Provision of prosthetic and orthotic services in low-income countries: A review of the literature

Background: Disability is inextricably linked to poverty. A total of 80% of the disabled population lives in low-income countries. The demand for prosthetic and orthotic services in these countries is increasing, and a variety of methods to provide services are currently used. Objectives: To assess current models of provision to facilitate sustainable, evidence-based prosthetic and orthotic services. Study Design: Literature review. Methods: A literature search was performed through Medline (Ovid), PubMed, ISI Web of Knowledge, EMBASE and RECAL Legacy using combinations of subject heading and text word searching strategies. Full-text publications were critically appraised and ranked according to the Scottish Intercollegiate Guidelines Network guidelines. Results: Three areas were deemed pertinent to the research question. Studies were grouped into one or more of these categories based on the issues addressed: instigators, types of service provision, demographics and region-specific issues. It was found that many complex factors influence prosthetic and orthotic services in low-income countries. Demographic and regional idiosyncrasies require prosthetic and orthotic services to be tailored to address the specific needs of individual countries. Conclusions: The lack of and quality of available research made efficacy of methods used to provide services in low-income countries difficult to determine. Clinical relevance This review aims to highlight areas of best practice in prosthetic and orthotic services in low-income countries and to show where further research is required in order to develop evidence-based prosthetic and orthotic services.