Wellbeing of persons with disabilities using lower limb assistive devices devices in low-income countries

To understand what is required to improve prosthetic and orthotic provision and services for persons with disabilities in low-income countries, it is of interest to investigate their well-being in terms of quality of life, access to mobility, education, health, rehabilitation, work and employment and their experiences of attitudes in the society. Data was collected using WHOQOL questionnaires measuring quality of life from 277 participants in India. In addition to this, individual qualitative interviews were conducted with 16 participants in Nepal and 12 participants in Sierra Leone. Statistical analysis and qualitative content analysis was applied to the data.In India participants with disabilities scored significantly lower than the persons without disabilities in three of the four domains; physical health, psychological and environmental domain. In Sierra Leone and Nepal participants were limited by poverty that affects access to education, employment and health care and wanted increased independence. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. In Sierra Leone, traditional beliefs have a negative impact on people with physical disabilities and are a cause for discrimination. In Nepal participants stressed that access to education and vocational training had the potential to improve their living situation

Living as a person using a lower-limb prosthesis in Nepal

Purpose: The purpose of this study is to explore experiences of persons in Nepal using lower-limb prostheses, in relation to specific articles in the Convention on the Rights of Persons with Disabilities that consider mobility, education, health, rehabilitation, and work and employment. Method: Qualitative interviews were conducted with 16 persons using lower limb prostheses. Content analysis was applied to the data. Results: Six themes emerged: The lower-limb prosthesis is essential for mobility and daily life; Limited mobility in challenging terrain and request for reduced pain when using prosthesis; Difficulties in finding and sustaining employment emphasized the importance of vocational training; Appreciation of comprehensive rehabilitation together with other persons with amputations, but covering related costs is a struggle; Satisfied with health care, but concerned that it creates debt and dependence upon others; and finally, Limited ability creates negative self-image and varied attitudes in other people. Conclusion: Persons with lower-limb amputations were restricted by poverty and wanted increased independence. Rehabilitation and prosthetic services in Nepal need to increase proportionally as they contribute to enabling those persons to a better daily life. Prostheses were essential but more advanced technology was requested. Access to education and vocational training has the potential to improve the socio-economic status of those with lower-limb amputations due lack of employment not requiring physical effort. Implications for rehabilitationTo increase access for persons with lower-limb amputations in Nepal to rehabilitation services, these services need to increase proportionally, and the policy for financial compensation to enable those persons to afford transportation to the rehabilitation center should be implemented.The design and manufacture of the low-cost polypropylene technology for prostheses used in Nepal needs to be improved, directed towards increasing the ability to ambulate on uneven surfaces and hilly terrain, and the ability to walk long distances.Adjustments of employment for persons with physical disabilities in Nepal have the potential to strengthen their socio-economic status.Vocational training programs and educational opportunities for persons with physical disabilities have the potential to improve income-generating employment and need to increase proportionally in Nepal.The policies developed in accordance with the Convention on the Rights of Persons with Disabilities need to be further implemented to decrease existing barriers to access to general health care and rehabilitation and prosthetic services for persons with disabilities in Nepal