons with a lower limb amputation due to non-vascular related causes. The associated implications for rehabilitation will also be discussed.
  3. To describe the common barriers which confront persons with an amputation in accessing physical rehabilitation services and their successful re-integration into society at the local service level in developing countries and areas of conflict.

Description

There is general agreement that the ultimate rehabilitation goal for persons who have undergone a lower limb amputation is to restore the maximum amount of function. In the case of persons with an amputation due to vascular complications research shows that the surgical act of a major limb amputation does not necessarily equate to a guarantee of improved quality of life. Preoperatively, the independent variables of old age, non-ambulatory status and those individuals with medical comorbidities such as end-stage renal disease are significant predictors for poor functional outcomes following a lower limb amputation. Postoperatively, the functional profiles of persons with an amputation due to vascular problems are known to be significantly lower than those associated with trauma and, that it these individuals that often end up being high utilizers of the healthcare system. In the longer term, research also reveals that persons living with a major lower limb amputation due to trauma are likely to suffer low back pain which can be attributed in part, to sustained high levels of prosthetic use over many years. At the local and national service delivery level, the International Committee of the Red Cross (ICRC) recognizes that physical rehabilitation is an important way of helping persons with a major amputation but that there are special challenges which need to be addressed in developing countries and areas of conflict before these services can be readily accessed.

Dr. Gillian Johnson from the University of Otago, New Zealand as the convenor will introduce the topic of rehabilitation for persons with a lower limb amputation including the wider issue of heath service provision for these individuals. Lonwabo Godlwana from the University of the Witwatersrand, South Africa will present the results of a study examining the preoperative health status in individuals prior to undergoing a lower limb amputation as a means of better understanding their special needs.

Dr. Prasath Jayakaran from Brunel University, United Kingdom will describe the difference in balance abilities between persons with a lower limb amputation secondary to vascular complications and those with a lower limb amputation secondary to traumatic events and the implications for rehabilitation.

Hemakumar Devan from the University of Otago, New Zealand will present an overview of secondary musculo-skeletal conditions identified in persons with a lower limb amputation due to non-vascular aetiology. Particularly, the nature, severity and potential contributing factors of low back pain in these individuals will be discussed.

Sara Drum, International Committee of the Red Cross (ICRC) who is currently based in Ethiopia will describe how the ICRC Physical Rehabilitation Programme works at the local level to reduce financial, technical and other barriers to enable lower limb amputees to access physical rehabilitation services and begin reintegration into society.

The presentations will be followed by a discussion session with the audience and concluding remarks by Dr Johnson.

Implications / Conclusions

Physiotherapists need to be aware that the participation levels and quality of life for persons who have undergone a lower limb amputation are decreased when compared with that of their premorbid status. Active participation is still the primary goal for all persons with a major amputation. However an important caveat is that rehabilitation programmes for persons with an amputation due to vascular complications require a more tailored approach if they are to reach their full potential. Furthermore, individuals with an amputation due to trauma need to be educated regarding the underlying biomechanical demands associated with common functional tasks in order to minimise the risk of developing low back pain. The experience of the ICRC Physical Rehabilitation Programme is that sustainable services designed for individuals with a major amputation in countries with conflict or political unrest are greatly enhanced by education and awareness raising at the local level.

Keywords

Persons with a lower limb amputation; Prosthetic rehabilitation; Service delivery and access

Funding acknowledgements

New Zealand Artificial Limb Board

Relevance to WCPT and expected audience

The evidence to support best practice for physical therapy assessment and management of persons with a major amputation and an appreciation of the strategies used by the International Committee of the Red Cross to deal with rehabilitation access issues at the local level in countries of political unrest or area of conflict are of relevance to physical therapists from professional practice, educational, public health and policy making perspectives.

Target audience

Physical therapists working in the areas of prosthetic rehabilitation, education and physical therapy health policy.