Physical and Cardiorespiratory Functioning of Patients with Unilateral Lower Limb Amputation in Sri Lanka

Abstract

::Background: Government and non-governmental hospitals and organizations are distributing massive rehabilitation programs all over the Sri Lanka to rehabilitate the people with amputation. Nevertheless, there is no proper pathway to measure the effectiveness of those programs in terms of participation in daily life after rehabilitation. Therefore this study was conducted to find out functional outcomes of patients with unilateral lower limb amputation who engaged in rehabilitation and to explore impact of socio-demographics, amputation status, medical, and rehabilitation guidance on functional outcomes. Methods: 48 unilateral lower limb amputees participated and were measured for functional outcomes using Locomotor Capabilities Index (LCI), Amputee Mobility Predictor with Prosthesis (AMPPRO), Six Minute Walk Test, VO2max and Spirometry. Self-constructed questionnaire and qualitative interview was carried out to determine the socio-demographics, amputation status, medical, and rehabilitation process. Results: Around 65% belongs to K3 and K4 level in AMPPRO classification and 96% of individuals have ability to perform basic daily activities without assistive devices, this reduced to 83% when engaged in advanced activities based on LCI. We found that 31% have a restrictive pattern of respiratory functions based on spirometry test, and 48% showed an unsatisfactory level of cardiovascular endurance based on VO2max. The level of amputation, years since amputation, time gap between amputation and admission for rehabilitation, prostheis usage and prosthetic usage satisfaction, and mobility hours per day significantly impact (p<0.005 at 95% CI) on physical functioning. 6MWD scores significantly change (p<0.005 at 95% CI) in respect to AMPPRO K level, gender, age and level of amputation. Individuals with K4 level have significantly higher 6MWD and VO2max values. From qualitative analysis appeared that government hospitals mainly focus on basic care after the amputation surgery but not on further advices or rehabilitation guidance. Rehabilitation services mainly focus on basic independence in daily life and basic walking training but not on long term survival, distance walking and cardiorespiratory endurance. Hence, this study recommending to arrange awareness programs to raise the awareness of the society about rehabilitation services and to medical and rehabilitation professionals in Sri Lanka to arrange their post-surgical and rehabilitation programs in an effective way, and government and responsible authorities to take further steps to fill-up gaps in rehabilitation services. Key words: Unilateral lower limb amputation, Rehabilitation, Physical functioning, cardiorespiratory functions, basic care and rehabilitation guidance