Ramstrand Nerrolyn, Maddock Alan, Heang Thearith, Ean Nil, Kheng Sisary
Department of Rehabilitation, Jönköping University, Jönköping, Sweden
Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
BMJ Open. 2025 Jul 25;15(7):e101187. doi: 10.1136/bmjopen-2025-101187.
The majority of people globally who have undergone limb amputations are living in low- and middle-income countries. For those with lower-limb amputations, ambulatory mobility with a prosthesis is considered a key factor for achieving independent living; however, little is known of determinants of mobility for prosthesis users in low- to middle-income countries. In this study, we sought to assess levels of self-reported mobility in Cambodian prosthesis users and to identify determinants associated with their ambulant mobility.
Cross-sectional survey.
Three secondary care centres located in urban and rural Cambodia.
Adults receiving prosthetic services for a major lower-limb amputation.
The Khmer version of the LCI-5 and the mobility dimension of the EuroQol five-dimensional five levels (EQ-5D-5L) were used as dependent variables, while personal, physical, psychological and social determinants served as independent variables. Associations were assessed using hierarchical and ordinal regression analyses.
347 participants completed the survey. Determinants that were negatively associated with mobility outcomes were as follows: being female, having an amputation due to dysvascular complications, using an above-knee prosthesis and reporting higher levels of psychological distress. Social determinants did not appear to have any major association with mobility outcomes.
Findings highlight the multidimensional nature of mobility and suggest that future interventions may benefit from targeting female prosthesis users and those with diabetes or vascular disease. Mental health interventions addressing symptoms of anxiety and depression may also contribute to improved mobility outcomes. Social determinants explored in the study were not associated with significant changes in mobility scores. This may be due to high overall levels of mobility, a relatively homogenous group or failure to identify context-specific variables that impact on mobility outcomes.
全球大多数接受肢体截肢的人生活在低收入和中等收入国家。对于下肢截肢者来说，使用假肢行走的能力被认为是实现独立生活的关键因素；然而，对于低收入和中等收入国家假肢使用者行走能力的决定因素知之甚少。在本研究中，我们旨在评估柬埔寨假肢使用者自我报告的行走能力水平，并确定与其行走能力相关的决定因素。
横断面调查。
柬埔寨城乡的三个二级医疗中心。
因主要下肢截肢而接受假肢服务的成年人。
高棉语版的LCI-5和欧洲五维健康量表（EQ-5D-5L）的行走维度用作因变量，而个人、身体、心理和社会决定因素用作自变量。使用分层和有序回归分析评估相关性。
347名参与者完成了调查。与行走能力结果呈负相关的决定因素如下：女性、因血管并发症而截肢、使用膝上假肢以及报告较高水平的心理困扰。社会决定因素似乎与行走能力结果没有任何重大关联。
研究结果突出了行走能力的多维度性质，并表明未来的干预措施可能会从针对女性假肢使用者以及患有糖尿病或血管疾病的人群中受益。针对焦虑和抑郁症状的心理健康干预措施也可能有助于改善行走能力结果。本研究中探讨的社会决定因素与行走能力得分的显著变化无关。这可能是由于总体行走能力水平较高、群体相对同质化，或者未能识别影响行走能力结果的特定背景变量。
