title: Patients' Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi.
abstract: People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients' satisfaction with assistive devices and associated services in the entire study group from these two low-income countries.
  
  
  
  Questionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi.
  
  
  
  Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7-3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received.
  
  
  
  Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, P.O Box 187, SE, 221 00, Lund, Sweden. lina.magnusson@med.lu.se.
authors.forename: Lina
authors.identifier: 0000-0003-4216-6255
authors.initials: L
authors.lastname: Magnusson
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, P.O Box 187, SE, 221 00, Lund, Sweden.
authors.forename: Gerd
authors.initials: G
authors.lastname: Ahlström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology*; D008295:Malawi; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D017060:Patient Satisfaction; D012656:Self-Help Devices; D012807:Sierra Leone; D011795:Surveys and Questionnaires; D016138:Walking; D055815:Young Adult
keywords: Assistive device; Disability; Low-income countries; Mobility; Orthosis; Prosthesis; QUEST; Satisfaction