Identification of Barriers in the Reintegration of Pakistan Military Amputees at the Workplace: A Cross Sectional Study
Keywords:
Amputation, Barriers, Military medicine, Pakistan, Re-integrationAbstract
Objective: : To identify barriers in the reintegration of Pakistan military amputees at their workplace and to suggest remedial
measures.
Methodology:A cross-sectional questionnaire-based study was planned and hospital ethics committee approval was obtained.
Two part survey was constructed consisting of demographics and questions about the possible barriers at the workplace. Fifty
eight military amputees (20-60 years, with disability class A and B due to major amputation of a limb) were approached and
requested to fill in the questionnaire after explaining the rationale and possible benefits of the study. Response rate was
100 %.
Results: All patients were males. Most of the patients had trans-tibial amputation (41). Majority were matriculate and earned
between Rs. 20,000- 40,000 (53.4%). All patients were provided with latest modular prosthesis of Ottobock (Germany) and
Ossur (USA), free of cost with life time maintenance and replacement by Armed Forces Institute of Rehabilitation Medicine
(AFIRM). Majority of the patients could ambulate independently, were confident after provision of prosthesis and were spared
by their units for timely follow-up. Major barriers included lack of accessible washrooms in the unit, too much time off-work
and lack of confidence even after provision of prosthesis.
Conclusion: Amputee rehabilitation can lead to successful and complete community re-integration. Pakistan Army is providing
comprehensive amputee rehabilitation services to those who sustain a limb loss. However, certain barriers can hinder the
rehabilitation process and it is important to identify and remove these barriers for better functional outcomes in amputees.
References
The free dictionary by Farlex. Available from http://medical- dictionary.thefreedictionary.com/amputation Accessed 2nd May 2017
Mavroforou A, Koutsias S, Fafoulakis F, Balogiannis I, Stamatiou G, Giannoukas AD. The evolution of lower limb amputation through the ages. Historical note. Int Angiol. 2007; 26(4):385-9
Shah SMA. Pakistan and the War against Terrorism. Pakistan Horizon 2007; 60: 85–107
South Asia Terrorism Portal. Fatalities in Terrorist Viol- ence in Pakistan 2003-2017. Available from http://www. satp.org/satporgtp/countries/pakistan/database/ casualties.htm Accessed 15th Feb 2017
Razzaq S, Mansoor SN, Rathore FA, Akhter N, Yasmeen
R. Rehabilitation Outcomes following lower extremity amputation at the Armed Forces Institute of Rehabilitation Medicine using lower extremity functional scale. Pak Armed Forces Med J 2013; 63: 210-5
Dougherty PJ, DeMaio M. Major General Norman T. Kirk and amputee care during World War II. Clin Orthop Relat Res. 2014; 472(10):3107-13
Harvey ZT, Loomis GA, Mitsch S, Murphy IC, Griffin SC, Potter BK, et al. Advanced rehabilitation techniques for the multi-limb amputee. J Surg Orthop Adv. 2012; 21(1):50-7
Potter BK, Scoville CR. Amputation is not isolated: an overview of the US Army Amputee Patient Care Program and associated amputee injuries. J Am Acad Orthop Surg. 2006; 14(10 Spec No.):S188-90
Czerniecki JM, Turner AP, Williams RM, Hakimi KN, Norvell DC. The effect of rehabilitation in a compr- ehensive inpatient rehabilitation unit on mobility outcome after dysvascular lower extremity amputation. Arch Phys Med Rehabil. 2012; 93(8): 1384-91
Davis BL, Kuznicki J, Praveen SS, Sferra JJ. Lower- extremity amputations in patients with diabetes: pre-and post-surgical decisions related to successful rehabili- tation. Diabetes Metab Res Rev. 2004; 20 Suppl 1:S4 5-50
Hermes LM. Military lower extremity amputee rehabilitation. Phys Med Rehabil Clin N Am. 2002;13(1)
:45-66
EU quality assurance in vocational education and training. Glossary. Vocational and educational training. Available from http://www.eqavet.eu/qa/gns/glossary/v/vocational- education-and-learning-aspx. Accessed 4th May 2017
Rathore FA, New PW, Iftikhar A. A report on disability and rehabilitation medicine in Pakistan: past, present, and future directions. Arch Phys Med Rehabil. 2011; 92(1):161-6
van Twillert S, Stuive I, Geertzen JH, Postema K, Lettinga AT. Functional performance, participation and autonomy after discharge from prosthetic rehabilitation: barriers, facilitators and outcomes. J Rehabil Med. 2014; 46: 915-23
Littman AJ, Boyko EJ, Thompson ML, Haselkorn JK, Sangeorzan BJ, Arterburn DE. Physical activity barriers and enablers in older Veterans with lower-limb amputation. J Rehabil Res Dev. 2014; 51: 895-906
Gawande A. Casualties of war--military care for the wounded from Iraq and Afghanistan. N Engl J Med. 2004; 351(24):2471-5
Stansbury LG, Lalliss SJ, Branstetter JG, Bagg MR, Hol- comb JB. Amputations in U.S. military personnel in the current conflicts in Afghanistan and Iraq. J Orthop Trauma. 2008; 22: 43-6
Atherton R, Robertson N. Psychological adjustment to lower limb amputation amongst prosthesis users. Disabil
Rehabil. 2006; 28(19):1201-9
Bhutani S, Bhutani J, Chhabra A, Uppal R. Living with Amputation: Anxiety and Depression Correlates. J Clin Diagn Res. 2016; 10(9):RC09-RC12
Meulenbelt HE, Geertzen JH, Dijkstra PU, Jonkman MF. Skin problems in lower limb amputees: an over- view by case reports. J Eur Acad Dermatol Venereol. 2007; 21: 147-55
Bui KM, Raugi GJ, Nguyen VQ, Reiber GE. Skin problems in individuals with lower-limb loss: literature review and proposed classification system. J Rehabil Res Dev. 2009; 46(9):1085-90
Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin LE. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehabil. 2005; 86: 1910-9
Ahmed A, Bhatnagar S, Mishra S, Khurana D, Joshi S, Ahmad SM. Prevalence of Phantom Limb Pain, Stump Pain, and Phantom Limb Sensation among the Amputated Cancer Patients in India: A Prospective, Observational Study. Indian J Palliat Care. 2017;23: 24-35
Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling, and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001; 82(8): 1031-7
Miller WC, Deathe AB, Speechley M, Koval J. The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among indivi- duals with a lower extremity amputation. Arch Phys Med Rehabil. 2001; 82: 1238-44
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Copyright (c) 2017 Ishrat Nabeel Toor, Farooq Azam Rathore, Farah Mehboob
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