@2024 Afarand., IRAN

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ISSN: 2008-2630    Iranian Journal of War & Public Health 2018;10(3):165-171

Background
... [1-6]. The most common level of amputation of the upper limb, is cutting off at the level below the elbow. ... [7-15]. Among the types of upper limb prosthesis used to cut off the organs of this area, myolectric prosthetics is one of the most advanced types of prosthetics [12].
Previous Studies
Most people with upper limb amputations prefer to either use inactive prosthetics or not use prosthestics at all [16-18]. Of course, the satisfaction of upper limb prosthetics has been reported in variables in various studies [19]. ... [20-25]. The assessment of users' satisfaction with the service, which shows the effectiveness of the system, is very difficult and depends on the quality of orthotics and prosthetics and quality of service [26, 27]. As a result, satisfaction can be evaluated in two dimensions of the satisfaction of the "device" and the "service" [25], most of which studies assess satisfaction with the satisfaction of the prosthetics and have very limited studies in both areas of satisfaction with arterial and prosthetic instruments and services has been considered simultaneously in the world and especially in Iran [25, 28, 29]. ... [30, 31].
Aim(s)
The aim of this study was to assess the satisfaction of amputees under the elbow from myolectric prosthetics and prosthetic services referring to the Kosar center of orthotics and prosthetic of Tehran.
Research type
The present study is descriptive.
Research society, place and time
This research was carried out in the community of amputees with amputation under the elbow referring to the Kosar Prosthetic and Orthetic Center between 2001 and 2016, who received myolectric prosthesis or mycolectric prosthetic services.
Sampling method and number
A sample of 59 people was selected through convenience sampling method. The criteria for entering the study included having a history of use of the myolectric prosthetics, the amputee under the elbow, the health of the stomp and the minimum length of the stomp for the myoelectric prosthetics. Exit criteria also include the development of perceptual and verbal problems (or for any reason that it is not possible to provide correct answers), neurological and mental illnesses and mental, social or any problems with the receipt and use of disabling prosthetics, lack of satisfaction for cooperation, patient's lack of proper cooperation and patient fatigue in a way that was not responsive and unwilling to continue working.
Used devices&materials
To collect data, a demographic questionnaire including demographic information (gender, year of amputation, age, year of first prosthesis, year of receipt of the prosthesis, type of prosthesis used, type of prosthesis, amputation side and duration of prosthodontics) In the medical records of the patients was used, the for orthotics and prosthestics users' satisfaction, the questionnaire Orthotics and Prosthetic User Satisfaction (OPUS) was used to assess the satisfaction of veterans. The questionnaire's satisfaction questionnaire consists of 21 questions, of which 11 relate to the assessment of "satisfaction with arthrosis and prosthesis" and 10 items related to the assessment of "service satisfaction." The "device" section of the OPUS questionnaire provides users with satisfaction based on the proper fit, weight, durability, maintenance, ease of wear, appearance, convenience, wear and tear of clothes, pain when wearing a device, skin damage and repairable repair and ease of change. Customer satisfaction section is based on the degree of respect and respect by the employees, the staff response to concerns and questions, the concerns expressed, the teaching in use of the tool, the waiting time, the involvement of the users in the decision process, the discussion of problems, the receipt of appointments in a timeline, explanation for selection of the best device, the coordination of staff and therapists with physicians and orthotics and prosthetics facility in order to choose the most suitable instrument [30]. For this purpose, a Persian-made version of the mentioned questionnaire prepared by Haddadi et al. was used. Its reliability was 0.76 for satisfaction with the device, 0.9 for service satisfaction, and its validity for the satisfaction of device was 0.36, and 0.46 for the satisfaction of the service [32]. The questions were scored on the six-point Likert scale include "I do not know and it is not applicable" (zero score), "totally disagree" (point 1), "disagree" (point 2), "neither agree nor disagree" (point 3), "I agree" (point 4) and "Totally Agree" (point 5). For data collection, demographic questionnaire was filled out using a telephone call, and the OPUS questionnaire was completed. All questionnaires were completed by a questionnaire familiar with the OPUS questionnaire. Data analysis was performed by SPSS-20 software, using Kolmogorov-Smirnov test to examine the normal distribution of data. One-way ANOVA was used to examine the difference between the mean of the data of different groups in terms of age, amputation side and duration of use, and Spearman correlation test was used for correlation between age and duration of use of prosthesis with total satisfaction, prosthetic satisfaction and satisfaction of services.
Findings by Text
Of the 59 participating veterans, 42.4% were between the ages of 40-49 years, and only two were female veterans. At the time of the study, 50 veterans were using myoelectric prosthesis, and 9 people used other prostheses due to the destruction of myolectric prosthesis (Table 1). In the satisfaction of the prosthesis, the most satisfaction was related to the ease of wearing the myolectric prosthesis and the least satisfaction with the cost of the purchase and maintenance of the prosthesis by the individual. In the service satisfaction section, the highest satisfaction was related to the politeness and respect of the staff and the least satisfaction was associated with the coordination of the services of the clinic staff with the therapists and doctors. The satisfaction score of the device was 58.44%, service satisfaction, was 74.88% and overall satisfaction was 66.66%, which indicates the satisfactory condition of the veterans (Table 2; 105 scores of the questionnaire has been calculated and reported in the form of percentages).The mean score of overall satisfaction, satisfaction with prosthesis and satisfaction of services by users with different age groups, amputation and duration of use of prosthesis did not show any significant difference. There was no significant correlation between age with total satisfaction (p = 0.48), satisfaction with prosthesis (p = 0.19) and satisfaction with services (p = 0.42) (Table 3). There was no significant correlation between duration of use of prosthesis with general satisfaction (p = 0.39), satisfaction with prosthesis (p = 0.19) and satisfaction with services (p = 0.75).
Main comparison to the similar studies
In the device section, the satisfaction level of myolectric prosthesis was 58.44%, which showed that the satisfaction level of the myolectric prosthesis was more than average, while in the study of the level of acceptance of myolectric prosthesis, it has been reported as 83% [17]. Rotier also stated that the satisfaction of myolectric prosthesis was 80% [29]. Considering that some studies have reported the satisfaction of myolectric prosthesis by more than 80% [17, 29], this difference may be due to differences in the expectations of the amputees due to lack of adequate knowledge of myolectric prosthesis or because of dissatisfaction with the prosthesis or the provision of services and how to format. Also, how to provide training on the use of prosthetics and follow-up can be effective. Although there was no specific study on myolectric prosthesis, in the study of Qhasiri and Bahramian, which was carried out on the whole of orthotic and prosthetic devices, it was concluded that in the satisfaction section of the device, the highest satisfaction was with the proper fit The device, and the lowest one, was the satisfaction of the appearance of the device [30]. In the study of Magnusson et al., The achievement of orthosis and prosthetics center for serving, repairs and financial issues for commuting was a problem for patients in relation to services [33]. In another study in the service satisfaction section, the highest satisfaction was expressed with respect to the staff and the lowest satisfaction was with the coordination between employees, therapists and doctors [30], which was consistent with the current study. ... [34-36].
Suggestions
It is suggested that periodic follow-up courses for upper limb amputees, especially those using mycolectric prosthesis, should be carried out to assess the degree of satisfaction with the prosthesis and services regularly and if problems with prostheses or services appear, it should be resolved in the shortest possible time. Also, if there were any problems with prosthesis or servicing, there should be suggestions for improvement to the orthotics and prosthetics centers. It is also suggested that in studies, qualitative study of the dimensions affecting the satisfaction of prosthetic services of amputated individuals at different levels be considered.
Limitations
From the limitations of this study, there were problems in communicating with veterans and lack of access to them.
Conclusions
Overall satisfaction level, satisfaction of prosthesis and received services of amputees under the elbows referring to the Kosar Center of Orthotics and Prosthetics in Tehran, from myolectric prosthesis is good. The age, side amputation and duration of using the prosthesis have no effect on the satisfaction of the prosthesis and received services.
Acknowledgments
Since this article is from the student dissertation, all the professors of the University of Welfare and Rehabilitation Sciences and all friends and loved ones of the Veterans Engineering and Medical Sciences Research Institute who helped us in this project, as well as the great veterans who participated in this project, are appreciated by the authors.
Conflict of interest
Non-declared
Ethical Permissions
The Ethics Committee's in Bioethics Committee in the Foundation of Martyrs and Veterans Affairs has approved this study with Code 103-D-E-95. Information about the individuals was kept confidential and if he did not want to be accountable, he was apologized for it and was excluded from the study.
Funding Sources
The cost of this project (thesis) is provided by the University of Welfare and Rehabilitation Sciences.

TABLES and CHARTS

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