CBR 2018 Pilot Program for People with Amputations in Guatemala

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The Range of Motion Project (ROMP) conducted a six-month community-based rehabilitation (CBR) pilot program in Guatemala in 2018 that was designed to improve the multifaceted mobility of its patients with amputations through specific objectives of improving their physical and mental health, physical mobility, livelihood, and quality of life.

Jonathan Naber, chief program officer with ROMP in Guatemala, highlighted the results of that CBR pilot project during the American Orthotic & Prosthetic Association (AOPA) National Assembly in San Diego September 25-28.

The eight patients who participated in that CBR project had received their protheses at the ROMP clinic and lived in Guatemala. An in-depth screening was conducted, and a needs-based intervention plan was created for each patient. As part of the pilot program, a small team of community rehabilitation workers (CWRs) visited each patient in their homes twice a month and followed a protocol that monitored and addressed the patient's general health, mental health, prosthesis, physical therapy, and intervention, Naber said. Outside those visits, the CWRs coordinated special services according to the needs of each patient, which could include services in medicine, nutrition, dentistry, psychiatry, prosthetic care, self- and wage-employment, and law, as well as vocational training among others. The participants were also trained in strategies for accessing services and caring for themselves as they graduated from the pilot study, Naber said. Data was collected at the beginning, middle, and end of the intervention to determine its impact on the aim and objectives of the CBR pilot, he said.

The subsequent data showed "wide-ranging and important signals of improvement" in the physical health, mental health, physical mobility, livelihood and quality of life for the group in the program, with limited signs of decline or, in some cases, no change at all, Naber said. "[The results showed that] CBR could be an effective way to improve the outcomes of patients with amputation," he said. However, more studies with higher statistical powering are needed to establish statistically significant evidence for the effectiveness of CBR, Naber said.

In addition to the effect on the participants during the 2018 pilot project, ROMP CBR methodologies and tools were developed, laying the foundation for the permanent operation of the program in Guatemala, as well as its adaptation to other countries, Naber said. Given the results of the CBR pilot, ROMP also decided to continue and expand its CBR program in Guatemala and launched a second cohort of CBR participants in February with an improved protocol and wider geographical reach, he said.