Keep moving: Training tools for the prevention and management of amputation in Pacific Island nations
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Publication: Prosthetics and orthotics international
Start Page: 119
Background: Seven of the top ten countries in the world for diabetes prevalence are Pacific Islands Nations (IDF 2013); countries that are arguably least equipped to meet the challenges associated with effectively managing diabetic foot problems and high rates of amputations. There is a limited health workforce to provide amputation prevention services and specialists are not existent in many countries. Further, access to rehabilitation services after an amputation is extremely limited. Aim: To identify and develop resources that could assist in the prevention of diabetic related lower limb amputation and support the return to mobility of men and women who have had an amputation.
Method: The project began with an analysis of the prevention and management of lower limb amputation; including identification of six phases and a range of interventions possible during each phase. A literature search was undertaken to identify related training tools and resources freely available for the health workforce in the Pacific region. Priority areas were then identified by a working group of stakeholders from Pacific Island Nations and resources developed addressing these priority areas. The resources were peer reviewed; piloted in one country (Kiribati); and tested by stakeholders in three countries by means of tablet technology.
Results: Training resources were developed for three priority areas; offloading foot ulcers, shoes for healthy feet and mobility without a prosthesis. Each topic is structured into three areas: 1) Learn, resources targeted at health and rehabilitation personnel to learn new skills and knowledge, 2) Teach tools for personnel, to facilitate their education of clients and 3) Advocate and share, resources that personnel could use with local adaptation to raise awareness amongst managers of the rationale for services, and human and physical resource requirements to implement specific interventions (for example off-loading). Feedback has been positive, with stakeholders noting content developed is appropriate and resources are easy to understand and follow. The three organisations trialling the tablets noted the use of tablets reinforced and strengthened the practise of providing client education, made client education easier; and were useful to share with and educate fellow health professionals.
Discussion & Conclusion Stakeholders identified many gaps regarding training resources for the prevention and management of amputation in their region. The tools developed through the Keep Moving project have begun to fill this gap. However further development of the remaining topics, development of video tools and increased support to use the resources would be beneficial to increase the impact and improve amputation prevention and management efforts in the region.