The epidemiology and functional outcomes after a major lower limb amputation (LLA) in Johannesburg

This thesis is being submitted in fulfilment of the requirements for the degree of Doctor of Philosophy at the University of the Witwatersrand, Johannesburg.Background: The incidence and prevalence of disease related lower limb amputation (LLA) operation at the Johannesburg metropolitan hospitals is unknown. Lower limb amputation (LLA) results in a marked decline in functional independence. In Johannesburg South Africa, the LLA population is generally underprivileged, and Chris Hani Baragwanath Hospital and Charlotte Maxeke Johannesburg Academic hospital are not in a position to offer long-term rehabilitation to them on an inpatient basis. Patients often get discharged early as these tertiary hospitals have a high turnover and the demand for hospital beds is high. Aims: To establish the cumulative incidence and prevalence of disease related LLA at Johannesburg Metropolitan Hospitals. To establish whether a self-administered postoperative exercise programme (home programme) will improve function and other selected outcomes. Measures were taken at three months and six months after the LLA. Methods: A population sample of all theatre register records was used to review theatre registers for the epidemiological study. All records of general surgery and vascular operations were reviewed to count the number of LLA operations performed over a two year period from June 2011-June 2013. A randomised controlled trial (RCT) (n=154, n=77 per group) was conducted on participants who met the inclusion criteria. Allocation into groups was concealed and the assessor was blinded. The Barthel index to measure function (BI), Modified Amputee Body Image Scale (MABIS), Participation Scale (P-Scale), Euroqol EQ-5D quality of life (EQ-5D), Modified Locomotor Capabilities Index (MLCI) and the Timed Up and Go test (TUG) were used to gather data from the participants. The control group received the standard rehabilitation from Chris Hani Baragwanath or Charlotte Maxeke Johannesburg Academic hospitals and the intervention group received an additional exercise programme and an exercise diary (ED) to keep a record of compliance. The intervention was a home exercise programme which was administered from discharge until three month post amputation. A research assistant (a physiotherapist) administered the intervention and did weekly reminding of the participants about the exercises and the researcher did all the testing (interviews and physical tests). Data were analyzed using IBM SPSS version 22. Descriptive and ratio analysis was used for the prevalence study. All continuous data are presented as means, standard deviations and medians and percentiles. The two groups were compared using Fisher’s exact test for categorical data and the Mann Whitney U-test for continuous data. Bonferroni correction method was used when testing the tools item by item. Survival was established using the Kaplan-Meier test and the Log Rank (Mantel-Cox) test for comparison. Generalised Linear models (GLM) Generalised Estimating Equations (GEE), Repeated Measures Analysis of Covariance (RM-ANCOVA and Analysis of Variance (ANOVA) were used to exclude confounders. A multiple linear regression was used to establish associations between baseline characteristics and functional outcomes. An intention to treat analysis was used. Results: A total population of N=23617 people underwent general and vascular surgical procedures at the Johannesburg Metropolitan Hospitals during the study period. The majority of the amputations were BKA followed by AKA. The total number of amputations performed was 879. The cumulative prevalence of LLA operations is 0.037 (95% CI) (or 3722.0 per 100 000 persons seen at the Johannesburg Metropolitan hospitals).Total amputation number of new LLA performed was 743. The cumulative incidence of LLA is 0.031(95% CI) (or 3146 per 100 000 persons -2-years of study). The cumulative incidence of LLA in males is 0.038(95% CI) (or 3849.14 per 100 000 persons -2-years of study). The cumulative incidence of LLA in females is 0.023(95% CI) (or 2300 per 100 000 persons -2-years of study). In the RCT, the median age was 58 per group (p=0.505), the control group had 66.2% males and the intervention group had 63.6% males (p=0.433). There were no significant (p˃0.05) differences in demographic characteristics between the two groups at baseline but the intervention group had a significantly (p=0.005) more participants with a BKA than the control group. The groups were comparable at baseline on all the outcome measures except participation with the intervention group demonstrating significantly more participation restriction (P-Scale) (p=0.038) (25th percentile 0;0, median 0;0, 75th percentile 0;5 for group 1 and 2 respectively). However, the intervetion group demonstrated significantly less (p=0.004) participation restriction at three months postoperatively compared to the control group (25th percentile 10;6, median 28;18, 75th percentile 41;27 for group 1 and 2 respectively). The intervention group demonstrated significantly lower (p=0.039) activity limitation levels (BI) at three months postoperatively compared to the control group (25th percentile 16;18, median 18;18, 75th percentile 19;20 for the control group and the intervention group respectively) and significantly lower (p=0.005) activity limitation levels (MLCI) (25th percentile 13;20, median 21;24, 75th percentile 30;38 for the control and the intervention group respectively) at three months postoperatively compared to control group. The intervention group demonstrated significantly lower (p=0.040) activity limitation levels at three months postoperatively compared to control group in the MLCI Basic Subscale score(25th percentile 7;9, median 9;11, 75th percentile 17;21 for the control and the intervention group respectively). Group 2 demonstrated significantly lower (p=0.001) activity limitation levels at three months postoperatively compared to the control group in the MLCI Advanced score (25th percentile 6;10, median 11;15, 75th percentile 14;19 for the control and the intervention group respectively). Body image perception (MABIS) showed no significant (p=0.201) difference between the groups (25th percentile 20;25, median 28;35, 75th percentile 40;43 for the control and the intervention group respectively) at three months. The intervention group demonstrated a significantly (p=0.001) better QOL VAS (25th percentile 30;50, median 60;80, 75th percentile 80;80 for the control and the intervention group respectively) and a significant (p=0.033) index scores(25th percentile 0.264;0.689, median 0.725;0.796, 75th percentile 0.796;0.796 for the control and the intervention group respectively) of QOL at three months postoperatively compared to control group. The intervention group demonstrated significantly less risk of falling (better ability to balance) (TUG) at three months(25th percentile 25;19, median 34;24, 75th percentile 45;36 for the control and the intervention group respectively) (p=0.036) and six months (25th percentile 19;13, median 25.5;21, 75th percentile 36;32 for the control and the intervention group respectively) (p=0.046) postoperatively compared to the control group. Only balance remained different at six months, the other outcomes were similar between the groups. Being in the intervention group was associated with higher functional outcomes (activity levels, higher participatation levels, higher QOL and lower risk of falling) postoperatively. Being old was associated with lower functional outcomes (lower activity levels and high risk of falling) postoperatively. Being female was associated with lower functional outcomes (lower activity levels), absence of diabetes was associated with high QOL and absence of other comorbidities was associated with lower risk of falling. Thirty-three participants died during the study period. There were significantly more smokers (p=0.016) and drinkers (p=0.022) among the group that died compared to the survivors. In the regression analysis, death was predicted by cigarette smoking, alcohol drinking and reduced preoperative participation. Conclusion: The intervention ensured early functional independence of the intervention group compared to the control group. This study suggests that the intervention could be adopted as standard care for lower limb amputation patients especially those from situations with limited resources as they tend to be discharged early from the hospitals in order to accommodate other admissions

The impact of lower limb amputation on quality of life: a study done in the Johannesburg Metropolitan area, South Africa

Thesis (M.Sc.(Physiotherapy)), Faculty of Health Sciences, University of the Witwatersrand, 2009Background: The impact of non-traumatic lower limb amputation on participant’s quality of life (QOL) is unknown. In an effort to provide better care for people with lower limb amputation, there is a need to first know the impact of this body changing operation on people’s quality of life. Aim of the study: To determine the impact of lower limb amputation on QOL in people in the Johannesburg metropolitan area during their reintegration to their society/community of origin. Objectives: 1. To establish the pre-operative and post-operative: QOL of participants (including the feelings, experiences and impact of lower limb amputation during the time when they have returned home and to the community). The functional status of participants. Household economic and social status of these participants. 2. To establish factors influencing QOL. Methods: A longitudinal pre (amputation) test –post (amputation) test study utilized a combination of interviews to collect quantitative data and in-depth semistructured interviews to gather qualitative data. Consecutive sampling was used to draw participants (n=73) for the interviews at the study sites pre-operatively. The three study sites were Chris Hani Baragwanath Hospital, Charlotte Maxeke Johannesburg General Hospital and Helen Joseph Hospital. Participants were then followed up three months later for post-operative interviews and key informants were selected for in-depth interviews (n=12). Inclusion criteria: Participants were included if they were scheduled for first time unilateral (or bilateral amputation done at the same time) lower limb amputation. The participants were between the ages of 36-71 years. Exclusion criteria: Participants who had an amputation as a result of traumatic or congenital birth defects were excluded from the study. Participants with comorbidities that interfered with function pre-operatively were not included. Procedures: Ethics: Ethical clearance was obtained from the Committee for Research on Human Subjects at the University of the Witwatersrand and permission was obtained from the above hospitals. Participants gave consent before taking part in the study. Instrumentation: A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI), the Barthel Index (BI) and semi-structured in-depth interviews were used. Data collection: Participants were approached before the operation for their preoperative interviews using the above questionnaires and then followed up postoperatively using the same questionnaires and some were selected to participate in semi-structured in-depth interviews three months later. Pilot study: The demographics questionnaire and the modified HESSI were piloted to ensure validity and reliability. iii Data analysis: Data were analyzed using the SPSS Version 17.0 and STATA 10.0. The significance of the study was set at p=0.05. All continuous data are presented as means, medians, standard deviations and confidence intervals (CI 95%). Categorical data are presented as frequencies. Pre and post operative differences were analyzed using Wilcoxon Signed-rank test. A median regression analysis (both the univariate and multivariate regression) was done to establish factors influencing QOL. Pre and post operative differences in the EQ-5D items and the BI items were analyzed using Chi square/Fischer’s exact depending on the data. Data were pooled for presentation as statistical figures in tables. Both an intension to treat analysis and per protocol analysis were used. A grounded theory approach was used to analyze the concepts, categories and themes that emerged in the qualitative data. Results: Twenty-four participants (33%) had died by the time of follow up. At three months, n=9 (12%) had been lost to follow up and 40(55%) was successfully followed up. The preoperative median VAS was 60 (n=40). The postoperative median VAS was 70. The EQ-5D items on mobility and usual activities were reported as having deteriorated significantly postoperatively (p=0.04, p=0.001respectively) while pain/discomfort had improved (p=0.003). There was no improvement in QOL median VAS from the preoperative status to three months postoperatively The preoperative median total BI score was (n=40). The postoperative median total BI score was 19. There was a reduction in function (median BI) from the preoperative status to three months postoperatively (p<0.001). The ability to transfer was improved three months postoperatively (p=0.04). Participants were also found to have a decreased ability to negotiate stairs (p<0.001). Mobility was significantly reduced three months postoperatively (p=0.04). During the postoperative stage (n=40), 38% of the participants were married. Most (53%) of the participants had no form of income. The highest percentage of participants in all instances (35%) had secondary education (grade10-11), while 25% had less than grade 5. Only one participant was homeless, 18% lived in shacks, 55% lived in homes that were not shared with other families. People with LLA in the Johannesburg metropolitan area who had no problem with mobility preoperatively (EQ-5D mobility item), who were independent with mobility (BI mobility item) preoperatively, who were independent with transfer preoperatively (BI transfer item) had a higher postoperative quality of life (postoperative median EQ-5D- VAS) compared to people who were dependent or had problems with these functions preoperatively. Being females was a predictor of higher reported quality of life compared to being male. Emerging themes from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hoping to get a prosthesis were reported. Some reported poor social involvement due to mobility problems, employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Participants’ QOL and function were generally scored high both preoperatively and postoperatively but there was a significant improvement in QOL and a significant reduction in function after three months although participants were generally still functionally independent. Good mobility preoperatively is a predictor of good QOL postoperatively compared to people with a poor preoperative mobility status Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their community of origin three months postoperatively with both functional and psychosocial challenges

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa

BACKGROUND: Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. OBJECTIVES: To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. STUDY DESIGN: A generic qualitative approach and an explorative design were utilised in this study. METHODS: A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. RESULTS: All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. CONCLUSION: Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users

The epidemiology and functional outcomes after a major lower limb amputation (LLA) in Johannesburg

This thesis is being submitted in fulfilment of the requirements for the degree of Doctor of Philosophy at the University of the Witwatersrand, Johannesburg.Background: The incidence and prevalence of disease related lower limb amputation (LLA) operation at the Johannesburg metropolitan hospitals is unknown. Lower limb amputation (LLA) results in a marked decline in functional independence. In Johannesburg South Africa, the LLA population is generally underprivileged, and Chris Hani Baragwanath Hospital and Charlotte Maxeke Johannesburg Academic hospital are not in a position to offer long-term rehabilitation to them on an inpatient basis. Patients often get discharged early as these tertiary hospitals have a high turnover and the demand for hospital beds is high. Aims: To establish the cumulative incidence and prevalence of disease related LLA at Johannesburg Metropolitan Hospitals. To establish whether a self-administered postoperative exercise programme (home programme) will improve function and other selected outcomes. Measures were taken at three months and six months after the LLA. Methods: A population sample of all theatre register records was used to review theatre registers for the epidemiological study. All records of general surgery and vascular operations were reviewed to count the number of LLA operations performed over a two year period from June 2011-June 2013. A randomised controlled trial (RCT) (n=154, n=77 per group) was conducted on participants who met the inclusion criteria. Allocation into groups was concealed and the assessor was blinded. The Barthel index to measure function (BI), Modified Amputee Body Image Scale (MABIS), Participation Scale (P-Scale), Euroqol EQ-5D quality of life (EQ-5D), Modified Locomotor Capabilities Index (MLCI) and the Timed Up and Go test (TUG) were used to gather data from the participants. The control group received the standard rehabilitation from Chris Hani Baragwanath or Charlotte Maxeke Johannesburg Academic hospitals and the intervention group received an additional exercise programme and an exercise diary (ED) to keep a record of compliance. The intervention was a home exercise programme which was administered from discharge until three month post amputation. A research assistant (a physiotherapist) administered the intervention and did weekly reminding of the participants about the exercises and the researcher did all the testing (interviews and physical tests). Data were analyzed using IBM SPSS version 22. Descriptive and ratio analysis was used for the prevalence study. All continuous data are presented as means, standard deviations and medians and percentiles. The two groups were compared using Fisher’s exact test for categorical data and the Mann Whitney U-test for continuous data. Bonferroni correction method was used when testing the tools item by item. Survival was established using the Kaplan-Meier test and the Log Rank (Mantel-Cox) test for comparison. Generalised Linear models (GLM) Generalised Estimating Equations (GEE), Repeated Measures Analysis of Covariance (RM-ANCOVA and Analysis of Variance (ANOVA) were used to exclude confounders. A multiple linear regression was used to establish associations between baseline characteristics and functional outcomes. An intention to treat analysis was used. Results: A total population of N=23617 people underwent general and vascular surgical procedures at the Johannesburg Metropolitan Hospitals during the study period. The majority of the amputations were BKA followed by AKA. The total number of amputations performed was 879. The cumulative prevalence of LLA operations is 0.037 (95% CI) (or 3722.0 per 100 000 persons seen at the Johannesburg Metropolitan hospitals).Total amputation number of new LLA performed was 743. The cumulative incidence of LLA is 0.031(95% CI) (or 3146 per 100 000 persons -2-years of study). The cumulative incidence of LLA in males is 0.038(95% CI) (or 3849.14 per 100 000 persons -2-years of study). The cumulative incidence of LLA in females is 0.023(95% CI) (or 2300 per 100 000 persons -2-years of study). In the RCT, the median age was 58 per group (p=0.505), the control group had 66.2% males and the intervention group had 63.6% males (p=0.433). There were no significant (p˃0.05) differences in demographic characteristics between the two groups at baseline but the intervention group had a significantly (p=0.005) more participants with a BKA than the control group. The groups were comparable at baseline on all the outcome measures except participation with the intervention group demonstrating significantly more participation restriction (P-Scale) (p=0.038) (25th percentile 0;0, median 0;0, 75th percentile 0;5 for group 1 and 2 respectively). However, the intervetion group demonstrated significantly less (p=0.004) participation restriction at three months postoperatively compared to the control group (25th percentile 10;6, median 28;18, 75th percentile 41;27 for group 1 and 2 respectively). The intervention group demonstrated significantly lower (p=0.039) activity limitation levels (BI) at three months postoperatively compared to the control group (25th percentile 16;18, median 18;18, 75th percentile 19;20 for the control group and the intervention group respectively) and significantly lower (p=0.005) activity limitation levels (MLCI) (25th percentile 13;20, median 21;24, 75th percentile 30;38 for the control and the intervention group respectively) at three months postoperatively compared to control group. The intervention group demonstrated significantly lower (p=0.040) activity limitation levels at three months postoperatively compared to control group in the MLCI Basic Subscale score(25th percentile 7;9, median 9;11, 75th percentile 17;21 for the control and the intervention group respectively). Group 2 demonstrated significantly lower (p=0.001) activity limitation levels at three months postoperatively compared to the control group in the MLCI Advanced score (25th percentile 6;10, median 11;15, 75th percentile 14;19 for the control and the intervention group respectively). Body image perception (MABIS) showed no significant (p=0.201) difference between the groups (25th percentile 20;25, median 28;35, 75th percentile 40;43 for the control and the intervention group respectively) at three months. The intervention group demonstrated a significantly (p=0.001) better QOL VAS (25th percentile 30;50, median 60;80, 75th percentile 80;80 for the control and the intervention group respectively) and a significant (p=0.033) index scores(25th percentile 0.264;0.689, median 0.725;0.796, 75th percentile 0.796;0.796 for the control and the intervention group respectively) of QOL at three months postoperatively compared to control group. The intervention group demonstrated significantly less risk of falling (better ability to balance) (TUG) at three months(25th percentile 25;19, median 34;24, 75th percentile 45;36 for the control and the intervention group respectively) (p=0.036) and six months (25th percentile 19;13, median 25.5;21, 75th percentile 36;32 for the control and the intervention group respectively) (p=0.046) postoperatively compared to the control group. Only balance remained different at six months, the other outcomes were similar between the groups. Being in the intervention group was associated with higher functional outcomes (activity levels, higher participatation levels, higher QOL and lower risk of falling) postoperatively. Being old was associated with lower functional outcomes (lower activity levels and high risk of falling) postoperatively. Being female was associated with lower functional outcomes (lower activity levels), absence of diabetes was associated with high QOL and absence of other comorbidities was associated with lower risk of falling. Thirty-three participants died during the study period. There were significantly more smokers (p=0.016) and drinkers (p=0.022) among the group that died compared to the survivors. In the regression analysis, death was predicted by cigarette smoking, alcohol drinking and reduced preoperative participation. Conclusion: The intervention ensured early functional independence of the intervention group compared to the control group. This study suggests that the intervention could be adopted as standard care for lower limb amputation patients especially those from situations with limited resources as they tend to be discharged early from the hospitals in order to accommodate other admissions

The impact of lower limb amputation on community reintegration of a population in Johannesburg: A Qualitative perspective

Aim: To explore the experiences and perceptions of people with lower limb amputations from the Johannesburg metropolitan area on the impact that their amputations had on their lives and their return to their communities. Methods: Semi-structured audio-taped in-depth interviews were used to collect data on 12 purposively selected participants. Ethical clearance was obtained. A General Inductive Approach was used to generate or discover themes within the data using a process of systematic coding. Results: Emerging from the qualitative data were psychological, social and religious themes. Suicidal thoughts, dependence, poor acceptance, public perception about body image, phantom limb related falls and hopes of obtaining prostheses were reported. Some reported poor social involvement due to mobility problems and employment concerns, while families and friends were found to be supportive. Participants had faith in God. Conclusion: Generally, most participants had come to terms with the amputation and were managing well while some expressed that they were struggling with reintegration to their communities of origin three months postoperatively with both functional and psychosocial challenges

Differences in characteristics between people with lower limb amputations who died before 12 weeks and those who survived: Short Report

The baseline determinants of survival following a non-traumatic lower limb amputation (LLA) in participants in the Johannesburg metropolitan area are unknown.The aim of the study was to establish the characteristics of participants who had died by three months after LLAA longitudinal pre- test- post test study utilized participant interviews (n=73).  Consecutive  sampling  was  used  to  select  participants  who  met  the  inclusion criteria. Ethical clearance was obtained. Permission was obtained from the hospitals. Participants gave consent before taking part in the study. A demographic questionnaire, the EQ-5D, the Modified Household Economic and Social Status Index (HESSI) and the Barthel Index (BI) were used, to collect data. Participants  were  interviewed  preoperatively  and  then  followed  up  three  months  post-operatively  to  establish survival/ existence. Twenty-four  participants  (33%)  had  died.  The  preoperative  median  Visual  Analogue  Scale  (VAS)  of  the  EQ-5D was 60 and 70 showing no significant difference in quality of life (QOL) between those who survived and those who  died  respectively.  The  preoperative  median  total  BI  score  was  20  and  19  showing  significantly  inferior  function for the deceased (p=0.01). The deceased were significantly older (p=0.009) used alcohol (p=0.02) and smoked tobacco (p=0.03).Being older, having poorer function, being a smoker and drinking alcohol preoperatively seem to decrease the chance of survival following LLA in Johannesburg

Global trends in incidence of lower limb amputation: a review of the literature

The aim of this paper was to compile a literature report on the global epidemiology of lower limb amputations. Specifically it aimed at capturing information on the incidence of traumatic and non-traumatic lowerlimb amputations throughout the world, to identify the etiology including diseases and lifestyle habits associated with lower limb amputees (LLA) in boththe developed and the developing countries, to identify the demographiccharacteristics, age, sex, race, geographical location of the people undergoing LLA including the levels of amputation as pointed out by the literature. Aliterature search was conducted. Different keyword combinations were used togather as much literature on the subject as possible. The authors systemicallyreviewed literature from some parts of Europe, Asia, North and South America and South Africa. The data was analyzed and presented under various themes. The existing literature shows that diabetes is the leading cause of LLA and trauma accounts for the minority of these cases. The incidence of LLA can be predicted by gender, age, maritalstatus, level of education and socio-economic status. Information on LLA in South Africa is almost absent

Quality of life following a major lower limb ampu tation in Johann esburg, South Africa.

To determine the impact of lower limb amputation on qualityof life in people in the Johannesburg metropolitan area of South Africa, duringtheir reintegration to their society/community of origin.A longitudinal pre- test- post test design was utilized. Consecutive samplingwas used to recruit and interview participants (n=73) who met the inclusioncriteria. Ethical clearance was obtained. The hospitals and participants gaveinformed consent.The EQ-5D, Barthel Index, and Modified Household Economic andSocial Status Index were used to collect data. Participants were interviewed preoperatively and then followed upthree months post-operatively. Data were analysed using STATA version 10. Categorical data were analysedusing Chi-square/Fischer’s exact test and continuous data were analysed using Wilcoxon signed rank and medianregression.Most (n=21, 52.5 %) participants had no income. One participant was homeless, 17.5% (n=7) lived in shacks.The preoperative and postoperative median VAS of the EQ-5D was 60 and 70 respectively showing no significantimprovement in QOL (median EQ-5D VAS). The preoperative and postoperative median total BI score was 20 and 19respectively, showing a significant reduction in function (median total BI) three months postoperatively (p<0.001).Preoperative mobility was a predictor of postoperative quality of life. Being female was a predictor of higher qualityof life.The average EQ-5D VAS score and overall function (total BI) were generally scored high both preoperativelyand postoperatively but there was no significant improvement in EQ-5D VAS score and there was a significant reductionin function after three months. Higher scores in mobility preoperatively is a predictor of higher quality of lifepostoperatively

The implementation of the Objective Structured Practical Examination (OSPE) method: Students’ and examiners’ experiences

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of  assessment.Objective. To describe and compare student performance and satisfaction and examiner satisfaction  with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment.Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets.Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet.Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly  listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored