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TitleProsthetic Use by Persons with Unilateral Above Knee Amputation in the Western Cape March
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Prosthetic Use by Persons with Unilateral Above Knee Amputation in

the Western Cape

March 2018

Elzbeth Pienaar

Research assignment presented in partial fulfilment of the requirements for

the degree Masters in Human Rehabilitation Studies at the Faculty of

Medicine and Health Sciences at Stellenbosch University

Supervisor: Dr Surona Visagie

Co supervisor: Ms Jenny Hendry

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By submitting this thesis electronically, I declare that the entirety of the work contained

therein is my own, original work, that I am the sole author thereof (save to the extent

explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch

University will not infringe any third party rights and that I have not previously in its entirety

or in part submitted it for obtaining any qualification.

Elzbeth Pienaar

March 2018

Copyright © 2018 Stellenbosch University

All rights reserved

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Participants who used their prosthesis most frequently, reported less prosthetic fitting

problems compared to those who had abandoned their prostheses. A systematic review

(Gholizadeh et al. 2013) reported that discomfort, skin problems and high energy

expenditure were causing people to stop using their prosthesis. Amongst non-use in this

study, similar reasons were given; skin irritation, pain and tiring to walk with prosthesis.

Prosthetic fitting problems leading to discomfort may also influence overall function with the

prostheses (Roth et al. 2014). The socket design and suspension used by current

participants has limitations, as described in 2.7 and could have negatively affected user

comfort, use, mobility and satisfaction (Gholizadeh et al. 2013).

The problem most commonly reported by current participants who wore their prosthesis, was

perspiration inside the socket. Studies by Trieb, Lang, Stulnig and Kickinger (1999), and

Gholizadeh et al. (2013) reported less perspiration inside the socket when using a liner as

suspension, compared to skin suction. It also showed a reduction in skin trauma, less stump

oedema and subsequent longer duration of wear. A liner is not a product option in Western

Cape government, however it could be an option to explore for certain prosthetic users, e.g.

the active user. The foot and knee components used, could also have negatively impacted

prosthetic use. All participants received a SACH foot and a single-axis knee. These two

components might have been especially trying for younger active participants, since the

components are designed for indoor and limited outdoor use only. A cross-sectional survey

of 135 persons from Turkey (Yilmaz, Gulabi, Kaya, Bayram & Cecen 2016) found that being

younger than 35 years was associated with higher levels of function. Current findings

showed that, of the five participants younger than 35 years, two were not using their

prosthesis and two used their prosthesis 3 days or less per week. The limitations that the

prosthetic components might have imposed on their mobility needs might have resulted in

their opting to use crutches rather than the prostheses.

5.4 Prosthetic Mobility

5.4.1 In, and outdoor mobility with the prosthesis

Interestingly, higher levels of prosthetic use were found in outdoor mobility (86%) compared

to indoor mobility (63%) even though outdoor mobility places more demands on the person

and the prosthesis. This pattern is reflected in other studies (Puhalski et al. 2008; Hagberg &

Branemark 2001; Gauthier-Gagnon et al.1999) where the above knee prosthesis was used

more often outdoors than compared to indoors. Outdoor prosthetic use encompasses more

than just the physical demands of prosthetic mobility. During interview, participants in a

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South African study reported that they were self-conscious about their image in public and

that attempts to preserve normal, physical appearances were important, e.g. wearing long

pants over the prosthesis when going out (Godlwana & Steward, 2013). Other possible

reasons for lower levels of indoor prosthetic mobility might be that indoor space was limited

and one could perform many tasks while seated. Some participants reported that the

prosthesis was too slow and that it was uncomfortable to sit with the prosthesis.

As can be expected, due to greater challenges with regard to balance and endurance, the

need for crutches increased when participants were walking outdoors and even further

increased when they were walking outdoors, on uneven terrain. Gauthier-Gagnon et al.

(1999) reported that frequency of prosthetic wear, in hours per week, were positively

associated with fewer assistive devices. Other researchers concurred (Tezuka et al. 2015;

Puhalski et al. 2008). Similar results are reflected in this study (Table 4.2), were people who

used their prosthesis more often tend to be less reliant on hand-held assisted devices across

terrains. Increased age impacts negatively on prosthetic mobility (Puhalski et al. 2008;

Hagberg & Branemark 2001). Davies and Datta (2003) found that participants under the age

of 50 years, who had undergone above knee amputation, almost all achieved household and

community mobility, while of those above 50 years of age, only 25% achieved community

mobility. Similar observations were made in current study, increase in age also showed an

increase in the need for additional assistive devices, across all terrains

The ability to climb steps is important as it impacts on overall mobility within the context of a

person’s indoor and outdoor living environment. The findings of the current study on stair

climbing ability with a prosthesis was similar to findings from research conducted by De Laat

et al. (2013) where most participants could do so, but when stairs did not have a handrail,

approximately 15% of the persons were unable to climb stairs. This inability may limit

household or community mobility, as many public and private buildings have a few steps at

the entrance, often with no handrail.

5.4.2 Prosthetic walking distance

Prosthetic rehabilitation had a statistically significant impact on walking distances. Overall

walking distances, however, were limited, with only 30% of the study population being able

to walk 500 steps or more. Bakkes’ (1999) findings, in comparison, reported that 74% could

walk 500m and more at a time, the intensity of rehabilitation could have impacted these

differences. In the current study, prosthetic rehabilitation where mostly limited to 3 outpatient

sessions, compared to Bakkes’ (1999) study where more intensive rehabilitation was

provided. Both studies, however, highlight the importance of prosthetic rehabilitation.

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44. In which category is your FAMILY’S GROSS ANNUAL INCOME situated (meaning
the total amount of revenue prior to taxes from all the people who contribute to

the family expenses)? Question 44 on income removed as classification on income will be obtained

from the medical records

… less than 29,999$

… 30,000$ to 59,999$

… 60,000$and more

45. Please indicate who filled in the questionnaire, if the person to whom the

questionnaire was addressed to could not answer it personally. Question 45 removed:

if answered by 3rd party will be indicated on informed consent document

… spouse or other family member

… person who takes care of him/her (other than a family member)

… other _____________________________________________________________
« specify»









We greatly appreciate your participation and

we thank you for your valued collaboration !

Christiane Gauthier-Gagnon M.Sc.

Marie-Claude Grisé M.S

Stellenbosch University

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Stellenbosch University

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