Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania

Background: The rise of diabetes and traumatic injury has increased limb loss-related morbidity in lowand middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL) and function has not been quantified. Objectives: Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees. Method: A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use. Results: Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p < 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p< 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p< 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p= 0.068). Conclusion: Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.