The purpose of this study was to evaluate the impact of a comprehensive prosthetic program aimed at restoring physical and psychosocial function to internally displaced amputees of Sierra Leone, West Africa.
Intervention: Thirty seven amputees fitted with the Socketless Mounting Platform (Innovative Prosthetic Designs, Inc.) below elbow prosthetic were randomly selected from the Amputee Care Center (ACC) rehabilitation program in Freetown, Sierra Leone to participate in the study. The ACC program consisted of technical prosthetic evaluation, physical and occupational therapy, psychosocial counseling and/or pastoral care. All amputees received these services at 3 days, 7 days and 1 month post fitting. Additional care was provided on a random basis over a 6 month period.
Study design: A mixed method qualitative/quantitative evaluation was conducted 6 months post fitting. Specific psychosocial measures included: qualitative group interviews, the Culture Free Self-esteem Index and the Duke Health Profile. A control group of non amputees was utilized for group comparison. Functional assessment included: range of motion (ROM) and manual muscle testing (MMT), functional activity test battery for men (don and doff, banana peel, lift and carry, hammer and chisel) and women (don and doff, orange peel with knife, carry and pour, rice husking, donning head dress).
Results: Group compliance to the ACC program was 80%, 66% and 51% respectively for the 3 day, 7 day and 1 month follow-up. Functional assessment of the amputees demonstrated 100% acceptable ROM and 69% acceptable limits with regard to MMT. All subjects were independent with don and doff with mean times of 25 + 17 seconds and 1:25 + 35 seconds for don and doff respectively. The remainder of the functional test battery was successfully accomplished by 100% of the males and 72% of the females. Limb assessment revealed the following issues: loose screws and bolts (50%), damaged rubber bands (50%), worn edges and surfaces (37%), maladjusted cables and straps (25%) and terminal device problems (25%). Survey data reveals low self esteem with a mean score of 14.3 + 3.5 compared to a score of 23.0 + 6.6 from a healthy reference population. Data from the Duke profile demonstrates minimal anxiety and depression with a mean of 35.4 + 11.2 out of a 100 point scale. There were no significant differences between the amputee and control groups for either survey data. Analysis of group interview data revealed strong themes in the area of limb cosmetics, lessened hostility, hope for a brighter future and a willingness toward reconciliation.
Conclusions: The Limbs of Hope program has provided the amputee with an acceptably functioning prosthetic, improved physical function and a level of psychological function that is similar to other members of Sierra Leone society.
Limitations: Lack of baseline data for pre-post comparison which has partially been corrected by inclusion of a non-amputee control group.