The biopsychosocial effects of a prosthesis and the roles of prosthetists in improving the quality of life of transtibial amputees

Abstract

Background: A myriad of physical, psychosocial, and environmental sequelae is associated with the loss of a limb. The prosthesis plays a significant role in restoring the individual’s prior level of mobility and functional independence whilst the prosthetist is well-positioned to provide support and improve the amputee’s physical health and psychosocial well-being. There is a paucity of South African data focusing on these aspects relating to the quality of life with a prosthesis and the contribution of prosthetists. This study sought to bridge these gaps. Aim: This study thus aimed to explore the biopsychosocial effects of a prosthesis and the roles of prosthetists in improving the quality of life of transtibial amputees. Methodology: A qualitative inquiry guided this study. Data were collected using one on-one in-depth interviews with 14 unilateral transtibial amputees (sample 1) and a focus group discussion with 16 medical prosthetists (sample 2). Participants were recruited from a medical facility under the KwaZulu-Natal Department of Health. Data were thematically analysed. Findings: Six broad themes and 18 sub-themes emerged from the data. Findings indicated that amputee participants encountered an array of biopsychosocial obstacles ranging from phantom limb pain and guilt to body image anxiety and fear of the future. Resilience, optimism, and strong support networks were facilitators of the adjustment process. Spirituality characterised by praying, reading the holy book, and receiving support from religious organisations were identified as key coping mechanisms by several amputees. Regaining mobility and functional independence were reported as factors that motivated amputees to obtain a prosthesis. The use of the prosthesis improved functional independence, decreased energy expenditure during ambulation, reduced anxiety associated with body image, and enhanced performance of daily activities. The data highlighted that uneven terrains, financial constraints, and high travel costs are potential environmental barriers. Findings indicated that the prosthetist participants encouraged amputees to exercise to improve their physical health, however they lacked sufficient expertise to improve the amputees’ psychosocial well being. Moreover, the prosthetist participants reported that factors such as language iii barriers, rotational systems, confined consultation spaces, and unrealistic expectations impeded the efficacy of their services. Conclusion: The findings suggest that the prosthesis ameliorates several negative physical and psychosocial effects of the amputation. The data emphasizes the areas that require attention regarding the components of a transtibial prosthesis, and interdisciplinary relationships. It is recommended that prosthetists should acquire professional psychology expertise, which will enable them to provide psychosocial support, thereby improving the patient’s psychological health. The salience of spirituality and support networks was also brought to the fore. Furthermore, integrating spiritual care in prosthetic services is highly recommended as it has potential to facilitate adjustment to the amputation.