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Activity, socket fit, comfort, and community participation in lower limb prosthesis-users: A Cambodian cohort study

Activity, socket fit, comfort, and community participation in lower limb prosthesis-users: A Cambodian cohort study
Activity, socket fit, comfort, and community participation in lower limb prosthesis-users: A Cambodian cohort study

Background: After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. Methods: Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24–60 years old and 3–43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. Results: Participants averaged 4470 steps/day (743–7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5–17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman’s rho r s = 0.59, and r s = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (r s = 0.49). A longer residual limb correlated with better community participation (r s = 0.56) and comfort (r s = 0.56). Self-reported community participation did not correlate with a person’s activity level (r s = 0.13), or their prosthesis comfort (r s = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (r s = 0.37). A simple 0–10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. Conclusion: Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.

3D scanning, Accelerometer, Activity, Comfort, Community participation, Limb volume, Low resourced country, Lower-limb prosthesis, Outcome measures
1743-0003
Diment, Laura
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Nguon, RaksmeyMutta
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Seng, Sovansereyrathna
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Sit, Vannsnavy
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Lors, Ply
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Thor, Phearsa
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Srors, Samedy
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Kheng, Sisary
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Granat, Malcolm
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Donovan-Hall, Margaret
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Worsley, Peter
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Dickinson, Alexander
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Diment, Laura
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Nguon, RaksmeyMutta
d2937863-a88f-4c16-8a5b-d1fe3f1d871f
Seng, Sovansereyrathna
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Sit, Vannsnavy
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Lors, Ply
667f6ccb-4fc8-43ff-b136-a134e5f678ad
Thor, Phearsa
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Srors, Samedy
76561b0d-aeec-444e-adb2-e877cfa45318
Kheng, Sisary
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Granat, Malcolm
fc2cdec6-d546-43af-8f50-43238c8dcb66
Donovan-Hall, Margaret
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Worsley, Peter
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Dickinson, Alexander
10151972-c1b5-4f7d-bc12-6482b5870cad

Diment, Laura, Nguon, RaksmeyMutta, Seng, Sovansereyrathna, Sit, Vannsnavy, Lors, Ply, Thor, Phearsa, Srors, Samedy, Kheng, Sisary, Granat, Malcolm, Donovan-Hall, Margaret, Worsley, Peter and Dickinson, Alexander (2022) Activity, socket fit, comfort, and community participation in lower limb prosthesis-users: A Cambodian cohort study. Journal of NeuroEngineering and Rehabilitation, 19 (42), [42]. (doi:10.1186/s12984-022-01021-7).

Record type: Article

Abstract

Background: After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. Methods: Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24–60 years old and 3–43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. Results: Participants averaged 4470 steps/day (743–7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5–17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman’s rho r s = 0.59, and r s = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (r s = 0.49). A longer residual limb correlated with better community participation (r s = 0.56) and comfort (r s = 0.56). Self-reported community participation did not correlate with a person’s activity level (r s = 0.13), or their prosthesis comfort (r s = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (r s = 0.37). A simple 0–10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. Conclusion: Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.

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In preparation date: 22 November 2021
Submitted date: 6 December 2021
Accepted/In Press date: 13 April 2022
Published date: 2 May 2022
Additional Information: Funding Information: The Engineering and Physical Sciences Research Council (EPSRC)/National Institute for Health Research (NIHR) Global Challenges Research Fund (grants EP/R014213/1 and EP/N02723X/1), The Alan Turing Institute (grant EP/N510129/1) and the Royal Academy of Engineering (RAEng grant RF/130). Funding Information: The authors thank Thearith Heang and Sam Simpson of Exceed Worldwide for facilitating, and Carson Harte of the Exceed Research Network (ERN) for providing critical review. We also thank the University of Southampton's Institute for Life Sciences/FortisNet interdisciplinary musculoskeletal research network for supporting our preliminary work. Publisher Copyright: © 2022, The Author(s).
Keywords: 3D scanning, Accelerometer, Activity, Comfort, Community participation, Limb volume, Low resourced country, Lower-limb prosthesis, Outcome measures

Identifiers

Local EPrints ID: 456913
URI: http://eprints.soton.ac.uk/id/eprint/456913
ISSN: 1743-0003
PURE UUID: 1be462b1-75f1-445a-bb40-d5fd90588f0e
ORCID for Peter Worsley: ORCID iD orcid.org/0000-0003-0145-5042
ORCID for Alexander Dickinson: ORCID iD orcid.org/0000-0002-9647-1944

Catalogue record

Date deposited: 17 May 2022 16:36
Last modified: 10 Jan 2023 02:41

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Contributors

Author: Laura Diment
Author: RaksmeyMutta Nguon
Author: Sovansereyrathna Seng
Author: Vannsnavy Sit
Author: Ply Lors
Author: Phearsa Thor
Author: Samedy Srors
Author: Sisary Kheng
Author: Malcolm Granat
Author: Peter Worsley ORCID iD

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