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.