Functional Outcome Following Lower Extremity Amputation: A Review of Contextual Factors Influencing Function in Low- to Middle-Income Group Countries
Lower extremity amputation (LEA) leads to reduced mobility and walking capacity. Contextual factors influencing activities of daily living and community participation in people with LEA vary in low-, middle-, and high-income countries. In the present study, we aimed to review contextual factors influencing function of people with LEA in low- to middleincome countries. A literature search for articles published between January 2000 and 2018 was carried out using PubMed, Google Scholar, and Cochrane reviews databases. In total, 27 relevant articles were identified and reviewed: 8 qualitative studies, 4 manuals and factsheets, 10 descriptive cross-sectional studies, 2 comparative studies and 1 survey.
Several external contextual factors were strongly linked with poor functional outcome, dissatisfaction, and participation restriction: lack of awareness and inadequate rehabilitation and prosthetic services; lack of social security systems; health insurance; poor quality and durability and high cost of prostheses; poor transport facilities; and level of education in low- to middle-income countries. Low income, inaccessible environment, and social stigma associated with amputation reduced functional outcome and community participation. Internal factors like poor coping strategies, negative self-esteem, old-age, female gender, and negative body image were linked with poor functional outcome, whereas strong family support improved participation of people with LEA.
Our review highlights a strong need to build greater awareness on rehabilitation measures following amputation and need for disability inclusive environment to promote community participation in low- to middle-income countries.