94 Burger, Kotnik / Rehabilitacija - letn. VII, supl. 3 (2008) FUNCTIONING OF ELDERLY LOWER LIMB AMPUTEES - PATIENTS’ PERSPECTIVE H. Burger, Sa. Kotnik H. Burger, Sa. Kotnik Institute for Rehabilitation, Ljubljana, Slovenia Institute for Rehabilitation, Ljubljana, Slovenia amputees. All the subjects visiting lower limb amputee outpatient clinic in January 2008, who had been amputated at least one year before, had prosthesis and were willing to participate were included into the study. Nineteen out of twenty-four subjects experienced pain, they had problems with 15 activities and participation items on average (0 to 34) and had 14 facilitators (8 to 21) and 13 (6 to 19) bar- riers in the environment. Abstract The aim of the present study was to find out whether International Classification of Functioning, Disabil- ity and Health (ICF) can be used to describe all the problems in the area of activities and participation and to define the most important environmental fac- tors influencing the functioning of elderly lower limb INTRODUCTION Most lower-limb amputations in the developed countries are performed due to vascular pathology (1). Most of the patients are therefore elderly at the time of amputation and may have many other diseases (2). V ascular problems usually affect the vessels of other organs which may together with age, other diseases and the amputation itself cause several problems in the patients’ functioning, such as phantom and stump pain, balance problems, walking and other mobility problems and others (3-5). There are several outcome measures and clinical tests used for assessing outcome and functioning after lower-limb amputa- tion. Some of them are generic, others have been developed especially for lower limb amputees, but there is no consensus among clinicians regarding the most appropriate one (6). Besides, they cover only partial and not the entire functioning of an individual person. In particular, there is a lack of out- come measures for participation and environmental factors. The aim of the present study was to find out whether Inter- national Classification of Functioning, Disability and Health (ICF) can be used to describe all the problems in the area of activities and participation and to define the most important environmental factors influencing the functioning of elderly lower limb amputees. METHODS AND SUBJECTS Methods The subjects’ functioning was assessed by ICF. All the codes relevant to each individual were used from Activities and Participation and from Environmental Factors. Only the subjects’ performance was assessed and two qualifiers only were used: 0 - no problem, 1 - problem. All the included sub- jects were interviewed by a trained student of occupational therapy. The results were statistically analysed. Subjects Subjects All the subjects visiting lower-limb amputee outpatient clinic in January 2008, who had been amputated at least one year before, had prosthesis and were willing to participate were included into the study. RESULTS The study included 24 subjects, 21 men and 3 women, ampu- tated 2 to 68 years before the study. Eleven had transfemoral and 13 transtibial amputation. Ten subjects were amputated due to an injury to lower limb, 12 due to peripheral vascular disease and 2 due to diabetes. Nineteen out of twenty-four subjects had pain which affected their functioning. Four subjects had problems with some basic learning activities, up to 14 had problems with Mobility, Self care, Domestic life and Participation. On average, they had problems with 15 activities and partici- pation items (0 to 34). Most of them had problems moving around, walking, driving, caring for household objects and doing housework. They had 14 facilitators (8 to 21) and 13 (6 to 19) barriers in the environment. Health professionals were facilitators for all of them, followed by products and technology for use in daily living. Design, construction and buildings for public use, attitudes of people in positions of 95 authority, support and relationships of peers, neighbours, community members and physical geography were the most frequent barriers. The subjects amputated due to an injury had fewer problems at the activities and participation level than those amputated due to vascular problems and diabetes (9 versus 18). The number of problems, facilitators and barriers did not depend on the amputation level. DISCUSSION The study found that elderly lower limb amputees had sev- eral problems at the activities and participation level and several barriers in their environment. Most frequent activity problems were those with mobility and household activi- ties. Some mobility problems are more or less addressed in almost all the outcome measures used in the assessment of lower-limb amputees (FIM, Locomotor Capability Index), but household activities are not. Also driving and using transportation are mentioned only in some studies that used questionnaires and are not found in most frequently used outcome measures (4). However, they are important especially at the level of participation (4). Most household activities covered by the interview are important for inde- pendent living. There were several facilitators, but still many barriers in the environment of the included subjects. In spite of the law on the accessibility of newly-built public buildings, these were still the main barrier in the environment. Additionaly, sup- port and relationship of peers, colleagues, neighbours and community members was low and worriesome, but even worse were the attitudes of people in positions of authority. People in Slovenia seem to have a very negative attitude towards persons with disabilities and are not really willing to help. Much more has to be done in the field of education to change those attitudes. The subjects included into the study were not a true rep- resentative sample of lower-limb amputees in Slovenia. In general, most of the amputees have been amputated due to vascular problems whereas in the present study almost half of the subjects had been amputated due to an injury. CONCLUSION Elderly lower limb amputates were found to have several activity limitations and barriers in their environment. Many of them have to be addressed and changed in order to improve the lives of lower limb amputees in Slovenia as well as the lives of other persons with disabilities. R References: eferences: 1. Rommers GM, Vos LDW, Ggroothoff JW, Schiling CH, Eisma WH. Epidemiology of lower limb amputees in the north of the Netherlands: aetiology, discharge destination and prosthetic use. Prosthet Orthot Int 1997; 21:92-9. 2. Pohjolainen T, Alaranta H. epidemiology of lower limb amputees in Southern Finland in 1995 and trends since 1984. Prosthet Orthot Int 1999; 23:88-92. 3. Pezzin LE, Dillingham TR, Mackenzie EJ. Rehabilitation and the long-term outcomes of persons with trauma- related amputations. Arch Phys Med Rehabil 2000; 81:292-300. 4. Burger H, Marinček Č, Isakov E. Mobility of persons after traumatic lower limb amputation. Disabil Rehabil 1997: 19: 272-277. 5. Matjačić Z, Burger H. Dynamic balance training during standing in people with trans-tibial amputation : a pilot study. Prosthet Orthot Int 2003: 27: 214-220. 6. Condie E, Treweek S. Lower limb prosthetic outcome measures: a review of the literature from 1995 to 2005. JPO 2006; 18:13-45. Burger, Kotnik / Rehabilitacija - letn. 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