Prosthetic Services 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.

Mobility Rates After Lower-Limb Amputation for Patients Treated with Physician-Led Collaborative Care Model

Clinical outcomes after major lower-limb amputation have been historically poor. The current care provided to most amputees is often disorganized and without physician supervision. The primary purpose of this study is to examine rates of postamputation mobility achieved with a prosthesis by patients with chronic limb-threatening ischemia and/or diabetes who required major lower-limb amputation and were treated under an established physician-led collaborative care pathway. The secondary purpose is to describe the structure and utilization of the care pathway by multiple independent vascular surgery practices in the United States to enable future exploration of its impact on key clinical outcomes within this patient population. Clinical records of 2,475 patients from 6 vascular practices that adopted this collaborative care pathway between 2017 and 2020 were retrospectively reviewed. Only records with sufficient documented histories of amputation surgeries, prosthetic services, and mobility status were included. Of 2,475 patient records reviewed, 1,787 patients (2,157 major amputations) were eligible for analysis. Sixty-two-point 2 percent (n=1,111) of patients achieved mobility with the collaborative care pathway. Mobility rate varied by amputation level in the study. Prosthetic mobility was achieved in 73.5% of transtibial amputations, 40.4% of transfemoral amputations, and 35.7% of through-knee amputations, regardless of patient laterality, which is superior or equivalent to the best published rates of mobility. The study describes the structure and utilization of a physician-led collaborative care pathway for treating patients who require lower-limb amputation that meets 5 of the 7 recommendations from the 2019 Global Vascular Guidelines on the Management of Chronic Limb Threatening Ischemia. Internal data analysis results suggest that patients treated via this care pathway can potentially achieve improved mobility rates with a prosthesis following amputation. This collaborative care pathway should be further evaluated for its ability to directly improve mobility and other clinically relevant amputation outcomes.

Limb Amputations in a Tertiary Care Hospital, North India: A Cross-sectional Epidemiological Study – Can We Prevent This?

Abstract Background: Disability due to limb amputations is a major but preventable public health problem that is associated with profound economic, social, and psychological effects on the patients and their families, especially in developing countries where the supportive (prosthetic) services are meager or almost absent. The purpose of this study was to outline the patterns and indications for limb amputations in a tertiary care center of northern India and to compare our experience with that of other published data. Materials and Methods: This was an observational study conducted at a tertiary care hospital in northern India. All the patients who underwent limb amputations at this hospital between January 2018 and April 2020 were included in the study. Results: A total of 37 patients underwent various amputations during the study period. The age group ranged between 12 and 80 years (mean of 54.9 years) and the most effected age group was between 50 and 60 years (45%). Males outnumbered females with a ratio of 4:1. When the pattern of amputations was studied, 34 were lower limb amputations and 3 were upper limb amputations. On subcategorization, 45% underwent below-knee amputations followed by above-knee amputations (29%). Diabetes mellitus was the most common cause, followed by trauma and peripheral arterial disease. Conclusion: Complications of diabetic foot ulcers and trauma resulting from road traffic accidents were the most common indications for major limb amputation in our study. Implementation of comprehensive care for diabetes by multidisciplinary approach via diabetic clinics at all the hospitals can help in reducing the complications of diabetes thus reducing the disability due to amputations. Road traffic accidents can also be reduced or prevented by implementing stricter laws and increasing the social awareness.

Factors influencing satisfaction with prosthetic and orthotic services – a national cross-sectional study in Sweden

Purpose To evaluate client satisfaction with prosthetic and orthotic services in Sweden, determine if satisfaction differs between clients using different devices and identify factors which influence client satisfaction. Materials and methods A cross-sectional design was used to survey 7318 clients. The survey included items related to demographics, quality of life, device comfort, device use, the extent to which clients’ needs were met and satisfaction with services. Ethics approval was provided by the Swedish Ethical Review Authority. Results A total of 2925 surveys were returned reflecting a response rate of 41%. Mean OPUS-CSS point score was 61.9(SD 16.8) with differences observed between device categories (p < 0.001). Factors that were identified as most positively influencing client satisfaction were, being a limb prosthesis user and being under 65 years. When analysing scores for individual OPUS items breast prosthesis users scored higher than users of other devices. Clients were most satisfied with the level of respect they were shown by staff (mean = 2.72/3) and less satisfied with coordination of services with other therapists/doctors(mean = 1.88/3). Conclusions Prosthetic and orthotic users are reasonably satisfied with the services they receive. Attention should be directed towards understanding why prosthetic users are more satisfied than orthotic users and why clients under 65 years report higher satisfaction scores.

A disparity in prosthetic access for Ecuadorians with lower-limb amputation.

Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services. To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry. Retrospective study. A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed. A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment. These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.

Exploring the patient experience and perspectives of taking part in outcome measurement during lower limb prosthetic rehabilitation: a qualitative study

Purpose Outcome measurement provides clinicians, services and funders with useful information. However, little is known about the experience of participating in outcome measurement during lower limb prosthetic rehabilitation from the patient’s perspective. Materials and methods Thirty-two participants who underwent lower limb amputation within 5 years, and had experience of taking part in outcome measurement during prosthetic rehabilitation, were recruited from UK limb fitting centers and social media. Data were collected using focus groups and interviews and analysed using reflexive thematic analysis. Results Four themes were identified. (1) How does participating in outcome measurement make me feel? (2) Do the outcome measures used in routine clinical care capture an accurate picture of my recovery? (3) Who is outcome measurement for? and (4) are prosthetic services measuring what is meaningful? These themes suggest outcome measurement is not a neutral activity for patients following lower limb amputation. Conclusions Harnessing the positive impacts of measuring outcomes could be used for motivation, to support adjustment and recovery, to improve communication and to support shared decision-making. This could make outcome measurement more meaningful and patient-centered. However, there may be potential for patients to respond negatively to outcome measures and clinicians should consider their impact on psychosocial factors.

Problems and Impacts of Taiwan’s Prosthesis Subsidy Policy: A User-Centered Perspective

義肢對於截肢者而言，是非常重要的生活輔具。隨著身心障礙者權益保障法令的進展，我國輔具政策於2012年產生重大轉變，強調從社會環境與結構理解身心障礙者個別化需求，為個人量身訂製適合的輔具服務。然而，從服務使用者經驗來看，卻與政策立意有許多斷裂、矛盾之處。為了解社會局所提供義肢費用補助制度的問題，以及伴隨這些制度缺失所產生的影響，本研究從下肢義肢使用者觀點出發，以質性研究方法，訪談八位曾申請社會局核發義肢補助費用的服務使用者、一位輔具評估人員以及兩位義肢公司業務員。研究發現我國社補義肢給付制度從提出申請、需求評估、到補助內容與核銷，皆有未盡完善之處，導致原本立意良善且支出龐大的福利服務未能充分發揮效能，且對服務使用者產生以下四種負面影響：（一）工作選擇與活動範圍受限；（二）有損身心健康與外在形象；（三）被迫成為非法福利盜竊者；（四）易淪為不平等權力關係下的受害者。最後，本研究針對以上問題，提出具體改進建議，以求輔具福利服務更貼近身障者需求。Prosthetic devices are pivotal in improving quality of life for individuals with amputations. Over the years, Taiwan has progressively developed policies surrounding persons with disabilities, including a notable change to assistive devices policy in 2012. This change, centered around a social model of disability, was made to prioritize the individual needs of those with disabilities and offer specialized assistive device services. However, despite good intentions and significant funding, this welfare policy is perceived by service users as problematic and at odds with its purported goals. Therefore, to better understand Taiwan&amp;rsquo;s prosthetic subsidy program, impacts, and defects, this study used qualitative research methods to examine the perspectives of lower limb prosthetic users through indepth interviews with eight prosthetic subsidy service users, one prostheses assessor, and two prostheses sales representatives. Findings from these interviews indicate systemic deficiencies throughout the subsidy application process, the needs assessment, the determining of subsidy scope, and reimbursement procedures. Such deficiencies were shown to negatively impact service users in four significant ways: 1. by imposing limitations at work and in daily activities; 2. by causing physical, mental, and cosmetic harm; 3. by pressuring users into committing welfare fraud; 4. by subjecting users to unequal power dynamics. Finally, this study offers user-centered policy recommendations to address the aforementioned issues and create services that effectively cater to the needs of people with disabilities.

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.

Feasibility of Freedom of Information Requests for Amputee Epidemiology in the United Kingdom.

While each of the 44 National Health Service commissioned artificial limb clinics in the United Kingdom record information about their own prosthetic limb users, these are not collated to give a national picture of amputee epidemiology. The requirement to respond to Freedom of Information (FoI) requests within 20 working days offers another way of extracting data from all centres, and this study describes a first attempt to use this method to update national epidemiological data. Questions were sent to the FoI email addresses of all 44 centres, requesting numbers of adult unilateral below-knee amputees, adult unilateral above or through-knee amputees and child unilateral above or through-knee amputees (all of K2 level mobility), numbers of people consistently using a prosthesis with a single axis myoelectric hand, and access to an occupational therapist with skills to teach someone to use a myoelectric hand. A FoI request was sent to NHS England seeking release of data that they collect every month from all the prosthetic services which they commission in England. All but one of the UK centres responded, the great majority within 31 days. Incomplete results were generally due to centres finding the questions ambiguous and many did not record mobility levels consistently. While 33 centres had access to skilled occupational therapy, only 4 reported more than 10 patients who constantly used a single axis myoelectric hand. Eighteen centres were unable to provide complete data, and the remainder reported a ranges of 5 to 992 below-knee amputees, 7 to 574 adult above-knee amputees and 0 to 137 child above-knee amputees, suggesting different approaches to managing missing mobility level data. Freedom of Information requests are an inexpensive way of gathering data from NHS prosthetic clinics, which can identify age, sex, level of amputation but not activity levels or use of a prosthesis and hence only gives limited demographic information of the amputee cohort.

Anatolian opportunity in orthopedics and prosthetic service employment...

Üsküdar University Orthopedic Prosthesis and Orthotics Program organized the "Clinical Approaches in Prosthetic Orthotics Workshop Enterprises" event.

Insights into the spectrum of transtibial prosthetic socket design from expert clinicians and their digital records.

Transtibial prosthetic sockets are often grouped into patella tendon bearing (PTB) or total surface bearing (TSB) designs, but many variations in rectifications are used to apply these principles to an individual's personalised socket. Prosthetists currently have little objective evidence to assist them as they make design choices. To compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes to improve understanding of socket design strategies. 163 residual limb surface scans and corresponding CAD/CAM sockets were analysed for 134 randomly selected individuals in a UK prosthetics service. This included 142 PTB and 21 TSB designs. The limb and socket scans were compared to determine the location and size of rectifications. Rectifications were compiled for PTB and TSB designs, and associations between different rectification sizes were assessed using a variety of methods including linear regression, kernel density estimation (KDE) and a Naïve Bayes (NB) classification. Differences in design features were apparent between PTB and TSB sockets, notably for paratibial carves, gross volume reduction and distal end elongation. However, socket designs varied across a spectrum, with most showing a hybrid of the PTB and TSB principles. Pairwise correlations were observed between the size of some rectifications (e.g., paratibial carves; fibular head build and gross volume reduction). Conversely, the patellar tendon carve depth was not associated significantly with any other rectification, indicating its relative design insensitivity. The Naïve Bayes classifier produced design patterns consistent with expert clinician practice. For example, subtle local rectifications were associated with a large volume reduction (i.e., a TSB-like design), whereas more substantial local rectifications (i.e., a PTB-like design) were associated with a low volume reduction. This study demonstrates how we might learn from design records to support education and enhance evidence-based socket design. The method could be used to predict design features for newly presenting patients, based on categorisations of their limb shape and other demographics, implemented alongside expert clinical judgement as smart CAD/CAM design templates.

Pendampingan dan Evaluasi Produk Kaki Prostetik bagi Kelainan Kongenital Kaki di Atas Lutut (Above Knee Prosthesis)

A prosthetic leg is a lower extremity movement aid in assisting the mobility of persons with physical disabilities. A prosthetic leg is used to replace a missing leg, either due to a birth defect or an amputation. The use of a prosthetic leg is a different matter if the user has never experienced movement sensation. This service will evaluate the process of assisting the use of prosthetic legs for people with physical disabilities from birth. So far, prosthetic foot manufacturing services that have been carried out by the Prosthetic Orthosis Profession in Indonesia have focused on making sockets. Most users have physical abnormalities for a history of amputation or not birth defects. So that in the process of practicing the use of prosthetic legs there are no difficulties. It's different if the user of this prosthetic leg is congenital who has not felt the sensation of stepping movement at all or what is known as the gait cycle. Forms of community service activities in the process of assisting the use of prosthetic legs and evaluating any obstacles encountered in the walking process.

Prosthetic Curricular Threads: Pilot Survey of Clinical Practice and Physical Therapy Education

ABSTRACT Introduction Physical therapists play a critical role in the rehabilitation of persons with limb loss/limb difference. The introduction to the skills and knowledge necessary to provide skilled care occurs during the physical therapist’s education in an accredited physical therapy program. Although clinical practice evolves as technological changes manifest and the evidence base progresses, it is unclear whether physical therapy education is adapting to stay current with clinical practice. Purpose The aim of this study was to explore the alignment of clinical practice with physical therapy education as it relates to prosthetic-specific curriculum. Methods Surveys were sent to inpatient rehabilitation hospitals, prosthetic service clinics, and accredited physical therapy programs. Each survey was designed to assess both limb loss/limb difference rehabilitation and prosthetic specific-content germane to the setting being surveyed. Results Sixty-eight physical therapy programs, 48 prosthetic-service providers, and 14 rehabilitation hospitals responded. Just over one third of physical therapy education programs reported having a course dedicated solely to prosthetic-related content. There was general alignment between what is being taught and what is being practiced in the clinics; however, there was variation in specific content and time devoted to prosthetic-related curriculum across programs. Conclusions Further alignment of prosthetic-related content and clinical practice is needed in physical therapy programs. Clinical Relevance Statement More careful alignment of prosthetic curricular content with clinical practice in physical therapy programs will increase the effectiveness of rehabilitation programs and help persons with amputations regain more function and quality of life.

Prosthetic device and service satisfaction, quality of life, and functional performance in lower limb prosthesis clients.

The aim of this study was to characterize the relationship between prosthetic device and service satisfaction, health-related quality of life (HRQOL), and functional movement in a diverse population of lower limb prosthesis users. An online survey was conducted on individuals with lower limb amputation between September and October 2021. Sample validated questionnaires assessing demographic and clinical features, satisfaction, functional outcomes, and quality of life were analyzed using path analysis. Participants were 1736 individuals with lower limb amputation. Overall, 44% of participants reported dissatisfaction with prosthetic device, whereas 37% were dissatisfied with prosthetic service. Low functional mobility was reported by 58% of participants and 61% reported low HRQOL. Lower extremity functional status (β = 0.55), HRQOL (β = 0.08), Activities-specific Balance Scale (β = 0.22), and modified fall efficacy scale (β = -0.07) are significantly associated with prosthetic device satisfaction ( P < 0.0005, R 2 = 0.47). Satisfaction with provider service was significantly associated with lower extremity functional status (β = 0.44) and balance confidence (β = 0.18) ( P < 0.0005, R 2 = 0.34). Civilians, veterans, and service members reported low functional mobility, low quality of life, and moderate levels of dissatisfaction with their lower extremity prosthetic device and provider service. Improvements in mobility, balance, quality of life, and fall efficacy may enhance device satisfaction. Functional mobility and balance improvements may increase ratings of provider service. This study provides feedback that may improve clinical decisions on lower limb prosthesis patient care.

Efficacy of rehabilitation after provision of ICRC lower limb prostheses in low-income and middle-income countries: A quantitative assessment from Myanmar.

Low-income and middle-income countries (LMICs) have poorly resourced health services. Lack of access to assistive devices, such as prosthetics, may limit the functional outcomes of persons with amputation and affect quality of life (QoL). The objective of this study was to assess the functional level and QoL of prosthetic users in LMICs when prescribed a prosthesis made from International Committee for Red Cross (ICRC) components. The study design included a quantitative descriptive methodology assessing functional outcomes and QoL after prosthetic provision. Participants were identified from the prosthetic service in Mandalay, Myanmar. Included participants were those with unilateral, traumatic, lower limb amputations, with ICRC devices delivered at least 6 months earlier. Participants attended the prosthetic service and were assessed using the Amputee Mobility Predictor with Prosthesis tool and the World Health Organization Quality of Life Brief and Disability modules. Thirty-five participants completed the study; of them, 63% were persons with transtibial level amputation and 37% were with transfemoral level amputation. Approximately 83% achieved a score of more than 37 using the Amputee Mobility Predictor with Prosthesis. There is a strong positive correlation between QoL and physical health (r = 0.55; p < 0.001), social relationships (r = 0.66; p < 0.001), and inclusion (r = 0.53; p < 0.001). Participants had a better QoL and overall health when they had better psychological health. The patient-based results presented within this study could be considered as a contribution to the evidence base and importance of provision of prosthetic services in LMICs. It was observed that participants with an amputation were able to achieve a high level of physical function with the ICRC prostheses while also reporting a high QoL.

Categorization and recommendations for outcome measures for lower limb absence by an expert panel.

Understanding the psychometric strengths and limitations of outcome measures for use with people with lower limb absence (LLA) is important for selecting measures suited to evaluating patient outcomes, answering clinical and research questions, and informing health care policy. The aim of this project was to review the current psychometric evidence on outcome measures in people with LLA to determine which measures should be included in a stakeholder consensus process. An expert panel was assembled, and a 3-stage review process was used to categorize outcome measures identified in a systematic literature review into 3 distinct categories (recommended for measures with better than adequate psychometric properties; recommended with qualification; and unable to recommend). Panelists were asked to individually categorize measures based on results of a systematic review of identified measures' psychometric properties. Each measure's final categorization was based on ≥70% agreement by all panelists. No outcome measure attained the ≥70% consensus threshold needed to achieve a rating of "recommend." Hence, panelists suggested combining "recommend" and "recommend with qualifications" into a single category of "recommend with qualifications." Using this approach, consensus was reached for 59 of 60 measures. Consensus could not be reached on 1 outcome measure (socket comfort score). Thirty-six outcome measures were categorized as "unable to recommend" based on available evidence; however, 23 (12 patient-reported measures and 11 performance-based measures) demonstrated adequate psychometric properties in LLA samples and were thus rated as "recommend with qualification" by the expert panel. The panel of experts were able to recommend 23 measures for inclusion in the subsequent stakeholder review. A key strength of this process was bringing together international researchers with extensive experience in developing and/or using LLA outcome measures who could assist in identifying psychometrically sound measures to include in a subsequent stakeholder consensus process. The above categorizations represent the current state of psychometric evidence on outcome measures for people with LLA and hence may change over time as additional research becomes available. The results will be used to achieve wider consensus from clinicians, health policymakers, health clinic managers, researchers, and end users (i.e., individuals with LLA) on outcome measures for the International Society of Prosthetics and Orthotics lower limb Consensus Outcome Measures for Prosthetic and Amputation ServiceS.

Demographic, medical, and financial statistics from the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) database, 1987-2018: a prosthetics, orthotics, and mobility clinic in northern Sri Lanka

Background When dealing in global health, it is crucial to have a comprehensive understanding of community demographics and needs. From 1983-2009, a 26-year ethnic civil conflict devastated Sri Lanka, disproportionately affecting people living in the north and creating a large amputee population. Here, we use routinely collected prosthetic and orthotic data to investigate the composition of the amputee community in northern Sri Lanka. Methods The Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) was established in 1987 and has been the only centre consistently providing prosthetic, orthotic, and non-orthopaedic services in northern Sri Lanka spanning during and after the civil war. In 2004, with the help of the charity Motivation, they established an electronic patient database, which records and maintains information on the JJCDR’s patients. An anonymized copy of the JJCDR database was obtained in November 2018. Summative statistics and temporal trends in patient data were investigated. Results 3,665 unique patients registered with the JJCDR from 1986-2018 (2,605 male, 1,060 female). Individuals ranged from 0-90 years old, with a mean/median age of 34.76/32 years old. Key findings include: (i) 93.0% patients with amputation site recorded were lower limb amputees, with 74.3% being transtibial amputees; (ii) The majority of patients with cause of amputation recorded had war-related amputations (61.2%); (iii) diabetes was the highest cause for non-war-related amputations (18.3%); (iv) war-related amputations have ceased, while diabetic amputations are on the rise; and (v) peak recorded financial costs due to prosthetic and orthotic (P&amp;O) creation/maintenance occurred in 2013, 4 years after the war ended. Conclusions These analyses provide crucial insight into the P&amp;O population in northern Sri Lanka, including distribution and frequency for causes/sites of amputations, temporal patterns in causes of amputations, and costs to a P&amp;O centre due to device creation and maintenance. This database and analysis provide invaluable insight into the P&amp;O cohort in northern Sri Lanka, and a unique insight into the P&amp;O needs of a post-conflict LMIC from the perspective of a P&amp;O centre.

Gender differences in prosthesis-related outcomes among veterans: Results of a national survey of U.S. veterans.

Women with lower extremity amputations (LEAs) tend to have poorer prosthesis-related outcomes than men, although the literature is sparse. To our knowledge, there are no prior studies examining prosthesis-related outcomes of women veterans with LEAs. To examine gender differences (overall and by type of amputation) among veterans who underwent LEAs between 2005 and 2018, received care at the Veterans Health Administration (VHA) prior to undergoing amputation, and were prescribed a prosthesis. It was hypothesized that compared to men, women would report lower satisfaction with prosthetic services, poorer prosthesis fit, lower prosthesis satisfaction, less prosthesis use, and worse self-reported mobility. Furthermore, it was hypothesized that gender differences in outcomes would be more pronounced among individuals with transfemoral than among those with transtibial amputations. Cross-sectional survey. Linear regressions were used to assess overall gender differences in outcomes and gender differences based on type of amputation in a national sample of veterans. VHA medical centers. The sample consisted of 449 veterans who self-identified their gender (women = 165, men = 284) with transtibial (n = 236), transfemoral (n = 135), and bilateral LEAs (n = 68) including all amputation etiologies. Not applicable. The Orthotics and Prosthetics User's Survey, Trinity Amputation and Prosthesis Experiences Scale, and Prosthetic Limb Users Survey of Mobility-Short Form were used to assess satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, prosthesis use, and self-reported mobility. Women had poorer self-reported mobility than men (d = -0.26, 95% confidence interval -0.49 to -0.02, p < .05); this difference was small. There were no statistically significant gender differences in satisfaction with prosthetic services, prosthesis fit, prosthesis satisfaction, daily hours of prosthesis use, or by amputation type. Contrary to the hypothesis, prosthesis-related outcomes were similar between men and women with LEAs. Minimal differences may in part be due to receiving care from the VHA's integrated Amputation System of Care.

Repairing the prosthetic science-policy rift: Challenges to improved access to and translation of prosthetic technologies

We outline a brief history of the technology and state of medical care for individuals with limb loss throughout several eras of innovation in the United States. We review current challenges to preventative and post-amputation prosthetic health access, as well as the racial and socioeconomic health disparities among individuals who experience limb loss. We explore scientifically-inspired solutions to bridge the gap between current and emerging advanced technology and health coverage that can expand patient access to prosthetic devices and services.

Translation and validation of the Malay version of modified orthotics and prosthetics users' survey.

An excellent validated and reliable instrument is paramount in holistically evaluating the prosthetic and orthotic (P&O) service, encompassing functional outcomes, health-related quality of life (HRQoL), and patient satisfaction with devices and service. To perform a translation and cross-cultural adaptation of 3 modules of the Orthotics and Prosthetics Users' Survey (OPUS): (1) lower-extremity functional status (LEFS), (2) client satisfaction with device and services (CSDS), and (3) HRQoL in Malay language, and analyze its psychometric properties. Translation and validation study. This translation process consisted of 4 phases: (1) a forward-backward translation, (2) content and face validity by utilizing content and face validity indices, (3) pilot testing and psychometric analysis using exploratory factor analysis, and (4) test-retest reliability. One item from OPUS Health Quality of Life Index-Malay pilot version, 5 items from OPUS LEFS-Malay pilot version, and 4 items of OPUS Satisfaction with Device and Services-Malay pilot version were deleted because of poor factor loading of <0.6. The final version of Modified OPUS HRQoL-M, Modified OPUS LEFS-M, and Modified OPUS CSDS-M consisted of 22 items, 15 items, and 17 items, respectively. The final versions of all 3 Modified OPUS Malay version possess good internal consistency of 0.854, 0.927, and 0.98, and intraclass correlation of 0.773, 0.871, and 0.821, respectively . Modified OPUS HRQoL-M, Modified OPUS LEFS-M, and Modified OPUS CSDS-M are valid and reliable instruments to be adopted into the local Malaysia population.