Disability, economic and work-role status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation: a cross-sectional study

Abstract

Background To quantify disability, occupation and socioeconomic status of individuals and their families in Bangladesh, post-unilateral lower-limb amputation (LLA) and pre-rehabilitation. Methods Between November 2017 and February 2018, people with unilateral LLA attending two XXX prosthetic rehabilitation centres were surveyed prior to rehabilitation, using the World Health Organization Disability Assessment Schedule (WHODAS-2.0) with additional socio-economic questions. Data was analysed descriptively, and cross-tabulation conducted with Chi-square test and Fisher’s exact tests. Results Seventy-six individuals participated. The majority had transtibial amputation (61.8%) from trauma (64.5%), were young adults (37.92 ± 12.35 years), in paid work prior to LLA (80%), married (63.2%), male (81.6%), from rural areas (78.9%), with primary/no education (72.4%). After LLA, mobility (WHODAS score 74.61 ± 13.19) was the most negatively affected domain. Most (60.5%) participants did not return to a paid or unpaid occupation. Acute healthcare costs negatively impacted most families (89.5%), and over 80% became impoverished. Nearly 70% of previous income-earners became economically dependent resulting in changes to traditional family roles. Conclusions Following LLA, most participants experienced significant mobility impairment, were unable to return to paid occupation and became economically dependent. The study population presents with many different characteristics from other people with LLA globally, which suggest with timely rehabilitation a return to paid employment is possible. The impact of LLA extends beyond the individual, including to families, many of whom face challenges with changes to traditional primary earner gendered roles. Improved access to timely and affordable rehabilitation is required to reduce the significant personal and societal costs of disability after LLA.

Rehabilitation professionals' perspectives of factors influencing return to occupation for people with lower limb amputation in East, South, and Southeast Asian developing countries: A qualitative study

“…"Occupation" in rehabilitation includes self-care, productivity, and leisure, all important for good health (4). Studies from East, South, and Southeast Asian developing countries (5,6) have identified that LLA usually impacts those in lower socio-economic groups, the young, and primary family earners, who experience difficulty returning to occupation (RTO), resulting in socio-economic stress for whole families (7)(8)(9). Despite the availability of acute care, identified gaps in this region include a lack of continuity of care between acute and rehabilitation services, as well as insufficient services and multidisciplinary professional teams to support RTO and community reintegration (7,10).…”

“…Despite the availability of acute care, identified gaps in this region include a lack of continuity of care between acute and rehabilitation services, as well as insufficient services and multidisciplinary professional teams to support RTO and community reintegration (7,10). In addition to the challenges of accessing rehabilitation for LLA, most services aim to provide only basic mobility outcomes increasing challenges for return to (1,7,8) and retaining work (2). These challenges are increased by the lack of bio-psychosocial approaches to rehabilitation in this region, where disability considerations do not commonly address interactions between the individual, their functionality, and their environment (11).…”