Ennion Liezel, Johannesson Anton
1 Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
2 Ossur, Reykjavik, Iceland.
Prosthet Orthot Int. 2018 Apr;42(2):179-186. doi: 10.1177/0309364617698520. Epub 2017 Mar 20.
There is a known shortage of rehabilitation staff in rural settings and a sharp increase in the number of lower limb amputations being performed. A lack of adequate pre-prosthetic rehabilitation will result in worse physical and psychological outcomes for a person with a lower limb amputation, and they will not be eligible to be fitted with a prosthesis.
To explore therapists' experiences with providing pre-prosthetic rehabilitation in a rural setting.
A qualitative descriptive approach was used to collect and analyse data.
Data were collected from 17 purposively sampled therapists in five district hospitals in a rural community in South Africa. Data were collected in two rounds of focus groups to explore the challenges of providing pre-prosthetic rehabilitation in rural South Africa.
The main themes identified in the study were (1) a lack of government health system support, (2) poor socioeconomic circumstances of patients and (3) cultural factors that influence rehabilitation. These themes all negatively influence the therapists' ability to follow up patients for pre-prosthetic rehabilitation after discharge from hospital. A lack of adequate pre-prosthetic rehabilitation is a substantial barrier to prosthetic fitting in rural South Africa. Patients who do not receive pre-prosthetic rehabilitation have a poorly shaped residuum or other complications such as knee or hip joint contractures which disqualifies them from being referred to prosthetic services.
Therapists involved in this study identified the most important barriers to patients having access to prosthetic services. Clinical relevance Pre-prosthetic rehabilitation provides care of the residuum; maintenance or improvement of physical strength, joint range of motion and referral to a prosthetist. By exploring the challenges known to exist in this service, we can identify potential ways to reduce these barriers and improve the lives of those who use it.
农村地区康复人员短缺，且下肢截肢手术数量急剧增加。缺乏充分的假肢术前康复会导致下肢截肢患者的身体和心理状况更差，且他们将无资格安装假肢。
探讨治疗师在农村地区提供假肢术前康复的经验。
采用定性描述方法收集和分析数据。
从南非一个农村社区的五家地区医院中，有目的地抽取17名治疗师收集数据。通过两轮焦点小组讨论收集数据，以探讨在南非农村地区提供假肢术前康复的挑战。
该研究确定的主要主题为：（1）缺乏政府卫生系统支持；（2）患者社会经济状况不佳；（3）影响康复的文化因素。这些主题均对治疗师在患者出院后进行假肢术前康复随访的能力产生负面影响。缺乏充分的假肢术前康复是南非农村地区安装假肢的重大障碍。未接受假肢术前康复的患者残肢形状不佳或存在其他并发症，如膝关节或髋关节挛缩，这使他们无法被转介至假肢服务机构。
参与本研究的治疗师确定了患者获得假肢服务的最重要障碍。临床意义 假肢术前康复可对残肢进行护理；维持或增强体力、扩大关节活动范围，并转介至假肢矫形师处。通过探讨该服务中已知存在的挑战，我们可以确定减少这些障碍的潜在方法，改善使用该服务者的生活。
