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The Long-Term Effects of a Medical Intervention: Determinants and Implications of Orthotic Equipment Failure in Uganda
Brief about:
Journal Article (2025)
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Other researchers:
Investigates the long-term effects of orthotic equipment failure on adults with disabilities in Uganda, examining determinants of failure and implications on subjective wellbeing.
Uganda, with a population exceeding 41 million, faces significant challenges in providing adequate rehabilitative care for individuals with disabilities. Despite improvements in life expectancy and reductions in infant mortality, disability prevalence remains high, with 1 in 7 Ugandans affected. Gender disparities are notable, with a higher prevalence among women (15%) compared to men (10%). The country is under-resourced, with only 19 Orthotic and Prosthetic (O&P) service centers across 72 districts. In regions like Acholi, Northern Uganda, the average distance to a referral hospital is 91 km, and less than 1% of patients are formally referred to rehabilitation services. The cost of lower limb assistive devices can reach up to US$400, significantly more than the average monthly household income of US$133, leading to only 26% of individuals with disabilities accessing rehabilitation services due to high costs.
The study addresses a gap in the literature concerning the long-term outcomes of orthotic interventions in developing countries. Previous research has predominantly focused on prosthetic interventions, with limited empirical evidence on orthotic outcomes. This study aims to fill this gap by evaluating a medical intervention conducted in 2012 in Kampala, Uganda, which provided orthotic equipment to 301 adults with lower limb disabilities. The research tracks these participants over six years to assess the determinants of equipment use and abandonment, and the impact on subjective wellbeing, including life satisfaction, health-related quality of life, and disability severity.
Key findings
- Women, older individuals, and those with access to follow-up care have a lower risk of orthotic equipment failure.Evidence
The study found that 37% of participants continued using their orthotic equipment six years post-intervention. Women had an 8.8% lower conditional probability of failure compared to men. Access to follow-up care reduced the hazard of failure by 8.5% points.
What it meansThese findings suggest that gender, age, and follow-up care are significant factors in the longevity of orthotic equipment use, highlighting the importance of continued care to improve device sustainability.
- Orthotic equipment failure negatively impacts subjective wellbeing.Evidence
Failure of the orthosis was associated with a reduction in life satisfaction and health-related quality of life, and an increase in disability severity. Specifically, equipment failure led to a decrease in life satisfaction by 0.31 points and HRQoL by 5.01 points, while increasing disability severity by 0.45 points.
What it meansThe negative impact of equipment failure on wellbeing underscores the need for interventions that ensure the durability and maintenance of orthotic devices to enhance the quality of life for users.
- Access to follow-up care improves subjective wellbeing by reducing disability severity.Evidence
Participants who received follow-up care experienced a reduction in disability severity, with a significant decrease of 0.11 points in the severity index.
What it meansFollow-up care plays a crucial role in mitigating the adverse effects of equipment failure on disability severity, emphasizing the need for sustained support post-intervention.
- Employment status and educational attainment positively influence subjective wellbeing.Evidence
Being employed was associated with a significant increase in life satisfaction (0.54 points) and HRQoL (7.79 points), while reducing disability severity by 0.28 points. Additionally, each extra year of schooling increased life satisfaction by 0.02 points and HRQoL by 0.20 points.
What it meansThese findings highlight the importance of socioeconomic factors in enhancing the wellbeing of individuals with disabilities, suggesting that interventions should also focus on improving employment opportunities and educational access.
Proposed action
- Expand and strengthen follow-up rehabilitation services to reduce the risks of orthotic equipment failureStep one
Invest in mobile or community-based rehabilitation outreach to serve remote regions where distance to referral hospitals is a major barrier
Step twoIntegrate follow-up care into primary healthcare services to ensure sustained support post-intervention.
Step threeTrain and deploy more orthotic and prosthetic professionals to underserved districts to help meet growing demand and improve access to care.
- Subsidize orthoses and integrate disability support with economic empowerment to reduce the costs of living with a disability and improve quality of lifeStep one
Implement targeted subsidies or voucher schemes for lower-limb orthoses to reduce out-of-pocket costs, especially for women and low-income households.
Step twoPair rehabilitation programs with skills training and job placement support for people with disabilities to boost long-term wellbeing and independence.
Step threeSupport inclusive education initiatives to improve long-term educational attainment and future health outcomes.
Helpful resources
- PublicationDisability in Uganda: a medical intervention to measure gendered impacts on functional independence and labour-market outcomesInsights on the short-term effects of the medical interventionVisit resource ↗
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The Long-Term Effects of a Medical Intervention: Determinants and Implications of Orthotic Equipment Failure in Uganda
Cite this brief: Abubakar, Aisha. 'The Long-Term Effects of a Medical Intervention: Determinants and Implications of Orthotic Equipment Failure in Uganda'. Acume. https://www.acume.org/r/the-long-term-effects-of-a-medical-intervention-determinants-and-implications-of-orthotic-equipment-failure-in-uganda/
Brief created by: Dr Aisha Abubakar | Year brief made: 2025
Original research:
- Abubakar, A., Bridges, S., & Owens, T., ‘The Long-Term Effects of a Medical Intervention: Determinants and Implications of Orthotic Equipment Failure in Uganda’ 0:1–15 (pp. 1–15) https://doi.org/10.1111/rode.13241. – https://doi.org/10.1111/rode.13241
Research brief:
Investigates the long-term effects of orthotic equipment failure on adults with disabilities in Uganda, examining determinants of failure and implications on subjective wellbeing.
Uganda, with a population exceeding 41 million, faces significant challenges in providing adequate rehabilitative care for individuals with disabilities. Despite improvements in life expectancy and reductions in infant mortality, disability prevalence remains high, with 1 in 7 Ugandans affected. Gender disparities are notable, with a higher prevalence among women (15%) compared to men (10%). The country is under-resourced, with only 19 Orthotic and Prosthetic (O&P) service centers across 72 districts. In regions like Acholi, Northern Uganda, the average distance to a referral hospital is 91 km, and less than 1% of patients are formally referred to rehabilitation services. The cost of lower limb assistive devices can reach up to US$400, significantly more than the average monthly household income of US$133, leading to only 26% of individuals with disabilities accessing rehabilitation services due to high costs.
The study addresses a gap in the literature concerning the long-term outcomes of orthotic interventions in developing countries. Previous research has predominantly focused on prosthetic interventions, with limited empirical evidence on orthotic outcomes. This study aims to fill this gap by evaluating a medical intervention conducted in 2012 in Kampala, Uganda, which provided orthotic equipment to 301 adults with lower limb disabilities. The research tracks these participants over six years to assess the determinants of equipment use and abandonment, and the impact on subjective wellbeing, including life satisfaction, health-related quality of life, and disability severity.
Findings:
Women, older individuals, and those with access to follow-up care have a lower risk of orthotic equipment failure.
The study found that 37% of participants continued using their orthotic equipment six years post-intervention. Women had an 8.8% lower conditional probability of failure compared to men. Access to follow-up care reduced the hazard of failure by 8.5% points.
These findings suggest that gender, age, and follow-up care are significant factors in the longevity of orthotic equipment use, highlighting the importance of continued care to improve device sustainability.
Orthotic equipment failure negatively impacts subjective wellbeing.
Failure of the orthosis was associated with a reduction in life satisfaction and health-related quality of life, and an increase in disability severity. Specifically, equipment failure led to a decrease in life satisfaction by 0.31 points and HRQoL by 5.01 points, while increasing disability severity by 0.45 points.
The negative impact of equipment failure on wellbeing underscores the need for interventions that ensure the durability and maintenance of orthotic devices to enhance the quality of life for users.
Access to follow-up care improves subjective wellbeing by reducing disability severity.
Participants who received follow-up care experienced a reduction in disability severity, with a significant decrease of 0.11 points in the severity index.
Follow-up care plays a crucial role in mitigating the adverse effects of equipment failure on disability severity, emphasizing the need for sustained support post-intervention.
Employment status and educational attainment positively influence subjective wellbeing.
Being employed was associated with a significant increase in life satisfaction (0.54 points) and HRQoL (7.79 points), while reducing disability severity by 0.28 points. Additionally, each extra year of schooling increased life satisfaction by 0.02 points and HRQoL by 0.20 points.
These findings highlight the importance of socioeconomic factors in enhancing the wellbeing of individuals with disabilities, suggesting that interventions should also focus on improving employment opportunities and educational access.
Advice:
Expand and strengthen follow-up rehabilitation services to reduce the risks of orthotic equipment failure
Subsidize orthoses and integrate disability support with economic empowerment to reduce the costs of living with a disability and improve quality of life