In recent research (pdf attached is below) we found that patients with a low educational level became adapted to the prosthesis less frequently.
This was a cross-sectional study. The patients were identified by primary healthcare teams.
The inclusion criterion was that these should be patients who underwent major lower-limb amputations of any etiology. Associations between sociodemographic and clinical variables and the adaptation to lower-limb prostheses were assessed.
We examined 149 patients. Adaptation to the prosthesis occurred in 40% (60/149) of them, but only 62% (37/60) of these were using it.
Adaptation occurred more often among male patients (P = 0.017) and among those who had a higher educational level (P = 0.013), with a longer time since amputation (P = 0.049) and when the etiology was trauma (P = 0.003).
The result from logistic regression analysis showed that only patients with low education (P = 0.031) were significantly associated with a lower frequency of adaptation to prostheses.
What's your opinion and experience about this?
At this paper (pdf attached below ) we concluded the prevalence of lower limb prostheses fit was 38%.
And patients with a low level of education were the least frequently prosthesis fit.
Do you heve any experience with lower limb prostesis fit?
What is your opinion about this?
Marco,
If you look at the data, you will also find that the trauma category had a higher variance than education. Trauma amputees use their prostheses 61% compared to 39% not using them. Non-Traumatic amputees use their prostheses 33% compared to 67% not using their prostheses.
You must not look at the amputation as the variable. The traumatic amputee can be any type of person. The non-traumatic amputee fits a particular profile.
Non-traumatic amputees will typically be dysvascular patients who are also non-compliant. They are also accompanied many times by vascular dementia, which is the second leading cause of dementia.
Additionally, the study did not discriminate between transfemoral amputations and transtibial amputations. Transfemoral amputees have 400% greater increase in disability compared to transtibial.
Why do they reject sockets?
Should they be able to stand on the bone? I believe so... we have hip implants that provide this for people... None for amputees.
Should we leave the medullary canal open, putting bone marrow and fat cells into the body, resulting in Fat Embolism Syndrome? We are concerned about Fat Embolism Syndrome for people... They have never been concerned about this for amputees.
Is the IT band important to walking? Gottschalk determined that it is the most important hip abductor for able bodied people in 1989. In 1994, he sutures it to the other side of the limb for amputees when he designed transfemoral amputation surgery. Ryser 1988 proves that 100% of healthy TF amputees are 30% weaker on the affected side.
And now, Marco, I ask you... Where do you believe the problems begin with prosthetic sockets? Perhaps the answer is that it begins with the surgery and that we have a tremendous opportunity to start correcting these problems at the point of surgery as well.
Dysvascular amputees struggle to understand how to use the prosthetic leg. Imagine how much more difficult it is when they have to overcome additional challenges that were not addressed by the surgeon.
I think patient's education is essential to understand and follow medical staff orders. That is important for adaptation and successful use of prosthesis.
Hi Thomas James Cutler.
You are right in all the points you brought up for discussion. Indeed the group of amputees is very heterogeneous.
And in answering your question I think surgery is absolutely fundamental to the rehabilitation process.
But there is something that I have observed and it has not entered this research properly. Perhaps one of the problems of prosthesis adjustment is in care immediately after surgery. This is a hypothesis that we are concerned to verify in new research, but it seems that the health team does not always worry about the care of the amputated stump and often do not refer the patient properly to the rehabilitation team.
I believe that the planning of public policies and the readjustment of care protocols can correct this situation.
But beyond all that you said I believe there is a problem that in the care team work processes that needs to be corrected and that may be contributing to this low frequency of prosthetic adjustments.
What you think about this?
Hi Salameh Aldajah
I agree with you and appreciate your comment.
There is another hypothesis that needs to be evaluated that is the fact that the country in which I live today is extremely unequal.
Since the degree of education may be related to economic and social inequalities, I believe that this aspect deserves to be better measured as well.
What do you think?
Marco Antonio Prado Nunes , yes, you are correct.
Much of this pertains to assumptions, and when we become aware of these assumptions, we find that the answers are often quite simple.
1. The vehicle for venous return is absent for amputees. This means that with a) gravity, b)cardiac effort, and c) arterial effort, we have 3 factors actively biased towards the periphery. That is, 3 things pushing blood and fluid to the incision site. But where is the concern post-amputation to venous return? Does this not contribute to pain levels with the excessive edema immediately after amputation?
The medical staff, accustomed to the other 97% of situations where the mechanism for venous return is intact, fail to realize that they are working from different assumptions after amputation.
2. According to Jaegers 1995, there is a 40-60% sarcopenia (atrophy) that occurs naturally in the limb with resected muscles. This means that without skeletal support, the residual limb is destined to "bottom out". Volume fluctuations can occur in a matter of minutes initially.
3. There is a failure to appreciate the force coupling that occurs between the limb and the socket. Many understand how to navigate a car in reverse, but everything changes when you are navigating in reverse with a car and a trailer. The same thing applies to the difference between a leg (car) and a limb/socket (car/trailer). This oversight also applies to shortcomings in understanding implant failure in hip replacements.
Consider also that the amputation is perceived as a failure overall, thus we tend to avoid engaging. This is why you have this opportunity for discovery. By properly engaging early, we reduce residual limb pain by 50% (from my experience), and I wonder about the reduction in neurological response to proper and timely care (reducing neuromas and reducing phantom limb pain by reducing pathological neurological signaling post-op).
Does that provide insight?
Best,
Tom
As amputations results in a variety of limitations that have emotional consequences for patients, we evaluated non-psychotic disorders and their associated factors in a sample of people with lower limb amputations.
We detected a prevalence of 43% of mental disorders assessed with the SRQ-20 questionnaire.
Patients with associated chronic diseases and lack of independence remained significant showed a higher positivity in relation to psychological morbidity.
Reference
https://pubmed.ncbi.nlm.nih.gov/22362046-common-mental-disorders-in-patients-undergoing-lower-limb-amputation-a-population-based-sample/
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