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Community Perception and Acceptance of Patients with Prosthetic Devices After Disabilities in Riyadh, Saudi Arabia

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Community Perception and Acceptance of Patients with Prosthetic Devices After Disabilities in Riyadh, Saudi Arabia Community Perception and Acceptance of Patients with Prosthetic Devices after Disabilities in Riyadh, Saudi Arabia Mohammed Ibrahim Alhumaidan ( [email protected] ) King Saud bin Abdulaziz University for Health Sciences https://orcid.org/0000-0002-4067-6262 Wazzan S. Al Juhani Ministry of National Guard Health Affairs Abdulmohsen A. Al Hussaini King Saud bin Abdulaziz University for Health Sciences Hussam S. Al Angari King Saud bin Abdulaziz University for Health Sciences Saad Z. Al Jabr King Saud bin Abdulaziz University for Health Sciences Abdullah F. Al Karni King Saud bin Abdulaziz University for Health Sciences Research Article Keywords: Prosthesis, Rehabilitation, Community Acceptance, Disability Posted Date: June 15th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-602684/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/11 Abstract BACKGROUND: It is well known that prostheses help people with special needs to adapt and have a better quality of life; however, the community’s perception and acceptance of patients with prosthetic devices due to their disabilities have not been fully assessed. The aim was to measure the community’s perception and acceptance of patients with prosthesis in Riyadh, Saudi Arabia. METHODS: A cross-sectional study was conducted from late 2019 using an online self-developed questionnaire, named the “Prosthesis Acceptance Assessment Test” (PAAT), which was developed in English for 20 items on a ve-point Likert scale. The questionnaire was validated with a Cronbach’s score of 0.913 and a pilot was initially conducted on a sample (n=50). Thereafter, the questionnaire was distributed via social media for a wider reach within the community. The result of descriptive analysis was presented as a frequency with percentages. Categorical data were tested using chi-square or Fisher’s exact test. Continuous variables were tested for mean differences using students’ t-test and association using Pearson’s correlation. ANOVA was used to determine the difference in the mean scores of acceptance rates by educational status. A p-value less than 0.05 was considered signicant. RESULTS: A total of 526 participants responded to the questionnaire, of which only 68 (12.9%) participants knew someone who had a prosthesis. The majority of participants were females (n= 292, 55.5%) and bachelor’s degree holders (n= 90, 26.1%). The acceptance rates were slightly higher in females (n= 78, 26.7%) than males (n= 58, 24.8%), with most participants (n= 390, 74.1%) not accepting of people with prosthesis. The mean scores of acceptance rates did not correlate with age (r2= 0.025, P= 0.565), and was not statistically signicant when compared by gender (T= -1.688, P=0.092) and educational status (x2 = 0.105, P = 0.907). CONCLUSION: We found that most participants were not accepting of people with prosthesis. Reasons were not explored as there were no age, gender, or educational status differences that may have potentially explained the low rate of acceptance. Background Prostheses are articial devices that enable people who suffer the loss of a body part due to trauma, disease (i.e., gangrene), or congenital conditions to function as normal humans and cope with life. The rst prosthesis in history was a toe. It belonged to a noblewoman in Egypt, and dated back to 950 − 710 B.C.E. (1) There are two general types of prosthesis: cosmetic and mechanical. The cosmetic prosthesis does not restore the function of the organ, but improves the patient’s appearance after the loss of a body part. For example, people who have lost an eye use an ocular prosthesis as an aesthetic solution, yet this kind of prosthesis does not restore eyesight. Mechanical prosthesis is used to restore the normal function of a missing body part. (2) An example of that would be the prosthetic lower limb. Page 2/11 A person who has lost a body part is generally seen as a person with disability. Disability is dened as “physical or mental impairment that substantially limits one or more major life activities of such individual”. Therefore, patients with prosthetic devices fall under this category. These patients suffer physically and psychologically from loss of normal function. The psychological effects may be aggravated by positive or negative community acceptance. Generally, patients who get prostheses start to function normally, hence, they should be accepted as normal. However, some people do not change their perspectives and continue to view them as people with disability, which leads to discrimination in different settings, such as workplaces and social events. For example, patients with articial limbs may not get the job they qualify for, regardless of credentials. Furthermore, they may not be accepted as potential spouses. Thus, I decided to measure the community’s perception and acceptance of people with prosthesis based on different variables in Riyadh, Saudi Arabia. A study on the inclusion of people with disability in the labor market in Brazil concluded that despite government issued bylaws, people with disabilities still face challenges such as preconceived ideas, discrimination, and lack of access in the labor market.(4) A different study stated that prosthetic upper and lower limbs have changed greatly over the past years. The rehabilitation of amputees had greatly beneted from the advanced technology leading to more independent life for patients with prosthesis.(5) Studies revealed that 89% of amputees returned to work after an amputation(6); furthermore, job reintegration was successful in 79% of the amputees. Signicant indicators of successful job reintegration included age at the time of amputation, wearing comfort of the prosthesis, and education level. Subjects who changed from physically demanding jobs, post-amputation, successfully returned to work more often than subjects who tried to stay at the same type of job.(7) Although amputee patients had a relatively good rate of job participation, they reported long delay between amputation and return to work, problems in nding suitable jobs, fewer possibilities for promotion, and diculty obtaining the requisite workplace modications. Amputee patients who had to stop working experienced a decline in health compared to those who continued working.(8) A study projected that the number of people living with the loss of a limb will more than double by the year 2050 to 3.6 million.(9) A 14-year retrospective study was conducted on 3210 amputees who were admitted from 1977–1990 at the Riyadh Medical Rehabilitation Centre (RMRC), which is the rst and largest rehabilitation center in the Kingdom of Saudi Arabia. The mean age was 30.5 years, male slightly older than female. The mean age of the lower limb amputees was 32.6 and of the upper limb amputees 21.8 years. An overall predominance of male to female with a ratio of 6.1:1 was observed. Males outnumbered females by 5 to 1 in the upper limb and 6.3 to 1 in lower limb amputees. The ratio of lower limb to upper limb and multiple limb amputees was 15:3.7:1. Trauma was the leading cause of upper limb amputations (86.9%). (10) Based on this literature review, to my knowledge, there are no available data in Saudi Arabia regarding Page 3/11 community’s perception and acceptance of patients with prosthetic body part, especially in the three desired domains: marriage, friendship, and employment. After formulating the thesis, I assessed community’s perception and acceptance of people with prosthesis based on different variables in Riyadh, Saudi Arabia. This study estimates the prevalence of community acceptance of patients with prosthetic devices and compares the difference in acceptance based on demographic characteristics, including gender, education level and age. Methods Study Aim, Design, and Setting: The aim of the study was to measure the community’s perception and acceptance of patients with prosthesis. This is a cross-sectional study that was performed using an online questionnaire through Google Forms in order to obtain data from the online community in Riyadh, Saudi Arabia. Those participants were questioned using an online questionnaire which was distributed in social media to facilitate data collection. The questionnaire included 20 Questions to assess three domains (Marriage, Employment, Friendship). Furthermore, the online questionnaire was chosen in order to obtain samples with different backgrounds, such as level of education and people who are living in urban areas and those who are not. Identication of study participants: The initial inclusion criteria were as follows: Saudi males/females above the age of 18 living in Riyadh. All participants were reviewed and those with intellectual disability or amputation were excluded. Of the 2.8 million population of Riyadh who are above 18 years with a condence level of 95% and margin of error of 5%. Assuming there are no previous studies, the prevalence rate of acceptance is 50%. The representative sample of the population is 384 as calculated using the SurveyMonkey sample size calculator. The sample size was increased to 526 after data collection. This study used a nonprobability convenience sample for participants who are willing to participate on their own and meet the inclusion and exclusion criteria. Data collection process: The research team used a self-developed questionnaire that was distributed through social media, using an online survey targeting adults who are above 18 years of age. The questionnaire consisted of 20 questions to assess three dimensions of community acceptance of people with prosthesis in: marriage, friendship, and as an employee. The questionnaire was validated using the Cronbach’s alpha test and scored 91, which is considered excellent. An English questionnaire was developed, which was translated into Arabic and then back to English, with the help of a specialized center. Data analysis: Page 4/11 The assessment of community acceptance of people with prosthesis was measured by the Prosthesis Acceptance Assessment Test (PAAT), which is 20 items on a ve-point Likert scale.
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