Access to health and rehabilitation services for persons with disabilities in Sierra Leone - focus group discussions with stakeholders.

BACKGROUND: In Sierra Leone persons with disabilities are at higher risk of living in poverty and have poor access to a fragile healthcare and rehabilitation services. The aim was to explore stakeholders' perceptions of access to health and rehabilitation services for persons with disabilities in Sierra Leone. METHODS: Seven focus group discussions, including stakeholders working within the field of disability was conducted. RESULTS: The subthemes were: continuous stigmatisation of persons with disabilities throughout life; long distances and transportation issues to access health and rehabilitation facilities; financial constraints; infrastructural barriers to healthcare and rehabilitation services and healthcare personnel's negative attitudes and inadequate knowledge towards persons with disabilities; rehabilitation and healthcare facilities lacking materials to provide quality services; lack of specialised services and rehabilitation personnel for complex rehabilitation and the need for continuous education of new and current rehabilitation personnel. CONCLUSION: Local actors need to take charge and renew efforts made by international organisations by providing trained rehabilitation staff and quality rehabilitation services. Rehabilitation services need to be affordable and transportation costs covered for persons with disabilities to access healthcare and rehabilitation services. Continuous education of the public and health personnel about disability is necessary to reduce negative attitudes towards persons with disabilities.

Quality of life of prosthetic and orthotic users in South India: a cross-sectional study.

BACKGROUND: The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education. METHODS: A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann-Whitney U and the Kruskal-Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment. RESULTS: Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment. CONCLUSIONS: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

Patients' Satisfaction with Lower-limb Prosthetic and Orthotic Devices and Service delivery in Sierra Leone and Malawi.

BACKGROUND: People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients' satisfaction with assistive devices and associated services in the entire study group from these two low-income countries. METHODS: Questionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi. RESULTS: Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7-3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received. CONCLUSIONS: Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.

Coordination of health and rehabilitation services for person with disabilities in Sierra Leone - a stakeholders' perspective.

PURPOSE: To explore stakeholders' perceptions of the coordination of health and rehabilitation services for persons with disabilities in Sierra Leone. MATERIALS AND METHODS: A qualitative study including seven focus group discussions with health, rehabilitation, and disability organisations stakeholders in Sierra Leone. Content analysis was used for data analysis. RESULTS: One theme emerged; poor governance in implementing disability policies, healthcare, and rehabilitation services, which included seven subthemes: insufficient implementation of healthcare policies for persons with disabilities; changes, lack of coordination and communication between ministries governing disability policies and rehabilitation services; need for accurate disability data and clinical record keeping; absence of funds and poor political priority to healthcare and rehabilitation services; continuous support for non-governmental organisations (NGOs) to provide healthcare and rehabilitation service delivery; lack of coordination between different healthcare and rehabilitation service providers and calling for increasing persons with disabilities capacity for greater inclusion in society. CONCLUSIONS: Increasing governmental prioritisation, and ensuring coordination and trust between donors, NGOs, and governmental programmes were keys for sustainable health and rehabilitation services. Stakeholders need to ensure national coverage and equally distributed health and rehabilitation services. Including rehabilitation services and assistive technology in the Free Healthcare Initiative would contribute to implementing the Disability Act. Implications for rehabilitationPolitical prioritisation of persons with disability (PWD) need to increase to provide national coverage and equally distributed health and rehabilitation services for PWD.To ensure access to rehabilitation services and access to basic assistive technology for PWD, the government of Sierra Leone could agree on basic rehabilitation services and a priority list of assistive devices to be distributed through rehabilitation centres and funded by the Free Health Care Initiative programme or the Sierra Leone health insurance scheme.To increase access to health services for PWD, the government of Sierra Leone could ensure inclusion of PWD in the Free Health Care Initiative programme.The government, donors, and organisations providing or funding health and rehabilitation services for PWD need to mobilise and coordinate resources better and be mutually held accountable to maximise the benefits of PWD resources.

Health care professionals' experiences and perceptions of health promotion through the health dialogue intervention in the scania region, Sweden: a qualitative interview study.

BACKGROUND: Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden. METHODS: The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used. RESULTS: The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care". CONCLUSIONS: Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process.

Experiences accessing and using rehabilitation services for people with physical disabilities in Sierra Leone.

PURPOSE: To explore the experiences of persons with physical disabilities accessing and using rehabilitation services in Sierra Leone. MATERIALS AND METHODS: Interviews of 38 individuals with differing physical disabilities in three locations across Sierra Leone. An inductive approach was applied, and qualitative content analysis used. RESULTS: Participants faced several barriers to accessing and using rehabilitation services. Six themes emerged: The initial and ongoing need for rehabilitation throughout life; challenges with the cost of rehabilitation and transportation to reach rehabilitation services; varied experiences with rehabilitation staff; coming to terms with disability and encountering stigma; the struggles without and opportunities with rehabilitation services; and limited knowledge and availability of rehabilitation services. CONCLUSIONS: There is a continued need to address the barriers associated with the affordability of rehabilitation through the financing of rehabilitation and transportation and exploring low-cost care delivery models. Rehabilitation services, assistive devices, and materials need to be available in existing rehabilitation centres. A national priority list is recommended to improve the availability and coordination of rehabilitation services. Improved knowledge about disability and rehabilitation services in the wider community is needed. Addressing discriminatory health beliefs and the stigma affecting people with disabilities through community interventions and health promotion is recommended.Implications for RehabilitationFinancing for rehabilitation, transportation to services and low-cost delivery models of care areneeded to reduce financial barriers and increase affordability of access and use.Community interventions and health promotion can provide information about the utility and availability of rehabilitation services, while addressing health beliefs and stigma towards persons with disabilities.The availability of both rehabilitation services and information, that is relevant and accessible is required to facilitate improved access and use of rehabilitation services.

Access to basic needs and health care for Malawian prosthetic and orthotic users with lower limb physical disabilities: a cross-sectional study.

PURPOSE: To investigate access to basic human rights such as health, a standard of living adequate for health, education, work, marrying and establishing a family, and voting for prosthetic and orthotic users with lower limb disabilities in Malawi. MATERIALS AND METHODS: A cross-sectional design and a questionnaire were used to collect data from 83 participants. RESULTS: Most participants reported their overall physical and mental health as good (60 [72%] and 50 [60%], respectively) and said they could access medical care (69 [83%]). Fifty (60%) participants had access to food, 72 (87%) had access to basic water, and 55 (66%) lived in housing adequate for their health. Most participants had studied in school (74 [89%]) but only 27 (33%) of the participants were working. Forty-three (52%) were married and 53 (64%) had children. Seventy-six (92%) participants could vote if they wished. CONCLUSIONS: Rurality and high costs of transport and medication increase the barriers to accessing several basic human rights for people with lower limb physical disabilities. Interventions to target these barriers and increase access to secondary school, employment, and income could improve health equity for people with physical disabilities in Malawi and similar contexts.Implications for RehabilitationIn Malawi, the convention on the rights of persons with disabilities is yet to be implemented.Policy makers in Malawi need to take actions to increase access to regular and specialized healthcare services for persons with physical disabilities including financial support to afford medications and transport to reach health services.Policy makers in Malawi need to take actions to increase access to secondary and higher education, and employment for persons with physical disabilities to increase their possibilities to earn an income.

Occupational balance and sleep among women.

BACKGROUND: In occupational therapy, while several studies have focussed on occupational balance, few have investigated it in the context of sleep. AIMS: The aim of this study was to investigate the associations between sleep and occupational balance among women. MATERIAL AND METHODS: In total, 157 women responded to the Occupational Balance Questionnaire and Karolinska Sleep Questionnaire. Linear regression was used to analyse data. RESULTS: The median score for occupational balance was 12 (interquartile range [IQR] 9), while that for sleep was 86 (IQR 16). Sleep and sleepiness fatigue were significantly associated (p < 0.1) with satisfaction with the number of occupations during a regular week. Difficulties awakening and snoring disorders were significantly associated (p < 0.1) with balance with physical, social, intellectual, and restful occupations. CONCLUSIONS: The majority of participants slept well and had a good sleep quality. There is an association between occupational balance and sleep. In particular, aspects related to the number of occupations, adequate time to perform them and the time spent recovering and sleeping were associated with good sleep quality. Balance among physical, social, intellectual, and restful occupations was associated with difficulties awakening and snoring. SIGNIFICANCE: Our results support the need for occupational therapists to focus on occupational balance, to improve women's sleep.

Access to human rights for persons using prosthetic and orthotic assistive devices in Sierra Leone.

Purpose: To evaluate the access to human rights of persons with disabilities who use prosthetic and orthotic assistive devices, and to compare groups of participants in terms of gender, residential area, income, and type and level of assistive device. The addressed areas were rights to: health, a standard of living adequate for health, education, marry and establish a family, vote, and work.Methods: Questionnaires were used to collect self-reported data from 139 lower-limb prosthetic and orthotic users in Sierra Leone.Results: About half of the participants considered their overall physical health good, while 37% said their mental health was bad. Most said they lacked access to medical care. About half of the participants had regular access to safe drinking water. Most had reasonable housing and 60% could read and write. Half of the participants were married and 70% had children. Almost all reported that they could vote if desired and about half were working.Conclusions: There is still a need for improved access to medical care when needed for persons with lower limb physical disability in Sierra Leone. Better access to food and clean water are also necessary to facilitate a standard of living adequate for health, to realize the health rights of persons with disabilities.Implications for rehabilitationIn Sierra Leone, persons with disabilities need a source of regular income to access basic needs, including clean water, access to food, medical care, and medications which should be considered in addition to providing rehabilitation services.To facilitate implementation of the Convention on the Rights of Persons with Disabilities, Sierra Leone's health system needs to be strengthened: an increased number of healthcare staff should be educated, knowledge of disability should be improved in the general public to reduce negative attitudes toward persons with disabilities, persons with disabilities should be included in mainstream health services, and national development policies should target sustainable development goals to a greater extent than during the millennium development goal era.

Professionals' perspectives of prosthetic and orthotic services in Tanzania, Malawi, Sierra Leone and Pakistan.

BACKGROUND: Evidence-based recommendations are lacking for prosthetic and orthotic services in low- and lower-middle-income countries. OBJECTIVES: The aim of this study was to compare and synthesise findings related to experiences of prosthetic and orthotic service delivery in Tanzania, Malawi, Sierra Leone and Pakistan from the perspective of local professionals. STUDY DESIGN: This is a qualitative inductive study. METHODS: A total of 49 associated prosthetists/orthotists and prosthetic/orthotic technicians participated in individual interviews. The second-order concept analysis was applied to the data. RESULTS: Four common themes emerged: low awareness and prioritisation of prosthetic and orthotic services; difficulty managing specific pathological conditions and problems with materials; limited access to prosthetic and orthotic services; and the need for further education and desire for professional development. A further theme was unique to Sierra Leone: people with disabilities have low social status. CONCLUSION: Local professionals felt unable to deliver high-quality prosthetic and orthotic services. Prosthetic and orthotic education needs to be adjusted to various countries' regulations to be recognised as allied health professions. Rehabilitation and prosthetic and orthotic service delivery need to be further integrated in low- and lower-middle-income countries' regular health systems to increase effective person-centred rehabilitation and to address governments' low awareness and low prioritisation of prosthetic and orthotic services. CLINICAL RELEVANCE: The results can inform international guidelines and curriculum development for associate prosthetist/orthotist education to better prepare graduates for the clinical scenario and attempts to improve prosthetic and orthotic service delivery programmes in low- and lower-middle-income countries.

Living as a person using a lower-limb prosthesis in Nepal.

PURPOSE: The purpose of this study is to explore experiences of persons in Nepal using lower-limb prostheses, in relation to specific articles in the Convention on the Rights of Persons with Disabilities that consider mobility, education, health, rehabilitation, and work and employment. METHOD: Qualitative interviews were conducted with 16 persons using lower limb prostheses. Content analysis was applied to the data. RESULTS: Six themes emerged: The lower-limb prosthesis is essential for mobility and daily life; Limited mobility in challenging terrain and request for reduced pain when using prosthesis; Difficulties in finding and sustaining employment emphasized the importance of vocational training; Appreciation of comprehensive rehabilitation together with other persons with amputations, but covering related costs is a struggle; Satisfied with health care, but concerned that it creates debt and dependence upon others; and finally, Limited ability creates negative self-image and varied attitudes in other people. CONCLUSION: Persons with lower-limb amputations were restricted by poverty and wanted increased independence. Rehabilitation and prosthetic services in Nepal need to increase proportionally as they contribute to enabling those persons to a better daily life. Prostheses were essential but more advanced technology was requested. Access to education and vocational training has the potential to improve the socio-economic status of those with lower-limb amputations due lack of employment not requiring physical effort. Implications for rehabilitation To increase access for persons with lower-limb amputations in Nepal to rehabilitation services, these services need to increase proportionally, and the policy for financial compensation to enable those persons to afford transportation to the rehabilitation center should be implemented. The design and manufacture of the low-cost polypropylene technology for prostheses used in Nepal needs to be improved, directed towards increasing the ability to ambulate on uneven surfaces and hilly terrain, and the ability to walk long distances. Adjustments of employment for persons with physical disabilities in Nepal have the potential to strengthen their socio-economic status. Vocational training programs and educational opportunities for persons with physical disabilities have the potential to improve income-generating employment and need to increase proportionally in Nepal. The policies developed in accordance with the Convention on the Rights of Persons with Disabilities need to be further implemented to decrease existing barriers to access to general health care and rehabilitation and prosthetic services for persons with disabilities in Nepal.

Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics.

PURPOSE: The aim of this study was to describe experiences of attitudes in the society of Sierra Leone from the perspective of individuals with poliomyelitis and people with amputations using orthotic or prosthetic devices. METHODS: Individual interviews were conducted using open-ended questions. Twelve participants with amputations or polio were included. Content analysis was applied to the data. RESULTS: The following six themes emerged during data analysis: Experience of negative attitudes; Neglected and respected by family; Traditional beliefs; The importance of assistive devices; People with disability struggle with poverty; and The need for governmental and international support. CONCLUSIONS: In Sierra Leone, people with disabilities face severe discrimination. They need to be included, recognized, and supported to a greater extent by the society, the community, and the family, as well as by the government and international organizations. Traditional beliefs have a negative impact on people with physical disabilities and are an important cause of discrimination in Sierra Leone. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. Prosthetic and orthotic services need to be accessible and affordable. Poverty affects access to education, employment, and health care for Sierra Leoneans with physical disabilities, forcing them to resort to begging to cover basic living needs. Implications for Rehabilitation In Sierra Leone, traditional beliefs related to disability and public attitudes need to change in order to protect the human rights of people with disabilities. Increased public awareness of disability and implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) at different levels in society is needed. To increase access to prosthetic and orthotic services in Sierra Leone, these services need to be affordable and related costs, such as transport, need to be covered by support. Increased access to education, employment, and financial support could contribute to an improved standard of living for people with physical disabilities. Governmental and international support is needed to decrease attitudinal and environmental barriers for people with disabilities in Sierra Leone.

Graduates' perceptions of prosthetic and orthotic education and clinical practice in Tanzania and Malawi.

BACKGROUND: Maintaining and improving the quality of prosthetics and orthotics education at the Tanzania Training Centre for Orthopaedic Technologists is essential for the provision of appropriate prosthetics and orthotics services in African countries. OBJECTIVES: To describe how Tanzanian and Malawian graduates' of the Diploma in Orthopaedic Technology perceive their education and how it could be improved or supplemented to facilitate clinical practice of graduates. METHODS: Nineteen graduates from the diploma course in orthopaedic technology were interviewed and phenomenographic analysis was applied to the data. RESULTS: Seven descriptive categories emerged, namely varied awareness of the profession before starting education, well-equipped teaching facilities, aspects lacking in the learning context, need for changes in the curriculum, enabling people to walk is motivating, obstacles in working conditions and the need for continuous professional development. All participants perceived possible improvements to the content and learning environment. CONCLUSIONS: Prosthetic and orthotic education can be better provided by modifying the content of the diploma programme by dedicating more time to the clinical management of different patient groups and applied biomechanics as well as reducing the programme content focusing on technical aspects of prosthetic and orthotic practice. Graduates were not prepared for the rural working conditions and the graduates desired continued training.

Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: a cross-sectional study.

OBJECTIVES: To investigate patients' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery in Sierra Leone; to compare groups of patients regarding type and level of assistive device, gender, area of residence, income; and to identify factors associated with satisfaction with the assistive device and service. METHODS: A total of 139 patients answered questionnaires, including the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire (QUEST 2.0). RESULTS: Eighty-six percent of assistive devices were in use, but half needed repair. Thirty-three percent of patients reported pain when using their assistive device. Patients had difficulties or could not walk at all on: uneven ground (65%); hills (75%); and stairs (66%). Patients were quite satisfied with their assistive device and the service (mean 3.7 out of 5 in QUEST), but reported 886 problems. Approximately half of the patients could not access services. In relation to mobility and service delivery, women, orthotic patients and patients using above-knee assistive devices had the poorest results. The general condition of the assistive device and patients' ability to walk on uneven ground were associated with satisfaction with the assistive devices and service. CONCLUSION: Patients reported high levels of mobility while using their device although they experienced pain and difficulties walking on challenging surfaces. Limitations in the effectiveness of assistive devices and limited access to follow-up services and repairs were issues desired to be addressed.

Malawian prosthetic and orthotic users' mobility and satisfaction with their lower limb assistive device.

OBJECTIVE: To investigate patients' mobility and satisfaction with their lower limb prosthetic or orthotic device and related service delivery in Malawi and to compare groups of patients regarding type and level of device and demographics. METHODS: Questionnaires were used to collect self-report data from 83 patients. RESULTS: Ninety percent of prostheses or orthoses were in use by patients, but approximately half of these needed repair. Thirty-nine percent reported pain when using their assistive device. The majority of patients were able to rise from a chair (77%), move around the home (80%), walk on uneven ground (59%) and travel by bus or car (56%). However, patients had difficulties walking up and down hills (78%) and stairs (60%). In general, patients were quite satisfied with their assistive device (mean of 3.9 out of 5) and very satisfied with the service provided (mean of 4.4 out of 5). Access to repairs and servicing were rated as most important, followed by durability and follow-up services. Lack of finances to pay for transport was a barrier to accessing the prosthetic and orthotic centre. CONCLUSION: Patients were satisfied with the assistive device and service received, despite reporting pain associated with use of the device and difficulties ambulating on challenging surfaces.

Experiences of providing prosthetic and orthotic services in Sierra Leone--the local staff's perspective.

UNLABELLED: In Sierra Leone, West Africa, there are many people with disabilities in need of rehabilitation services after a long civil war. PURPOSE: The aim of this qualitative study was to explore the experiences of prosthetic and orthotic service delivery in Sierra Leone from the local staff's perspective. METHOD: Fifteen prosthetic and orthotic technicians working at all the rehabilitation centres providing prosthetic and orthotic services in Sierra Leone were interviewed. The interviews were transcribed and subjected to latent content analysis. RESULTS: One main theme emerged: sense of inability to deliver high-quality prosthetic and orthotic services. This main theme was generated from eight sub-themes: Desire for professional development; appraisals of work satisfaction and norms; patients neglected by family; limited access to the prosthetic and orthotic services available; problems with materials and machines; low public awareness concerning disabilities; marginalisation in society and low priority on the part of government. CONCLUSIONS: The findings illustrated traditional beliefs about the causes of disability and that the public's attitude needs to change to include and value people with disabilities. Support from international organisations was considered necessary as well as educating more prosthetic and orthotic staff to a higher level.

Prosthetist/orthotist educational experience & professional development in Pakistan.

PURPOSE: To explore areas in which the education at the Pakistan Institute of Prosthetic & Orthotic Science (PIPOS) could be improved or supplemented to facilitate clinical practice of graduates. To describe educational opportunities PIPOS graduates have had since their graduation and explore their further educational needs. METHOD: 15 graduates from PIPOS participated in semi-structured interviews. A qualitative content analysis was applied to the transcripts. FINDINGS: Respondents indicated a need to upgrade the education at PIPOS. This should include upgrading of resources such as literature and internet access as well as providing staff with the opportunity to further their own education. Females experienced inequality throughout their education but were supported by management. Upon entering the workforce graduates reported that they were supported by senior staff but experienced difficulties in determining appropriate prescriptions. They further indicated that a multidisciplinary approach to patient care is lacking. Graduates knowledge of workshop management was identified as a problem when entering the workforce. Limited awareness of the prosthetics and orthotics profession by both the general community and the medical community was also identified as a problem. If offered the opportunity to continue their studies the respondents would like to specialize. "Brain drain" was noted as a risk associated with post graduate education. Interaction from international collaborators and networking within the country was desired. CONCLUSION: The education at PIPOS meets a need in the country. Graduates indicated that P&O services for Pakistan can be better provided by modifying program content, upgrading teachers' knowledge, improving access to information and addressing issues of gender equality. PIPOS graduates have had limited opportunities for professional development and have a desire for further education.