Article

After amputation, rehabilitation and limb fitting services are
critically important to optimise outcomes. We investigated the reported patient
experience and variation in limb fitting services after amputation for
musculoskeletal tumours in England. METHODS: A postal survey instrument was
developed following literature review, patient and clinician consultation and
piloting. The survey was sent from each of the five bone tumour surgical centres
in England. RESULTS: One hundred and five responses were received from 250
patients (42%). The number of limb fitting centres accessed by each surgical
centre varied from 2 to 28. Many patients reported care falling short of national
standards in areas including pre-amputation counselling, information provision,
meeting someone with a similar amputation before surgery, psychological support
and falls management. Patients were seen sooner where limb fitting services were
on site. Many patients rely on being driven, ambulance and public transport to
access services. CONCLUSION: This study demonstrates variation in the reported
experience of limb fitting services by sarcoma patients. Areas for improvement
include information provision, pre-amputation counselling, psychological support
and falls management. Clinicians should be aware services are highly variable,
and this may impact on outcomes. Patients treated in sarcoma centres with limb
fitting services on site may experience better care. Implications for
Rehabilitation Rehabilitation services should strive to meet agreed national
standards consistently. Where preamputation counselling involving meeting someone
with a similar amputation is not possible, good information including video could
be helpful. Services should support rehabilitation in the form of early walking
aids and efficient prosthetic repair and maintenance. Psychological support,
occupational therapy and physiotherapy support must be provided in the acute and
chronic phases, including access to long-term rehabilitation care. Rehabilitation
programmes must include training to patients and families on reporting,
prevention and management of falls. On site services may support better care.
Mechanisms for delivering expert specialist care close to home are needed.

Langue : ANGLAIS