Prosthetic Prescription Research Articles

Clinicians’ Perspectives of Activity Monitoring Applications and Facilitators for Lower-Limb Prosthetic Service Provision

ABSTRACT Introduction Clinicians involved in lower-limb prosthetic provision and care do not have an objective method for measuring patients’ real-world prosthesis usage. This results in a poor understanding of the full picture of the patient’s everyday life impacting the reporting of outcome following prosthetic prescriptions. There is need to understand what information from wearable prosthetic monitors would be relevant to clinicians and how that information should be displayed to enable health care professionals to make informed decisions. Moreover, clinicians’ perspectives regarding potential use and application of information from monitoring technologies are important in the development and implementation of this technology to improve evidence-based systems for informed clinical decisions for lower-limb prosthesis users. This study aims to explore clinicians’ experiences and perceptions of information obtained from free-living wearable prosthetic monitors used in clinical practice. Methods Seven clinicians from private practice and academia were recruited to participate in the study. A semistructured interview was held for each participant, which lasted about 30–45 minutes. Data and transcripts were analyzed using inductive thematic analysis method. Results Themes of objectiveness and motivation were identified as specific applications of monitoring technologies. Other themes such as awareness and integration were identified as the facilitators of monitoring technologies for prosthetic care in clinical settings. Clinicians identified frameworks in which these monitoring technologies could be incorporated into the clinic, how they can receive feedback as a multidisciplinary team, and the inclusion within patients’ medical records. Conclusions This information from prosthetic monitoring technologies could potentially change clinical practice in several ways: by improving the clinical assessment process, improving the prescription process, and improving the rehabilitation process. To improve the clinical assessment process, prosthetic monitoring information can provide real-world data of prosthesis user’s utilization, which could be used to quantify patients’ self-reports. To improve the prescription process, prosthetic monitoring information can enable clinicians to see if a patient was actively involved in any form of exercise and support them to position their prescription of components within an activity category for their patients. To improve the rehabilitation process, prosthetic monitoring information can be used to plan goals for patients, to measure the progress of patients, and to check for patients’ compliance. Clinical Relevance Statement The impact of these potential changes in clinical practice can ultimately lead to improved clinical decisions in prosthetic care and creation of an evidence-based system.

Prognosticating Prosthetic Ambulation Ability in People With Lower Limb Amputation in Early Post-operative Phase

ObjectiveTo formulate a prognostication model in the early post-operation phase of lower limb amputation to predict patient's ability to ambulate with a prosthesis post rehabilitation. DesignRetrospective cohort study, using data collected from electronic medical records. Predictive factors and prosthetic ambulation outcomes post rehabilitation were used to develop prognostic models via machine learning techniques. SettingRegional hospital's ambulatory rehabilitation clinic. ParticipantsPatients with major lower limb amputation (N=329). InterventionsNot applicable. Main Outcome MeasuresThe outcome of prosthetic ambulation ability post rehabilitation collected was categorized in 3 groups: non-ambulant with prosthesis, homebound ambulant with prosthesis (AP), and community AP. ResultsIn a 2-class model of non-ambulant and AP (homebound and community), the model with highest accuracy of prediction included ethnicity, total Functional Comorbidity Index (FCI), level of amputation, being community ambulant prior to amputation, and age. The f1-score and area under receiver operator curve (AUROC) of the model is 0.78 and 0.82. In a 3-class model consisting of all 3 groups of outcomes, the model with highest accuracy of prediction required 10 factors. The additional factors from the 2-class model include presence of caregiver, history of congestive heart failure, diabetes, visual impairment, and stroke. The 3-class model has a moderate accuracy with a f1-score and AUROC of 0.60 and 0.79. ConclusionThe 2-class prognostication model has a high accuracy which can be used early post-amputation to predict if patient would be ambulant with a prosthesis post rehabilitation. The 3-class prognostication model has moderate accuracy and is able to further differentiate the walking ability to either homebound or community ambulation with a prosthesis, which can assist in prosthetic prescription and setting realistic rehabilitation goals.

Low-profile prosthetic foot stiffness category and size, and shoes affect axial and torsional stiffness and hysteresis.

Passive-elastic prosthetic feet are manufactured with numerical stiffness categories and prescribed based on the user's body mass and activity level, but mechanical properties, such as stiffness values and hysteresis are not typically reported. Since the mechanical properties of passive-elastic prosthetic feet and footwear can affect walking biomechanics of people with transtibial or transfemoral amputation, characterizing these properties can provide objective metrics for comparison and aid prosthetic foot prescription and design. We characterized axial and torsional stiffness values, and hysteresis of 33 categories and sizes of a commercially available passive-elastic prosthetic foot model [Össur low-profile (LP) Vari-flex] with and without a shoe. We assumed a greater numerical stiffness category would result in greater axial and torsional stiffness values but would not affect hysteresis. We hypothesized that a greater prosthetic foot length would not affect axial stiffness values or hysteresis but would result in greater torsional stiffness values. We also hypothesized that including a shoe would result in decreased axial and torsional stiffness values and greater hysteresis. Prosthetic stiffness was better described by curvilinear than linear equations such that stiffness values increased with greater loads. In general, a greater numerical stiffness category resulted in increased heel, midfoot, and forefoot axial stiffness values, increased plantarflexion and dorsiflexion torsional stiffness values, and decreased heel, midfoot, and forefoot hysteresis. Moreover, for a given category, a longer prosthetic foot size resulted in decreased heel, midfoot, and forefoot axial stiffness values, increased plantarflexion and dorsiflexion torsional stiffness values, and decreased heel and midfoot hysteresis. In addition, adding a shoe to the prosthetic foot resulted in decreased heel and midfoot axial stiffness values, decreased plantarflexion torsional stiffness values, and increased heel, midfoot, and forefoot hysteresis. Our results suggest that manufacturers should adjust the design of each category to ensure the mechanical properties are consistent across different sizes and highlight the need for prosthetists and researchers to consider the effects of shoes in combination with prostheses. Our results can be used to objectively compare the LP Vari-flex prosthetic foot to other prosthetic feet to inform their prescription, design, and use for people with a transtibial or transfemoral amputation.

Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial.

Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921. DERR1-10.2196/53412.

Moving a missing hand: children born with below elbow deficiency can enact hand grasp patterns with their residual muscles

Children with a unilateral congenital below elbow deficiency (UCBED) have one typical upper limb and one that lacks a hand, ending below the elbow at the proximal/mid forearm. UCBED is an isolated condition, and affected children otherwise develop normal sensorimotor control. Unlike adults with upper limb absence, the majority of whom have an acquired loss, children with UCBED never developed a hand, so their residual muscles have never actuated an intact limb. Their ability to purposefully modulate affected muscle activity is often assumed to be limited, and this assumption has influenced prosthetic design and prescription practices for this population as many modern devices derive control signals from affected muscle activity. To better understand the motor capabilities of the affected muscles, we used ultrasound imaging to study 6 children with UCBED. We examined the extent to which subjects activate their affected muscles when performing mirrored movements with their typical and missing hands. We demonstrate that all subjects could intentionally and consistently enact at least five distinct muscle patterns when attempting different missing hand movements (e.g., power grasp) and found similar performance across affected and typically developed limbs. These results suggest that although participants had never actuated the missing hand they could distinctively and consistently activate the residual muscle patterns associated with actions on the unaffected side. These findings indicate that motor control still develops in the absence of the normal effector, and can serve as a guide for developing prostheses that leverage the full extent of these children’s motor control capabilities.

Implementation of relative phase analysis to evaluate continuous interlimb coordination and stability in individuals with lower limb loss: Design and protocol for a retrospective analysis

IntroductionThe number of people with lower limb loss continues to grow, though most research to date has been non-committal and lacks the appropriate clinical guidance required for proper prosthetic prescription....

Lower limb prosthetic prescription.

Lower limb amputations are the most common level of amputation. Mobilization of patients with lower limb amputations is an important rehabilitation goal. It is critical to prescribe the most appropriate prosthesis for the patient to achieve the rehabilitation goal in lower extremity amputations. Appropriate prosthesis prescription in lower extremity amputations is based on the selection of the correct prosthetic parts. The choice of prosthesis should be based on the patient's activity level and potential. The prosthesis decision should be made by a team, particularly with the participation of the patient.

Comparison of Loading-Displacement Relationships and Energy-Storing Properties of the Jaipur Foot Against Low-, Mid-, and High-Activity Prosthetic Feet Using Static Proof Testing

ABSTRACT Introduction The Jaipur foot is a low-cost prosthetic foot developed in Jaipur, India. Despite its worldwide use, few data are available on its mechanical properties. In general, there is a lack of objective data on the mechanical performance of prosthetic feet, hindering the objectivity of the prosthetic foot prescription process. The aim of this project was to compare the properties of the Jaipur foot with three prosthetic feet of differing activity levels (a SACH foot and two ESPFs) used commonly in the UK National Health Service (NHS), specifically evaluating loading-displacement relationships and energy-storing properties. Materials and Methods Static proof testing was performed on the four prosthetic feet (BMVSS Jaipur foot, 1D10 Dynamic, 1C30 Trias, and 1C60 Triton) using ISO:10328 methods. Loading-displacement graphs for the forefoot and heel were produced, from which instantaneous stiffness at forces typical of walking and running was produced and energy-storing properties were calculated. Results The Jaipur foot demonstrated the highest heel stiffness at both walking and running forces, the highest forefoot stiffness at walking forces, and the lowest energy return of the four feet overall. The ESPFs demonstrated the lowest forefoot stiffness, along with the highest energy returns. Conclusions Although low cost and cultural requirements should be taken into account, these data have demonstrated the inferior energy-storing properties of the Jaipur foot compared with Western prosthetic feet, using ISO methods to allow future cross-study comparison. Clinical Relevance The mechanical and energy-storing data from this study can be compared with other research using ISO methods to make the prosthetic prescription process more objective, allowing the most appropriate choices to be made for patients.

Upper limb prosthetic prescription.

One of the most important parameters of prosthesis rehabilitation is to determine the most suitable prosthesis in patients with upper extremity amputation. When deciding on the prosthesis, the clinical features of the amputee should be highly matched with the predicted prosthesis. Prescribing the most suitable prosthesis and minimizing the mismatch can be possible with a detailed prosthetic evaluation.

The development of rating scales to evaluate experiential prosthetic foot preference for people with lower limb amputation.

Selection of a foot is an important aspect of prosthetic prescription and vital to maximizing mobility and functional goals after lower limb amputation. Development of a standardized approach to soliciting user experiential preferences is needed to improve evaluation and comparison of prosthetic feet. To develop rating scales to assess prosthetic foot preference and to evaluate use of these scales in people with transtibial amputation after trialing different prosthetic feet. Participant-blinded, repeated measures crossover trial. Veterans Affairs and Department of Defense Medical Centers, laboratory setting. Seventy-two male prosthesis users with unilateral transtibial amputation started, and 68 participants completed this study. Participants trialed three mobility-level appropriate commercial prosthetic feet briefly in the laboratory. "Activity-specific" rating scales were developed to assess participants' ability with a given prosthetic foot to perform typical mobility activities (eg, walking at different speeds, on inclines, and stairs) and "global" scales to rate overall perceived energy required to walk, satisfaction, and willingness to regularly use the prosthetic foot. Foot preference was determined by comparing the rating scale scores, after laboratory testing. The greatest within-participant differences in scores among feet were observed in the "incline" activity, where 57% ± 6% of participants reported 2+ point differences. There was a significant association (p < .05) between all "activity-specific" rating scores (except standing) and each "global" rating score. The standardized rating scales developed in this study could be used to assess prosthetic foot preference in both the research and clinical settings to guide prosthetic foot prescription for people with lower limb amputation capable of a range of mobility levels.

PROClass: The Development and Validation of a Novel Prosthetic Component Sophistication Classification System

ObjectiveTo develop a lower limb prosthesis (LLP) sophistication classification system that categorizes prosthetic component prescriptions into “basic,” “intermediate,” and “advanced” and assess its content validity, reliability, and accuracy. DesignClassification development and validation study. SettingThe Veterans Affairs (VA) Corporate Data Warehouse database and National Prosthetics Patient Database were used to identify patients undergoing their first amputation at the transtibial or transfemoral level due to diabetes or peripheral artery disease and to identify the associated codes for each LLP. ParticipantsAn expert panel of 6 nationally recognized certified prosthetists, a national expert in VA prosthetics data and coding, a physical medicine and rehabilitation physician, and an epidemiologist developed an LLP classification system (PROClass) using 30 transfemoral and transtibial lower limb amputees. Main Outcome MeasuresThe expert panel reviewed 20 consecutive participants meeting study criteria for the development of the PROClass system and a subsequent 30 consecutive cases for assessing the inter- and intra-rater reliability and accuracy. ResultsThe interrater and intrarater reliability was almost perfect with Gwet's AC1 values ranging from .82 to .96 for both expert panel members and research assistants. The accuracy of the research assistant's classifications to the “criterion standard” was excellent with Gwet's AC1 values ranging between .75 and .92. ConclusionsPROClass is a pragmatic, reliable, and accurate prosthetic classification system with strong face validity that will enable the classification of prosthetic components used for large data set research aimed at evaluating important clinical questions such as the effects of sophistication on patient outcomes.

Audit to assess the quality of 916 prosthetic prescriptions of removable partial dentures.

The objectives of this study were to assess the quality of prosthetic prescriptions of removable partial dentures (RPDs) and to analyze the current situation of the communication and information delivery between clinicians and technicians. All RPD prosthetic prescriptions received by a major dental laboratory in 4 weeks were involved in a quality audit, and the prescriptions were divided into three groups in accordance with the grades of clients. The filling of prosthetic prescriptions was recorded. The items in the prescriptions for audit included the general information of the patient, the general information of the clinician, the design diagram information, other detailed information, and the return date. The prescriptions were categorized into four levels on the basis of their quality by two quality inspectors who have been working for more than 10 years. A total of 916 prescriptions were collected and assessed. The names in the general information of the patient and the clinician were filled out best, both at the rate of 97.6% (n=894). The return date was filled out worst, only at the rate of 6.4% (n=59). Of those prescriptions, 86.8% (n=795) exhibited inadequate design diagram information. The results of the quality assessment demonstrated that 74.2% of prescriptions were assessed as noncompliant ones and failed to meet the acceptable clinical quality standard. At present, the overall quality of RPD prosthetic prescriptions is poor. The responsibilities of clinicians and technicians are unclear, and the communication between them is not ideal.

Criteria for Advanced Prosthetic Foot Prescription: Rationale, Design, and Protocol for a Multisite, Randomized Controlled Trial.

The prescription of prosthetic ankle-foot devices is often based on the professional judgment of the limb loss care team or limited evidentiary research. Current prosthetic research efforts have focused on the design and development of prosthetic devices rather than on understanding which devices are the most appropriate to prescribe. This investigation will evaluate biomechanical, functional, and subjective outcome measures to help determine the optimal prescription parameters of prosthetic ankle-foot devices. This study aims to develop evidence-based guidelines for limb loss care teams for the appropriate prescription of commercially available prosthetic ankle-foot devices to improve function and satisfaction. This investigation will be a multisite, randomized, crossover clinical trial targeting the enrollment of 100 participants. Participants will use 3 different types of prosthetic devices (energy storing and returning, articulating, and powered) in random order. Participants will be fitted and trained with each device and then separately use each device for a 1-week acclimation period. Following each 1-week acclimation period, participants will be evaluated using several functional measures and subjective surveys. A random subset of participants (30/100, 30%) will also undergo full-body gait analysis, following each 1-week acclimation period, to collect biomechanical data during level ground and incline and decline walking. After all individual device evaluations, participants will be given all 3 prostheses concurrently for 4 weeks of home and community use to capture user preference. Activity monitoring and a guided interview will be used to determine overall user preference. The study was funded in August 2017, and data collection began in 2018. Data collection is expected to be completed before July 2023. Initial dissemination of results is expected to occur in the winter of 2023. By identifying biomechanical, functional, and subjective outcomes that are sensitive to differences in prosthetic ankle-foot devices, a benchmark of evidence can be developed to guide effective prosthetic prescription. ClinicalTrials.gov NCT03505983; https://clinicaltrials.gov/ct2/show/NCT03505983. DERR1-10.2196/45612.

Differences in Prosthetic Prescription Between Men and Women Veterans After Transtibial or Transfemoral Lower-Extremity Amputation: A Longitudinal Cohort Study (2005-2018)

ObjectiveTo evaluate whether prosthetic prescription differed by gender and the extent to which differences were mediated by measured factors. DesignRetrospective longitudinal cohort study using data from Veterans Health Administration (VHA) administrative databases. SettingVHA patients throughout the United States. ParticipantsThe sample included 20,889 men and 324 women who had an incident transtibial or transfemoral amputation between 2005 and 2018. InterventionsNot applicable. Main Outcome MeasuresTime to prosthetic prescription (up to 1 year). We used parametric survival analysis (an accelerated failure time model) to assess gender differences. We estimated mediation effects of amputation level, pain comorbidity burden, medical comorbidities, depression, and marital status on time to prescription. ResultsIn the 1 year after amputation, the proportion of women (54.3%) and men (55.7%) prescribed a prosthesis was similar. However, after we controlled for age, race, ethnicity, enrollment priority, VHA region, and service-connected disability, the time to prosthetic prescription was significantly faster among men compared with women (acceleration factor=0.73; 95% confidence interval, 0.61-0.87). The difference in time to prosthetic prescription between men and women was significantly mediated by amputation level (23%), pain comorbidity burden (–14%), and marital status (5%) but not medical comorbidities or depression. ConclusionsAlthough the proportion of patients with prosthetic prescription at 1-year postamputation was similar between men and women, women received prosthetic prescriptions more slowly than men, suggesting that more work is needed to understand barriers to timely prosthetic prescriptions among women, and how to intervene to reduce those barriers.

An Engineering Platform for Clinical Application of Optogenetic Therapy in Retinal Degenerative Diseases.

Optogenetics is a new approach for controlling neural circuits with numerous applications in both basic and clinical science. In retinal degenerative diseases, the photoreceptors die, but inner retinal cells remain largely intact. By expressing light sensitive proteins in the remaining cells, optogenetics has the potential to offer a novel approach to restoring vision. In the past several years, optogenetics has advanced into an early clinical stage, and promising results have been reported. At the current stage, there is an urgent need to develop hardware and software for clinical training, testing, and rehabilitation in optogenetic therapy, which is beyond the capability of existing ophthalmic equipment. In this paper, we present an engineering platform consisting of hardware and software utilities, which allow clinicians to interactively work with patients to explore and assess their vision in optogenetic treatment, providing the basis for prosthetic design, customization, and prescription. This approach is also applicable to other therapies that utilize light activation of neurons, such as photoswitches.Clinical and Translational Impact Statement-The engineering platform allows clinicians to conduct training, testing, and rehabilitation in optogenetic gene therapy for retinal degenerative diseases, providing the basis for prosthetic design, customization, and prescription.

Outcome Measures Used to Assess Hand Activity in Amputee and Intact Populations: a Literature Review.

The human hand is critical in assisting with activities of daily living (ADL). Amputation of the hand can affect a person physically, socially and psychologically. Knowledge of outcome measures used to assess upper limb activity of intact and amputee populations may aid in guiding research to develop applicable measurement tools specific to the amputee population. Tools could aid developments in prosthetic design and prescription, which benefit both users and healthcare researchers. This literature review examined outcome measurement tools used with non-amputee and amputee populations to assess hand activity. The objectives were to identify which characteristics of hand activity are captured by currently available measurement tools. Searches were conducted using PubMed, Cochrane and ProQuest for studies investigating hand activity for amputee and non-amputee populations. A total of 15 studies were included. PRISMA guidelines were used to assist with study selection. Data extraction and narrative synthesis were carried out. A total of 32 outcome measures were found. Frequently used tools were: Box and Block Test, Swedish Disabilities of the Arm Shoulder and Hand Questionnaire, and range of motion. Studies employed a combination of 2 to 12 tools. Themes extracted were: importance of function and quality of life, the need for realistic tasks, and the need for outcome measures specific of the population. There is a gap in research surrounding outcome measurement tools used to assess hand activity in the amputee population. A combination of outcome measures are required to obtain insight into the hand activities of intact and amputee populations. Function and quality of life are important aspects to consider when describing hand activity.

Spatiotemporal gait patterns in individuals with unilateral transfemoral amputation: A hierarchical cluster analysis.

Gait pattern classification in individuals with lower-limb amputation could help in developing personalized prosthetic prescriptions and tailored gait rehabilitation. However, systematic classifications of gait patterns in this population have been scarcely explored. This study aimed to determine whether the gait patterns in individuals with unilateral transfemoral amputation (UTFA) can be clustered into homogeneous subgroups using spatiotemporal parameters across a range of walking speeds. We examined spatiotemporal gait parameters, including step length and cadence, in 25 individuals with UTFA (functional level K3 or K4, all non-vascular amputations) while they walked on a split-belt instrumented treadmill at eight speeds. Hierarchical cluster analysis (HCA) was used to identify clusters with homogeneous gait patterns based on the relationships between step length and cadence. Furthermore, after cluster formation, post-hoc analyses were performed to compare the spatiotemporal parameters and demographic data among the clusters. HCA identified three homogeneous gait pattern clusters, suggesting that individuals with UTFA have several gait patterns. Further, we found significant differences in the participants' body height, sex ratio, and their prosthetic knee component among the clusters. Therefore, gait rehabilitation should be individualized based on body size and prosthetic prescription.

AMPREDICT PROsthetics—Predicting Prosthesis Mobility to Aid in Prosthetic Prescription and Rehabilitation Planning

ObjectiveTo develop and validate a patient-specific multivariable prediction model that uses variables readily available in the electronic medical record to predict 12-month mobility at the time of initial post-amputation prosthetic prescription. The prediction model is designed for patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation because of complications of diabetes and/or peripheral artery disease. DesignMulti-methodology cohort study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected their patient-reported mobility. SettingThe VA Corporate Data Warehouse, the National Prosthetics Patient Database, participant mailings, and phone calls. ParticipantsThree-hundred fifty-seven veterans who underwent an incident dysvascular TT or TF amputation and received a qualifying lower limb prosthesis between March 1, 2018, and November 30, 2020 (N=357). InterventionsNot applicable. Main Outcome MeasureThe Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). ResultsMultinomial logistic lasso regression, a machine learning methodology designed to select variables that most contribute to prediction while controlling for overfitting, led to a final model including 23 predictors of the 4-category AMPSIMM outcome that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation—levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. ConclusionsThe AMPREDICT PROsthetics model can assist providers in estimating individual patients’ future mobility at the time of prosthetic prescription, thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for anticipated functional goals.

AMPREDICT PROsthetics- Predicting Prosthetic Mobility to Aid in Prosthetic Prescription and Rehabilitation Planning

Research Objectives To develop and validate a patient-specific multivariable prediction model that utilizes readily available predictors to predict 12-month mobility at the time of initial post amputation prosthetic prescription. The prediction model is designed to be used on patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation for chronic limb threatening ischemia (CLTI). The overall goal is to enhance prediction of future mobility to assist the rehabilitation team in setting appropriate, evidence-based goals, to better inform patient expectations, and to facilitate appropriate prosthetic prescription. Design Mixed-methods study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected patient reported mobility. Setting The Veterans Administration Corporate Data Warehouse (CDW), the National Prosthetics Patient Database (NPPD), participant mailings and phone calls. Participants 357 Veterans who underwent an incident TT or TF amputation for CLTI and received a qualifying lower limb prosthesis (LLP) between March 1, 2018, and November 30, 2020. Interventions Not applicable. Main Outcome Measures The Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). Results Variable selection, using a machine learning methodology, led to a final model of 23 predictors that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation – levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. Conclusions The AMPREDICT PROsthetics model can assist providers in estimating individual patient's future mobility at the time of prosthetic prescription thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for their anticipated functional goals. Author(s) Disclosures No conflicts of interest. This project was completed from funding provided by a Veterans Administration Research Rehabilitation and Development Grant. To develop and validate a patient-specific multivariable prediction model that utilizes readily available predictors to predict 12-month mobility at the time of initial post amputation prosthetic prescription. The prediction model is designed to be used on patients who have undergone their initial transtibial (TT) or transfemoral (TF) amputation for chronic limb threatening ischemia (CLTI). The overall goal is to enhance prediction of future mobility to assist the rehabilitation team in setting appropriate, evidence-based goals, to better inform patient expectations, and to facilitate appropriate prosthetic prescription. Mixed-methods study that identified patients retrospectively through a large Veteran's Affairs (VA) dataset then prospectively collected patient reported mobility. The Veterans Administration Corporate Data Warehouse (CDW), the National Prosthetics Patient Database (NPPD), participant mailings and phone calls. 357 Veterans who underwent an incident TT or TF amputation for CLTI and received a qualifying lower limb prosthesis (LLP) between March 1, 2018, and November 30, 2020. Not applicable. The Amputee Single Item Mobility Measure (AMPSIMM) was divided into a 4-category outcome to predict wheelchair mobility (0-2), and household (3), basic community (4), or advanced community ambulation (5-6). Variable selection, using a machine learning methodology, led to a final model of 23 predictors that effectively discriminates household ambulation from basic community ambulation and from advanced community ambulation – levels of key clinical importance when estimating future prosthetic demands. The overall model performance was modest as it did not discriminate wheelchair from household mobility as effectively. The AMPREDICT PROsthetics model can assist providers in estimating individual patient's future mobility at the time of prosthetic prescription thereby aiding in the formulation of appropriate mobility goals, as well as facilitating the prescription of a prosthetic device that is most appropriate for their anticipated functional goals.

Mining Literature to Identify Factors Influencing Prosthetic Prescription and Rehabilitation of Persons With Lower-Limb Amputations

ABSTRACT Introduction Proper prosthetic prescription directly impacts rehabilitation and the quality of life of an individual with amputation, yet complications during the prescription process remain a challenge for prosthetists as a variety of patient-specific and prosthetic-specific factors need to be considered simultaneously during prescription. This research aims to identify the factors that affect decision making during prosthetic prescription and rehabilitation processes of individuals with lower-limb amputation via evidence-based approaches. Materials and Methods Abstracts of 140 articles were analyzed using topic modeling—a natural language processing algorithm. Results Mining abstracts of relevant literature revealed seven factors that influence prosthetic prescription and six factors that affect rehabilitation of individuals with amputation. Conclusion The findings of this study focus on improving the rehabilitation process of individuals with lower-limb amputation, enhancing the patient-provider relationship, and improving the overall quality of life via evidence-based methods. Clinical Relevance Understanding the factors that affect prosthetic prescription and patient rehabilitation from the past literature is critical to the establishment of formal and standard prescription strategies that can eventually improve the quality of life of persons with lower-limb amputation.