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

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

FIGURE 1

Eligibility criteria and schedule of data collection events: (a) the inclusion and exclusion criteria along with rationale used to generate the included cohort of patients and (b) the schedule of which assessments were performed at each timepoint throughout the study. The data collected at 12 months was dependent on whether the visit was conducted in-person or by telephone.

FIGURE 2

Flowchart demonstrating screening, enrolment and follow-up for study participants.

FIGURE 3

Patient-reported outcomes before amputation, at the casting visit before prosthesis fitting, 1, 6 and 12 months after prosthesis fitting: (a) EuroQol-5D (EQ-5D) health status scores before amputation (pre-amputation), at the casting visit before prosthesis fitting (pre-prosthesis) and at 1 month (1 mo), 6 months (6 mo) and 12 months (12 mo) follow-up after prosthesis fitting; (b) EQ-5D health status scores for patients separated by the reason for amputation at pre-amputation, pre-prosthesis, 1 mo, 6 mo and 12 mo for patients reported to be using their prosthesis; (c) Prosthetic Limb Users Survey of Mobility (PLUS-M) scores at pre-amputation, pre-prosthesis, 1 mo, 6 mo and 12 mo; (d) PLUS-M scores for patients separated by the reason for amputation at pre-amputation, pre-prosthesis, 1 mo, 6 mo, and, 12 mo for patients reported to be using their prosthesis.

FIGURE 4

Functional outcomes before amputation, at the casting visit before prosthesis fitting, 1, 6 and 12 months after prosthesis fitting: (a) 2-minute walk test scores at the casting visit before prosthesis fitting (pre-prosthesis) and at 1 month (1 mo), 6 months (6 mo) and 12 months (12 mo) follow-up after prosthesis fitting; (b) 2-minute walk test scores for patients separated by the reason for amputation at pre-prosthesis, 1 mo, 6 mo and 12 mo; (c) Physiologic Cost Index (PCI) at pre-prosthesis, 1 mo, 6 mo and 12 mo and (d) PCI for patients separated by the reason for amputation at pre-prosthesis, 1 mo, 6 mo and 12 mo.