Evaluation of Amputee Rehabilitation Services in Gaza Governorates: Mixed Method Approach
Ahmed Haidar Mousa
أحمد حيدر محمد موسى
People with amputations require integrated rehabilitation services. Within the context of the Gaza Strip, no studies have been conducted to evaluate the provided rehabilitation services to people with amputations. This study aims to evaluate the available rehabilitation services to people with amputations in the Gaza Governorate in order to propose recommendation and interventions that could improve the overall performance of amputee’s rehabilitation services, thus, improving the overall well-being of people with amputations. This study utilized a mixed-method approach; the quantitative study is cross-sectional that involved collecting data from randomly selected 370 people with amputations through a face-to- face questionnaire. The qualitative data were collected through conducing eight in-depth interviews with key informants and three focus group discussions with healthcare service providers. The quantitative data were analyzed using the SPSS software and the qualitative data were analyzed using the open coding thematic technique. Reliability test was very high. In the Gaza Strip, the main cause of amputations is conflict-related and the second major cause is the lower-limb amputations due to uncontrolled Diabetes Mellitus. More than half of the study participants were hospitalized before the amputation (58.1%). The mean of hospitalization days after the amputation was 26.54 days. All the study participants (370 amputees) received medical care during their hospitalization, 45.70% received physiotherapy and 24.1% received psychological support services during the same period. After discharge from hospitals, more than two-third of study participants were referred to another health provider to continue and/or to start their rehabilitation program. The study findings have revealed that most of the study participants received rehabilitation services at more than one place. Most of the study participants (87.24%) expressed their satisfaction with the rehabilitation services provided by the Artificial Limbs and Polio Center. Moreover, the findings of the prosthesis evaluation which measured different domains have revealed mainly average results of most domains. The mean of participants’ satisfaction with the prosthesis usefulness / utility was 6.17, with the residual limb health was 6.21, with appearance was 6.48, with sound was of 6.18, with ambulation was 5.65, with transfer was 6.64, with perceived response was 8.19, with frustration was 5.79, and with social burden was 7.62. The quality of life for people with amputations is generally good as the average percentage of quality of life was 74.4%. Only, 45.3% of clients have reported a good quality of life compared to 19% who did report poor quality of life and 1.6% who did report a very low quality of life. Interestingly, 25.7% could not decide if they have a good or a poor quality of life. Additionally, from the study participants point view, the society was not fair enough to them as they feel somehow discriminated and socially excluded. The study results have shown that the available services are effective and relatively of good quality. However, there is a room for further improvements in the interaction and dynamics across the provider of the phases of amputee rehabilitation services and referral pathway People with amputations are not receiving comprehensive services, thus services provided need to tailored to meet the need of people with amputations, including health and education services. Investment in health promotion programmes to prevent and control chronic diseases are highly needed in order to reduce the chances of amputations due to such diseases. Also, people with disabilities need to be financially supported to meet their basic life needs, as well as to meet the increase in their demand for services due to disability. The current financial support is not enough to cover their basic life needs. There is also a need to conduct other studies using mixed methods to deeply explore providers’ perspective with regard to available amputee rehabilitation services and to assess the accessibility and affordability of services for people with disabilities, including education, work, and health services. Finally, enforcement of the legal framework Law No.4 (1999), which highlights the rights of people with disabilities to have work and upholds the rights of the People with disabilities based on equity principles is urgently needed.