Prosthetic Experience of Persons with Lower Limb Amputation in a Nigerian City

For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Prosthetic Experience of Persons with Lower Limb Amputation in a Nigerian City Arinze Christian Okonkwo1,3, Obiageli Cherry Nwanna2, Joseph Onuwa Umunnah1, Peter Olanrewaju Ibikunle1, Ebere Yvonne Ihegihu1, Stanley Monday Maduagwu1, and Chinwendu Vivian Okonkwo1. 1Medical Rehabilitation Department (Physiotherapy), Faculty of Health Sciences and Technology, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria. 2Department of Physiotherapy, Nigerian Navy Hospital Calabar, Cross-River State, Nigeria. 3Primary Care Physio, Seisdon Primary Care Network, Wolverhampton, United Kingdom. ABSTRACT Background: Despite literary works on prosthetic use and experiences following lower limb amputation, it appears that there is little or no data available in Nigeria. Objectives: To explore and correlate the levels of prosthetic experience, satisfaction, and adjustment to prosthetic use and physical activity among persons with lower limb amputation. Materials and Methods: This cross-sectional survey involved 60 individuals living with lower limb amputation recruited through the snowball sampling technique in Awka, Nigeria. Trinity amputation and prosthesis experience scale was used to assess for prosthetic experience, physical activity, satisfaction, and adjustment to prosthetic use. Inferential statistics of Spearman correlation and Mann-Whitney U were used to establish the relationship and comparisons respectively. The level of significance was set at <0.05. Results: A significant correlation exists between prosthetic experience and physical activity (p=0.0001), and adjustment to prosthetic use (p=0.01) but none with satisfaction with prosthetic use (p=0.90).There was no influence of age on prosthetic experience (p=0.271) and physical activity (p=0.074), gender has a significant influence on prosthetic experience (p=0.014) but not on physical activity (0.941). Amputation level has no significant influence on prosthetic experience (p=0.577) and physical activity (p=0.179). Duration of prosthetic use has no significant influence on prosthetic experience (p=0.144) and physical activity (p=0.220). Conclusion: High levels of prosthetic experience, satisfaction, adjustment to prosthetic use, and low levels of physical activity were prevalent among the studied participants. Keywords: Prosthetic experience; lower limb; amputation; satisfaction. OPEN ACCESS *Correspondence Arinze Christian Okonkwo Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria. Email: [email protected] Tel: +2348064137839. Article Metrics Submitted: 8 Dec 2024 Accepted: 12 June 2025 Published: Jan-June 2025 Citation: AC Okonkwo, OC Nwanna, JO Umunnah, PO Ibikunle, EY Ihegihu, SM Maduagwu et al. Prosthetic Experience of Persons with Lower Limb Amputation in a Nigerian City. Trop J Med Res. 2025:24(1);65-75. DOI: 10.5281/zenodo.17291938. Journal Metrics ISSN: p1115-0521, e3027-2890 Website: www.orientjom.org.ng E-mail: info. [email protected] Publisher: cPrint, Nig. Ltd Email:[email protected] Access Code www.tjmr.org.ng Original Article www.tjmr.org.ng 66 For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., INTRODUCTION mputation is an acquired condition characterized by the loss of a limb or part of it, typically due to injury, disease, or surgical intervention. [1, 2] In Nigeria, limb amputations are among the most frequently performed orthopedic surgical procedures and serve as a critical life-saving measure when limb preservation is not possible— particularly in patients who present late to healthcare facilities with advanced limb pathologies.[3] Thanni and Tade estimated the prevalence of extremity amputation in Nigeria at 10 per 100,000 population, with 70–90% of these involving the lower limbs.[4] A national review conducted over two decades ago identified the major indications for amputation as follows: trauma (34%), complications from traditional bone setting (23%), malignant tumors (14.5%), diabetic gangrene (12.3%), infections (5.1%), peripheral artery disease (2.1%), and burns (2.1%). [4] More recent evidence indicates a shift in these trends, with diabetic foot gangrene now emerging as a leading cause of limb amputation [6, 7], followed closely by trauma-related cases and complications arising from mismanaged fractures treated by traditional bone setters. [8, 9] This shift is consistent with global projections, which estimate a 50.7% increase in the prevalence of diabetes between 2011 and 2030—corresponding to an average annual growth rate of 2.7%, nearly 1.7 times higher than the annual growth rate of the global adult population. [10] Although amputation can be beneficial from a medical point of view, the loss of a limb may have a considerable impact on the patient’s health-related quality of life. This leads to a permanent disability and brings a dramatic change in the life and function of the individual. They, also, experience multiple challenges which can range from learning how to care for their amputated limb, how to walk, and how to adjust and cope with their limb loss. This changed situation is experienced more by the lower limb amputees than by the upper limb amputees [1]. Amputation is referred to as triple insult, as it brings loss of function, loss of sensation, and loss or change of body image [11].This dramatic change affects the quality of life of the individual due to the reduced involvement in physical activity following amputation; as well as has longer-term implications in varied facets of life. It also affects the individuals at the psycho-social level. Finally, it can have longterm economic implications on their lives and opportunities for employment [12].Previous study has shown that individuals with amputation suffer from poor health-related quality of life [13] and have recommended comprehensive social assessment and activity participation as needful for a better quality of life among individuals with limb amputation[13,14]. Prosthesis has to do with an artificial device fitted to replace a missing body part. A prosthetic device is designed for functional or cosmetic reasons or both [15], while experience according to Merriam Webster is defined as something personally encountered, undergone, or lived through [16]. Judging from these two definitions, one could define prosthetic experience as the personal encounter one has undergone or lived through while using an artificial device fitted to replace a body part. This type of personal encounter can only be acquired through prosthetic use. Prosthetic use has been examined in several prior studies [17, 18]. Two studies of transtibial (TT) and transfemoral (TF) amputees (primarily dysvascular) 1 year after surgery found a high rate of mean daily prosthetic use; Pohjolainenet al [17] Reported 9.3 hours of prosthetic use for women and 10.1 h for men 1 year after surgery [17], while Gauthier-Gagnon et al [18] found that 75 percent of subjects wore their prosthesis for 9h and 20 percent wore theirs for 4 to 8h. These results may be skewed to reflect the typical use patterns of a younger population with fewer comorbid conditions. Although limited, current data suggest that prosthetic use deteriorates over time in persons with dysvascular amputation.[19] A myriad of biopsychosocial factors may affect prosthesis use. Physical Health factors, such as phantom-limb pain, have been shown to result in fewer hours of prosthetic use per day [20], as have dementia, end A 67 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 stage renal disease (ESRD), and coronary artery disease [21]. Psychological factors such as selfefficacy, perception of symptoms, knowledge of treatment options, and balance confidence are associated with greater prosthetic use [22,23]. Lastly, social factors are important in understanding prosthetic use. Among the elderly, dysvascular persons with lower-limb amputation, both the presence of a family member at home and marriage predicted the likelihood of prosthetic fitting [24]. A large study of 752 people with lower-limb amputation found that married individuals or individuals living with a partner used prosthesis for more hours per day than people living alone [20]. Ambulation after lower limb amputation is usually restored by prosthetic devices. [26] Efforts have been made in the last decade to improve the prosthetic components and the rehabilitation programs for persons who lose a lower limb through amputation. [27] The goal of rehabilitation is the reintegration of these persons into their environment to pursue daily activities promoting bipedal functional displacements. [27, 28] The ambulatory function after lower limb amputation has been reported to significantly decline three months postoperatively [29] leading to mobility difficulties which affect activities of daily living (eg: household chores) and overall wellbeing including anxiety and depression [29, 12]. People with lower limb amputation due to diabetes have poorer psychological adjustments to their situation [30,31]. The amputation of lower limb may result in psychological difficulties in coming to terms with the stump and body image [31]. Many Outcome analyses of prosthetic rehabilitation have been reported in the literature [32].Evaluation of the impact of prosthetic rehabilitation, however, has relied mostly on the assessment of prosthetic use or disuse after discharge from rehabilitation. An understanding of prosthetic experience, that is use or disuse behaviour by persons with lower limb amputation, is necessary and possible only through the interpretation of associated variables predisposing, enabling, and reinforcing this behavior [33]. In a later study [38] on prosthetic users and their experiences, it was reported that participants described the process of learning to use a prosthetic limb as painful and arduous. Some participants even talked about hating their prostheses initially. However, Murray [37] found that adapting to prosthesis was an ongoing activity and that initial problems became more manageable over time. A growing number of studies highlight the importance of psychosocial support together with physical rehabilitation in facilitating patients’ prosthetic use [35, 39, 40]. Studies have noted that people with lower limb amputation who eventually use a prosthesis have their quality of life improved, in terms of overall well-being [37-39, 41]. Despite the above literary works on prosthetic use and experiences following lower limb amputation, it appears that there is little or no data available, to reference and consult, as regards the levels of prosthetic experience in a Nigerian city Awka. Therefore, this study intends, and was designed, to fill the missing gap and thus investigate the levels of prosthetic experience of individuals with lower limb amputation in Awka, Nigeria. METHOD Design: This was a cross sectional survey conducted in 2021. Study Participants Before the study began, ethical approval was obtained from the Ethics Review Committee of the Faculty of Health Sciences, NnamdiAzikiwe University Nnewi campus. The sample size of sixty was determined using G+ Power Statistical Package Version 3.0.1.0. Snowball sampling technique was utilized to recruit sixty participants. It is a non-probability non-probability sampling technique where research participants are asked to assist researchers in identifying other participants for a study and this research technique is used where potential participants are hard to find. Some of the participants were reached through the records of the Joint National Association of Persons with Disability (JONAPWD) in Awka and a private 68 For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., prosthetic fabrication clinic inAwka. They were traced to their respective places of residence through the contact address in the association records and the clinics contact records while some participants were also contacted with the help of some of the initial participants who were reached at their associations meeting points at the designated meeting centers. Inclusion and Exclusion Criteria: Included in the study were participants with lower limb amputation who could speak and understand the English language, and who have used lower limb prosthesis consistently for at least a month. Participants with inconsistent use of lower limb prosthesis, and those with disabling co morbidities were excluded. A written consent form which explained the aim and nature of the study issued to the participants. Participants were assured of confidentiality before having their data collected. Data Collection The participants demographic data such as age, sex, level of amputation, and duration of use of prosthesis were collected and recorded. The reversed Trinity Amputation and Prosthetic Experience Scale (TAPES-R) was then intervieweradministered. The TAPES-R was used for this research because it was recommended by the International Society for Prosthetics Orthotics (ISPO) COMPASS Report that was recently released. The TAPES-R is a multidimensional assessment scale designed to facilitate examination of the psychosocial processes involved in adjusting to prosthesis and the specific demands of wearing prosthesis. The TAPES-R comprises of two parts (Part I and Part II) but only the part I was used for this study, which consists of 3 Subscale; the Psychosocial subscale, the Activity restriction subscale, and the Satisfaction with prosthesis subscale. The psychosocial subscale has 15 items merged into three scales (general adjustment, social adjustment, and adjustment to limitation). The items were measured along a 5-point rating scale (strongly disagree, disagree, neither agree nor disagree, agree, strongly agree). Scores range from 5 to 25, with higher scores indicating greater levels of adjustment. The general adjustment, social adjustment, and adjustment to limitation subscales scores were summed up to produce the psychosocial adjustment subscale. The second section comprises 10 items which are subdivided into 3 scales an activity restriction which suggests physical activity restriction such as ‘going to work’, ‘sport and recreation and athletic activity restriction such as walking more than a mile or participating in strenuous sports. These 10 items were measured along a 3-point rating scale (not at all limited, limited a little, limited a lot). Scores range from 0 to 2, with higher scores indicating greater activity restriction. The scores of all the activity restriction subscales were summed up to produce the physical activity restriction subscale. The third section consists of Satisfaction with the Prosthesis and comprises 9 items, which are subdivided into three scales, the aesthetic characteristics with 3 items suggesting aesthetic satisfaction such as ‘color, shape, and appearance, and the functional characteristics of the prosthesis with 5 items suggesting functional satisfaction such as ‘weight, reliability, fit, usefulness and comfort and the global satisfaction scale of 0-10 with( 0 for not at all satisfied to 10 for very satisfied).These 9 items were measured on a 3-point rating scale (not satisfied, satisfied, and very satisfied), scores range from 1 to 3 with higher scores indicating greater satisfaction. The items of the functional, aesthetic, and global prosthesis satisfaction subscales were summed up to produce the overall satisfaction with prosthesis subscale. The total of these 3 subscales; psychosocial adjustment subscale, activity restriction subscale, and satisfaction with prosthesis subscale made up the prosthetic experience in this study. They demonstrated a validity of r= 0.733, and reliability internal consistency of 0.865, 0.838, and 0.763 [43]. Part II of the TAPES-R was not used in this study because the study was majorly concerned with the levels of prosthetic experience of the participants. 69 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Data Analysis The data obtained from this study were coded in Microsoft Excel and summarized using Statistical Package for Social Sciences (SPSS) for Windows, version 20[32]. This was subsequently analyzed using the descriptive statistic of mean, standard deviation, proportion, and frequencies. Inferential statistics of the Mann-Whitney U and KruskalWallis tests were used to compare levels of prosthetic experience, satisfaction and adjustment to prosthetic use, and physical activity restriction. Spearman’s rank correlation was used to establish the relationships between the variables. The level of significance was set at<0.05. RESULTS A total of 60 people participated in this study. On the majority were participants aged 71-80 years (30%), males (68.3%), below knee amputation (70.0%), 13years period of prosthetic use (48.3%) (table 1). Table 1: Participants socio-demographic and some clinical profiles Variables Category Frequency (n) Percentage (%) Age 21-30 years 1 1.7 31-40 years 4 6.7 41-50 years 7 11.7 51-60 years 16 26.7 61-70 years 14 23.3 71-80 years 18 30.0 Gender Male 41 68.3 Female 19 31.7 Level of Amputation Below knee 42 70.0 Above knee 18 30.0 Duration of prosthetic use 1-3 years 29 48.3 4-6 years 20 33.3 7-9 years 4 6.7 10 years and above 7 11.7 The majority of the participants had a high level of experience on prosthetic use (71.7%), a high adjustment level (78.3%) and high Satisfaction level (63.3%), low physical activity level (53.3%) following prosthetic use (Table 2). Table 2: Participant’s levels of Prosthetic experience, adjustment, satisfaction, and physical activity. Variable Category Frequency (n) Percentage (%) level of prosthetic experience Low 17 28.3 High 43 71.7 Adjustment level Low 13 21.7 High 47 78.3 Satisfaction level Low 22 36.7 High 38 63.3 physical activity level Low 32 53.3 High 28 46.7 There was a significant correlation between participants’ prosthetic experience with their physical activity level (r= -0.514; p=<0.001), participants’ prosthetic experience with their adjustment level (r= 0.261; p=0.01). However, there was no significant correlation between participant’s prosthetic experience with their Satisfaction level (r= -0.017; p=0.90) (Table3). Table 3: Correlation between participant prosthetic experience, adjustment, satisfaction, and physical activity Variable N rValue p-value Prosthetic Experience VS Adjustment 6 0.261** 0.01 Satisfaction 60 -0.017 0.90 physical activity 60 -0.514** 0.00 r: Spearman’s rank correlation, Correlation is significant at p< 0.05 70 For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., Participants who aged between 21-30years had the highest mean score (39.0) on prosthetic experience, while those between 51-60 years had the highest mean score (38.8) on physical activity level. However, there was no significant influence of age on prosthetic experience (p= 0.271) and physical activity level of participants (p=0.074) (Table 4). There was a significant influence of sex (p= 0.014) on the prosthetic experience of the participants but not on physical activity level (p=0.941) (Table 4). In table 4 and table 5, satisfaction to prosthetic use and adjustment to the use of prosthesis was not included because the researchers specifically wanted to compare the level of prosthetic experience and physical activity of the participants against their age, sex, level of amputation and duration of prosthetic use to determine which age range had a high level of prosthetic experience and physical activity, if males or females had a higher or lower level of prosthetic experience and physical activity, if below knee amputees had a higher level of prosthetic experience and physical activity than above knee amputees or vice versa and if participants who had used prosthesis for a longer duration had a higher level of prosthetic experience and physical activity than participants who had used it for a shorter duration. Table 4: Comparisons of age and gender on the participants of prosthetic experience and physical activity. Variable Category N Mean Rank K P-value Prosthetic experience 21-30 years 1 39.00 6.379 0.271 31-40 years 4 24.00 41-50 years 7 26.14 51-60 years 16 25.88 61-70 years 14 34.71 71-80 years 18 34.00 Physical Activity 21-30 years 1 14.50 10.03 0.074 31-40 years 4 37.00 41-50 years 7 31.64 51-60 years 16 38.88 61-70 years 14 25.21 71-80 years 18 26.17 Prosthetic experience Male 41 28.76 318.5 0.014 Female 19 34.26 Physical Activity level Male 41 30.60 385.0 0.941 Female 19 30.29 No considerable influence of Level of Amputation, and duration of use of prosthesis was observed on physical level and prosthetic experience of participants. (Table5) Table 5: Comparisons of prosthetic experience and physical activity to Amputation level, Amputation cause, and duration of prosthetic use. Variable Categories N Mean Rank U/K p-value Prosthetic experience BK 42 31.14 351.0 0.577 AK 18 29.00 Physical Activity BK 42 28.79 306.0 0.179 AK 18 34.50 Prosthetic experience 1-3 years 29 28.66 5.411 0.144 4-6 years 20 36.00 7-9 years 4 24.00 10 years and above 7 26.14 Physical Activity 1-3 years 29 34.16 4.414 0.220 4-6 years 20 26.50 7-9 years 4 22.00 10 years and above 7 31.64 Key: AK =Above Knee, BK=Below Knee 71 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 DISCUSSION Participants’ Socio-demographic and Clinical Profile Sixty persons (male 68.3%, female 31.7%) with lower limb amputation were involved, implying a preponderance of males. Similar findings have previously been established in the literature [3, 44, 45,46]. Events that may have predisposed males to lower limb amputation seems more common within the environments such as motorbike riding, tricycle riding, and commercial transport activities which may be devastating because of the deplorable conditions of roads in the environment. Most of the participants were between the ages of 51-70 years which is similar to a previous study [46] in which the majority fell within the age range of 61-70 years. At this age, there seems to be a decline in the routine physiologic strength of an individual and even exposure to age-related co-morbid conditions such as type II diabetes capable of exposing individuals to limb amputation if not properly controlled. Findings from this study also showed below-knee amputation to be prevalent (70.0%) thereby reflecting the trend in the literature [45, 46] regarding levels of lower limb amputation. Participants' levels of Prosthetic experience, satisfaction, adjustment to prosthetic use and physical activity As revealed by the study, the level of prosthetic experience is high (71.7%). This implies that most of the studied participant were accustomed to prosthesis over time. Similar findings exist in a work reported by Akosile et al [45] whereby a lot of ambulation categories such as wheelchairs, crutches, and prostheses were identified as being used by persons with lower limb amputation. This finding is also in agreement with a study done by Gallagher, P. and MacLachlan [46] which also revealed an elevated level of prosthetic experience. High prosthetic experience in Awka community as established in this study signifies improvement in the knowledge, application and clinical utility of functional and ambulatory dimension of amputee rehabilitation. This study thus also reveals that the adjustment level and satisfaction level were high. For adjustments, this implies that most participants have gotten well fitted and used to wearing prostheses. This agrees with the study conducted by Gallagher and MacLachlan[47], which shows a high adjustment level. For satisfaction, it means that the majority of the participants were contented with the color, shape, cosmetic appearance, and overall use of the prosthesis. These findings were also reported in a previous study by Sinha et al [48] which also revealed an elevated level of adjustment and satisfaction with prosthetic use. These findings imply that ambulation following lower limb amputation has gotten better and that amputees can be seen to be less dependent in moving from one place to another in this environment and in carrying out basic activities of daily living such as walking. The physical activity level of the studied participants is low (53.3%), which means that the majority of them were restricted in doing physical activities, vigorous activities such as running, lifting heavy objects and participating in strenuous sports, climbing one or several flights of stairs, running for a bus, sports, and recreation, walking more than a mile, walking half a mile, walking a hundred meters, working on hobbies, going to work. This finding concurs with the output of previous studies [45, 47] also reported a low physical activity level. Similarly, a significant correlation exists between prosthetic experience and physical activity, implying that prosthetic experience supposed to have bettered the lots of the participants in experience and satisfaction level, meaning that there may be attributes of satisfaction which may have affected the prosthetic experience such as the weight of the prosthesis, reliability, fit and comfort. Participants whose prosthesis limited them from working on hobbies, going to work, and participating in sports activities, thereby reducing their physical activity level also showed low prosthetic experience. This agrees with a previous study done by Mathi et al [1] which showed many of them were limited a lot in engaging in vigorous activities, such as running, lifting heavy objects, and participating in strenuous sports which may have contributed to their similarity. This present study also shows there was no significant 72 For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., relationship between the Satisfaction level and prosthetic experience of persons with lower limb amputation. Most participants were not satisfied with color, shape, and appearance (aesthetic satisfaction). In a similar study poor satisfaction was associated with more proximal amputation level, younger age, and black race [49]. The result from this study showed that age and gender did not influence the physical activity level of persons living with lower limb amputation. This is in agreement with a previous study [44, 45] which showed no significant influence between age and gender on physical activity level as both old and young and males and females were limited from engaging in vigorous activities and participating in a sport which also revealed that there may be other factors that could influence physical activity, which play a major role in participation restriction among persons with lower limb amputation. Moreover, this present study revealed that age had no significant influence on the prosthetic experience of the participants while females had a significantly higher score than their male counterparts. This however differs from a previous study [48] on adjustments to amputation and an artificial limb in lower limb amputees which found that both age and gender had significant influence on the prosthetic experience of the participants [48]. This present study also shows that no significant difference exists in Levels of Amputation, physical activity and prosthetic experience of the participants, implying that participants’ activity restriction and level of experience using a prosthesis are not dependent on amputation level. This study however differs from a previous study done by Luza et al [50] on the Psychosocial and physical adjustments and prosthesis satisfaction being expressed by below knee amputees: This present study is also like another previous study which reveals that amputation level affects physical balance, prosthesis satisfaction, and physical activities [51]. However, no significant difference was seen between the levels of amputation on the prosthetic experience of participants. This result differs from this present study [49]. This present study also shows that no significant influence on the duration of use of prosthesis was observed on the physical activity level and prosthetic experience of participants. This seems to suggest that the needs of users may change over time, and so requirements that were satisfactory at the time of fitting will not be later on. The implication of this is that if this need is not monitored and met, prosthetic use may decline and lead to social isolation. The involvement of only participants who could speak and understand English language may have affected the sample size. Thus feature studies may have to get the questionnaire translated to the native language of the studied environment so to have a robust sample size. The study has hitherto provided previously unavailable data on the levels of prosthetic experience, satisfaction, and adjustment to prosthetic use and physical activity in the lives of persons with lower limb amputation in a Nigerian City of Awka. Clinicians involved in rehabilitation, prosthetic training and fitting of individuals with amputation should routinely evaluate their physical activity restriction level and device appropriate intervention to address their needs in this area. The government and its agencies can also help accomplish the provision of affordable prosthetic aids with proper fittings as some individuals are not satisfied with the weight and color of their prosthetic limbs. CONCLUSION High levels of prosthetic experience, satisfaction, adjustment to prosthetic use, and low levels of physical activity were prevalent among the studied participants Acknowledgement: The authors hereby sincerely appreciate the assistance of the patients who participated in the research. Author contributions: ACO, JOU, POI and EYI conceptualized and designed the study. ACO and OCN contributed to implementation of the project and revision of the manuscript. All authors were involved in the writing and revision of the 73 Prosthetic experience of persons with lower limb amputation Okonkwo AC et al., For Reprint: [email protected] Trop J Med Res, Vol. 24, No. 1, 2025 manuscript. The authors read, approved the final manuscript and agree to be accountable for all aspects of the work. Data availability: The data used to support the findings of this study are available from the corresponding author upon reasonable request. Funding: No funding sources. 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