Nonfinancial Barriers to Prosthetic Use Following Upper-Limb Amputation: A Prospective Observational Study in India

Abstract

ABSTRACT Introduction Upper-limb traumatic amputation is a common and poorly managed situation. Despite the huge burden, no study from the developing countries has evaluated rates of prosthesis acceptance and reasons for rejecting prostheses. Materials and Methods This was a longitudinal prospective observational study with a consecutive sampling technique. Participants were assessed after a period of 6 months of isolated upper-limb amputation. Patients were evaluated for reasons of nonfitment of upper-limb prosthesis despite their willingness to be fitted with an appropriate prosthesis. We conducted semistructured interviews to identify the potential hindrances. Results A total of 44 patients were recruited, out of which 38 did not get the prosthesis. A total of 57.8% reported a nonfinancial reason for prosthesis nonfitment. Nonfinancial is further classified into medical and nonmedical categories as per verbatim remarks by the patient. Among the nonmedical reasons, the most common reason was apprehension toward the use of the prosthesis, followed by satisfaction without the prosthesis and the weight of the prosthesis. In terms of medical reasons, the most common reason was persistent phantom limb pain, followed by residual limb infection. Conclusions Identification of “potentially correctable” hindrances to prosthesis acceptance is an essential step in the rehabilitation of persons with limb loss. All efforts should be made toward these hindrances so that persons with limb difference can be better rehabilitated. Clinical Relevance Given that some persons with limb difference need to be fitted with prostheses for optimal rehabilitation and to return as an able contributor to society, the identification of hindrances to prosthesis fitting is imperative to make further inroads toward improving prosthesis acceptance rate.