We invited the Institute of Global Orthopaedics and Traumatology (IGOT) at University California San Francisco (UCSF) to share one of their research projects:

'A few studies from low and middle-income countries exist in the current literature reporting etiologies of lower extremity amputation and lack of prosthetics and rehabilitation services. However, no publish literature addresses determinants of quality of life after limb loss or its economic impact.

IGOT is leading a study designed to explore that topic and add to the current literature.

The objective of this study is to:

  • determine the quality of life and functional outcomes in above-knee amputees before and after receiving a prosthesis,
  • estimate the direct and indirect medical costs associated with above-knee amputations in Tanzania and the economic impact and cost-effectiveness of prosthetics for individuals with above-knee amputations, and
  • estimate the incremental cost-effectiveness ratio (ICER) for lower extremity prostheses in US Dollars per Quality-Adjust Life Year.

We hypothesize that receiving a prosthesis will improve the quality of life and functional outcomes for the patients with above-knee amputations. In this study, above-knee amputation patients at the Muhimbili Orthopaedics Institute in Dar es Salaam, Tanzania were recruited and assessed at baseline for functionality and economic status.

A follow-up was conducted a year after receiving a prosthesis to compare data from the baseline. During the follow up, functional outcomes (EQ-5D and PLUS-M questionnaires, and a 2-minute walk test) and direct and indirect medical costs associated with the prosthesis were assessed.  EQ-5D is a validated measurement tool that assess patient’s mobility. PLUS-M questionnaires assess quality of life through sets of questions given to the patient. The 2-minute walk test/ Physiologic Cost Index is a functional metric that assess patient’s mobility. It measures the distance that the patient is able to move and the change in heart rate during this activity.

The cost data to measure economic impact include direct and indirect costs. The direct costs include variables costs, such as cost associated with medical personnel, medication, etc. Fixed costs are also a direct cost, which includes administrative costs incurred by the clinic for patient care and the cost of the prosthetic components. Indirect costs that were collected include patient’s employment, time away from work, transportation, room/board costs for the caregivers and patient. The indirect costs were recorded using a caregiver survey. 

We believe these data will create a compelling case to advocate for better access to prosthetics in low-resource settings like Tanzania.'

Study lead: Prof David Shearer, IGOT, UCSF

Find out more: https://orthosurgery.ucsf.edu/outreach/global/igot_program.html



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