SURİYELİ MÜLTECİ ALT EKSTREMİTE AMPUTELERİNDE PROTEZE BAĞLI YAŞAM KALİTESİNİN ARAŞTIRILMASI

Öz

Amaç: Protez kullanımı ve bireyin protez algısı yaşam kalitesi ile yakından ilişkilidir. Bu çalışmanın amacı, Suriyeli mülteci alt ekstremite amputelerinde proteze bağlı yaşam kalitesini araştırmaktı. Yöntem: Çalışma, Uluslararası Doktorlar Derneği tarafından yönetilen üç farklı protez-ortez merkezinde yapıldı. Tek taraf alt ekstremite amputasyonu (transtibial ve transfemoral/diz dezartikülasyonu) geçirmiş 76 erkek (yaş=37,76±12,83 yıl) ve 12 kadın (yaş=37,16±16,07 yıl) Suriyeli mülteci ampute dahil edildi. Demografik veriler, amputasyon ve protez ile ilgili özellikler kaydedildi. Proteze bağlı yaşam kalitesini değerlendirmek için Protez Değerlendirme Anketi (PDA) kullanıldı. Sonuçlar: Transtibial ve transfemoral/diz dezartikülasyonu olan amputelerin tüm PDA puanları benzer bulundu (p>0,05). Bekar olan bireylerin PDA-Görünüş puanının evlilere göre anlamlı derecede düşük olduğu gözlendi (p=0,013). Bir yıldan uzun süredir protez kullananlarda PDAAmbulasyon puanının anlamlı derecede yüksek olduğu bulundu (p=0,038). Bir yıldan kısa süredir protez kullananların ise, PDA-Ses puanı anlamlı derecede yüksekti (p=0,048). PDA-Ses puanı kronik hastalık nedenli amputasyonlarda, kaza ve savaş nedenli amputasyonlara göre anlamlı olarak daha yüksekti (p=0,020). Tartışma: Mülteci amputelerin, protezleri ve yaşam kalitesi ile ilgili algılarının, amputasyon seviyesinden bağımsız olarak, birbirine benzediği bulundu. Protez kullanım süresinin artışı ile beklentilerde değişim görülmekte ve bekar bireylerde görsellik beklentisi ön plana çıkmaktadır.

Anahtar Kelimeler

• Ampute
• PEQ
• Protez
• Suriye Sivil Savaşı

AN INVESTIGATION OF QUALITY OF LIFE RELATED TO PROSTHESIS IN SYRIAN REFUGEE LOWER EXTREMITY AMPUTEES

Abstract

Purpose: The use of prosthesis and an individual's perception of the prosthesis are associated with the quality of life. The study aimed to evaluate the quality of life related to prosthesis in Syrian refugees with lower extremity amputees. Methods: The study was conducted at three different prosthetic-orthotic centers managed by the Alliance of International Doctors. Seventy-six male (age=37.76±12.83 years) and 12 females (age=37.16±16.07 years) Syrian refugees with unilateral lower extremity (transtibial and transfemoral/knee disarticulation) amputation were evaluated. Demographic and amputation and prostheses-related characteristics were recorded. Quality of life related to the prosthesis was evaluated using the Prosthetic Evaluation Questionnaire (PEQ). Results: All PEQ scores of the transtibial and transfemoral/knee disarticulation amputees were similar (p>0.05). The PEQ-Appearance score of the single amputees was observed to be significantly lower than the married amputees (p=0.013). The PEQ-Ambulation score of participants using prosthesis over one year was significantly higher (p=0.038). The PEQ-Sound score of participants using prosthesis less than one year was found significantly higher (p=0.048). The PEQ-sound scores of chronic disease group were significantly higher than those of accident and war associated amputees (p=0.020). Conclusion: Quality of life of the refugee amputees regarding prosthesis and living with a prosthesis were similar regardless of the level of amputation. Expectations change with the increase in the duration of prosthesis use, and in single amputees, the expectation of cosmetic appearance becomes a concern.

Keywords

• Amputee
• PEQ
• Prosthesis
• Syrian Civil War

References

1. 1. World Health Organization (WHO). WHOQOL: Measuring Quality of Life. 1997.
2. 2. Sinha R, Heuvel W, Arokiasamy P. Factors affecting quality of life in lower limb amputees. Prosthet Orthot Int. 2011;35(1):90–6.
3. 3. Williamson G, Schulz R, Bridges M, Behan A. Social and psychological factors in adjustment to limb amputation. J Soc Behav Pers. 1994;9(5):249–68.
4. 4. Kaluf B. Evaluation of mobility in persons with limb loss using the amputee mobility predictor and PEQ-Mobility Subscale: A six-month retrospective chart review. J Prosthetics Orthot. 2014;26(2):70–6.
5. 5. Legro MW, Reiber GD, Smith D, Aguila M, Larsen J, Boone D. Prosthesis evaluation questionnaire for persons with lower limb amputations: Assessing prosthesis-related quality of lifes. Arch Phys Med Rehabil. 1998;79(5):931–8.
6. 6. Asano M, Rushton P, Miller W, Deathe B. Predictors of quality of life among individuals who have a lower limb amputation. Prosthet Orthot Int. 2008;32(2):231–43.
7. 7. Saradjian A, Thompson A, Datta D. The experience of men using an upper limb prosthesis following amputation : Positive coping and minimizing feeling different. Disabil Rehabil. 2008;30(11):871–83.
8. 8. Hamidreza T, Moharamzad Y, Mafi A, Amini A, Naghizadeh M, Soroush M, et al. Quality of life among veterans with war-related unilateral lower extremity amputation: A long-term survey in a prosthesis center in Iran. J Orthop Trauma [Internet]. 2009;23(7):525–30.

9. 9. Inclusion H. Syria, a mutilated future: A focus on the persons injured by explosive weapons. 2016.
10. 10. Christensen J, Ipsen T, Doherty P, Langberg H. Physical and social factors determining quality of life for veterans with lower-limb amputation(s): a systematic review. Disabil Rehabil. 2016;38(24):2345–53.
11. 11. Condie E, Scott H, Treweek S. Lower Limb Prosthetic Outcome Measures: A Review of the Literature 1995 to 2005. J Prosthetics Orthot. 2006;18(6):13–45.
12. 12. Franchignoni F, Giordano A, Ferriero G, Orlandini D, Amoresano A, Perucca L. Measuring mobility in people with lower limb amputation: Rasch analysis of the mobility section of the prosthesis evaluation questionnaire. J Rehabil Med. 2007;39(2):138–44.
13. 13. Pinzur M, Pinto M, Saltzman M, Batista F, Gottschalk F, Juknelis D. Health-Related Quality of Life in Patients with Transtibial Amputation and Reconstruction with Bone Bridging of the Distal Tibia and Fibula. Foot Ankle Int. 2006;27(11):907–12.
14. 14. Day S, Buis A. Cross cultural equivalence testing of the Prosthetic Evaluation Questionnaire (PEQ) for an Arabic speaking population. Prosthet Orthot Int. 2012;36(2):173–80.
15. 15. Prosthetics ResearchStudy. Guide for the Use of the Prosthesis Evaluation Questionnaire. 1998
16. 16. Hafner BJ, Willingham LL, Buell NC, Allyn KJ, Smith DG. Evaluation of function, performance, and preference as transfemoral amputees transition from mechanical to microprocessor control of the prosthetic knee. Arch Phys Med Rehabil. 2007;88(2):207–17.
17. 17. Horne C, Neil J. Quality of life in patients with prosthetic legs: A comparison study. J Prosthetics Orthot. 2009;21(3):154–9.
18. 18. Kahle J, Highsmith M. Transfemoral interfaces with vacuum assisted suspension comparison of gait, balance, and subjective analysis: Ischial containment versus brimless. Gait Posture. 2014;40(2):315–20.
19. 19. Kahle J, Highsmith M, Hubbard S. Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference. J Rehabil Res Dev. 2008;45(1):1–14.
20. 20. Sedki I, Moore R. Patient evaluation of the echelon foot using the seattle Prosthesis Evaluation Questionnaire. Prosthet Orthot Int. 2012;37(3):250–4.
21. 21. Arwert H, Doorn-Loogman M, Koning J, Terburg M, Rol M, Roebroeck M. Residual-limb quality and functional mobility 1 year after transtibial amputation caused by vascular insufficiency. J Rehabil Res Dev. 2007;44(5):717–22.
22. 22. Miller W, Deathe A, Speechley M, Koval J. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation. Arch Phys Med Rehabil. 2001;82(9):1238–44.
23. 23. Hafner B, Gaunaurd I, Morgan S, Amtmann D, Salem R, Gailey R. Construct validity of the Prosthetic Limb Users Survey of Mobility (PLUS-M) in adults with lower limb amputation. Arch Phys Med Rehabil. 2017;98(2):277–85.
24. 24. Tatar Y. Body image and its relationship with exercise and sports in Turkish lower-limb amputees who use prosthesis. Sci Sport [Internet]. 2010;25(6):312–7.
25. 25. Murray C, Fox J. Body image and prosthesis satisfaction in the lower limb amputee. Disabil Rehabil. 2002;24(17):925–31.
26. 26. Singh R, Hunter J, Philip A, Tyson S. Gender differences in amputation outcome. Disabil Rehabil. 2008;30(2):122–5.
27. 27. Dillingham T, Pezzin L, Mackenzie E, Burgess A. Use and satisfaction with prosthetic devices among persons with trauma-related amputations. A long-term outcome study. Am J Phys Med Rehabil. 2001;80(8):563–71.
28. 28. Sanders J, Harrison D, Allyn K, Myers T. Clinical utility of in-socket residual limb volume change measurement: Case study results. Prosthet Orthot Int. 2009;33(4):378–90.
29. 29. Zachariah S, Saxena R, Fergason J, Sanders J. Shape and volume change in the transtibial residuum over the short term: Preliminary investigation of six subjects. J Rehabil Res Dev. 2004;41(5):683–94.
30. 30. Norvell D, Turner A, Williams R, Hakimi K, Czerniecki J. Defining successful mobility after lower extremity amputation for complications of peripheral vascular disease and diabetes. J Vasc Surg. 2011;54(2):412–9.
31. 31. Hafner B, Amtmann D, Morgan S, Kajlich A, Salem R. Normative PEQ-MS and ABC scores with lower limb loss. American Academy of Orthotists & Prosthetists 39th Academy Annual Meeting and Scientific Symposium, February 20-23
32. 32. Webster J, Hakimi K, Williams R, Turner A, Norvell D, Czerniecki J. Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study. J Rehabil Res Dev. 2012;49(10):1493–504.