Prosthetic Services Research Articles

Prosthetic use by persons with unilateral transfemoral amputation in a South African setting.

Due to limitations in provision of prosthetic care in South Africa, a screening tool to select transfemoral prosthetic candidates has been implemented. To describe prosthetic services, use and mobility of people with transfemoral amputation, identified as prosthetic candidates through the Guidelines for Screening of Prosthetic Candidates: Lower Limb, and to identify variables that might influence prosthetic use and mobility. Cross-sectional survey. The study population included all adults who received their first prosthesis from the Orthotic and Prosthetic Centre in the Western Cape between 1 June 2011 and 31 December 2014. Data were collected, with an adapted version of the Prosthetic Profile of the Amputee, from 43 participants, through telephonic interviews. Descriptive and inferential analysis, with the chi-square test, was done. The majority of participants were older than 50 years (77%). Most participants (35; 81%) used their prosthesis; however, only 42% (18) used it daily. A significant association ( p = 0.000) was found between prosthetic rehabilitation and self-reported prosthetic walking distance. Less than half of participants received prosthetic rehabilitation and only 10 (30%) could walk 500 steps and more without resting. Participants used their prosthetic leg, but experienced limitations in frequency of wear and mobility. Current findings showed that participants' prosthetic mobility was curtailed. In less-resourced settings, carefully selecting prosthetic candidates may be necessary to provide access to services. Prosthetic provision is advised to be followed up with prosthetic rehabilitation for favourable mobility outcomes.

A scoping literature review of studies assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions

Purpose: Approximately 1.5% of the world’s population (∼100 million people) need a prosthesis/orthosis. The objective of the study was to establish an overview of the literature that has examined prosthetic and orthotic interventions with a view to inform policy development.Methods: Fourteen databases were searched from 1995–2015. Studies reporting primary research on the effectiveness or cost-effectiveness of prosthetic and orthotic interventions were examined. Metadata and information on study characteristics were extracted from the included studies.Results: The searches resulted in a total of 28,958 articles, a focus on studies with the words “randomized” OR “randomized” OR “cost” OR “economic” in their citation reduced this total to 2644. Research has predominantly been conducted in Australia, Canada, Germany, Netherlands, UK and USA. A total of 346 randomized controlled trials were identified, with only four randomized controlled trials examining prosthetic interventions. The majority of research examined lower limb orthoses in the adult population and used a wide range of outcome measures.Conclusions: While various international organizations have highlighted the value of providing prosthetic and orthotic services, both to the user and society as a whole, the availability of scientific research to inform policy is limited. Future structured evaluation of prosthetic and orthotic interventions/services is warranted to inform future policy developments.Implications for rehabilitationResearch into prosthetic and orthotic interventions has grown substantially in the last 20 years, with most of this research conducted in a small number of countries and focusing on the use of lower limb orthotics in adult populations.Research to date has utilized an extensive range of outcome measures, the development of agreed standardized sets of outcomes would allow comparison and combination of results in future research.This study highlights the need for further research in this area, especially studies which examine the cost-effectiveness of prosthetic and orthotic provision.

Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014

ABSTRACT Background There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007–2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011–2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services. Methods This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011–2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed. Results Patients who received lower extremity orthotics had 18-month episode costs that were $1,939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2,094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p<0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis. Conclusions These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.

Economic Value of Prosthetic Services among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study

ABSTRACT Context There are few studies of the economic impact or value of lower extremity prosthetic services. Results from this study can inform the value proposition concerning prosthetic services within military health, where over 40,000 Veterans with limb-loss receive care for their amputations through the Veterans Administration health care system. Purpose To determine the extent to which Medicare patients who received selected prosthetic services had less health care utilization, lower Medicare payments, and/or fewer negative outcomes compared to matched patients not receiving these services. Methods This retrospective cohort analysis using Medicare claims data (2007–2010) and propensity score matching techniques to control for observable selection bias based on etiological diagnosis, comorbidities, patient characteristics, and historical health care utilization one year before the etiological diagnosis. Findings: Patients who received lower extremity prostheses had comparable Medicare episode payments ($6,099 per-member-per-month for study group, $6,015 per-member-per-month for comparison group) and better outcomes than patients who did not receive prostheses. Study group patients were more likely to receive extensive outpatient therapy than comparison group patients ( P < 0.05). Receiving physical therapy is associated with fewer hospitalizations and emergency room visits, and less facility-based care ( P < 0.05), essentially offsetting the cost of the prosthetic over a 12-month time frame.

Limbless Medical Data Analyzing using CRISP Model a Case Study of UK Limbless Patients

Data mining, usually known as knowledge elicitation in the field of computer science databases, is the procedure to find out an important relationship, useful patterns in a huge amount of raw data. Besides, many sectors have adapted and used data mining in their applications such as healthcare and industry sector. In the healthcare sector, data mining can help in determining the probability of particular health cases in medical issues which the related variables pre-known as well as predicting future events. The availability of medical data for data mining usually exist in a raw data format, therefore, it needs for making ready and exploration to be willing to use. In the context of this paper, an analyzing of medical data was introduced to support prosthetics service centers to analyze find out the significant information from limbless medical cases, besides, in providing a comprehensive understanding of amputation and its types as well as the level of amputation. To ensure extract meaningful information from the intended data sets as well as to follow a systematic approach, the CRISP-DM model was adopted. The findings show the important and meaningful of the analyzing data using data mining modes.

GLOBAL STANDARDS FOR PROSTHETICS AND ORTHOTICS

Over the past decade, essential documents and agreements have emerged to help improve the lives of people with physical disabilities. These include Convention on the Rights of Persons with Disabilities (CRPD), ratified by more than 170 countries, and the World Health Organization (WHO) global disability action plan. While the principles in these broad agreements can be applied to people who would benefit from assistive technology, specific service standards are required to operationalize the CRPD and WHO objectives. Therefore, WHO, in partnership with the International Society for Prosthetics and Orthotics (ISPO) and the United States Agency for International Development (USAID), prepared global standards and an implementation manual to assist Member States in setting up, improving, or transforming their systems for delivering appropriate prosthetic and orthotic services.
 Article PDF Link:https://jps.library.utoronto.ca/index.php/cpoj/article/view/31371/23745
 How to cite: Lemaire ED, Supan T, Ortiz M. Global Standards for Prosthetics and Orthotics. Canadian Prosthetics & Orthotics Journal. Volume1, Issue2, No.3, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.31371

Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011\u20132014

BackgroundThere are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011 to 2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services.MethodsThis is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011–2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed.ResultsPatients who received lower extremity orthotics had 18-month episode costs that were $1939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p < 0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis.ConclusionsThese results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.

Satisfaction of Veterans with Trans-Radial Amputations from Myoelectric Prosthesis and Prosthetic Services Referring to Kowsar Orthotics and Prosthetics Center in Tehran

Satisfaction of Veterans with Trans-Radial Amputations from Myoelectric Prosthesis and Prosthetic Services Referring to Kowsar Orthotics and Prosthetics Center in Tehran

Experiences of lower limb prosthetic users in a rural setting in the Mpumalanga Province, South Africa.

Ambulation with a prosthesis is the ultimate goal of rehabilitation for a person with a major lower limb amputation. Due to challenges with prosthetic service delivery in rural settings, many patients with amputations are not benefitting from prosthetic interventions. Inaccessibility to prosthetic services results in worse functional outcomes and quality of life. Learning from the experiences of current prosthetic users in this setting can assist to improve prosthetic service delivery. To explore the experiences of lower limb prosthetic users and to understand the importance of a lower limb prosthesis to a prosthetic user in a rural area of South Africa. A generic qualitative approach and an explorative design were utilised in this study. A semi-structured interview guide was used to collect data from nine prosthetic users in a rural area in the Mpumalanga province of South Africa. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Demographic details and information related to acute in-patient rehabilitation were analysed descriptively. All participants were independent in activities of daily living with their prosthesis and participated actively in their community. Participants reported that their prosthesis was essential to their functioning. High travel cost was highlighted as a barrier to the maintenance of their prosthesis. Patients were dissatisfied with being unemployed. Prosthetic intervention positively influences function, independence and community participation. Challenges relating to the accessibility, cost and maintenance of prosthetics should be a priority to ensure continued functional independence for prosthetic users. Understanding the importance of a prosthesis to a prosthetic user validates prosthetic intervention for persons living with an amputation in a rural setting and is vital in establishing and remodelling effective systems for prosthetic service delivery.

Taxonomy of clinical encounters during the first 90 days post-delivery of an initial lower limb prosthesis.

The incidence and etiology of prosthetic services utilization is poorly understood during the first 90 days post-delivery of the initial lower limb prosthesis. This period is of critical importance, as prevailing policy dictates limits on the reimbursement for certain services provided during this time period. The first step in understanding the financial ramifications of such policy is to examine the taxonomy behind clinical encounters during this tenuous time period. Quantify and categorize clinical encounters by incidence and etiology. Retrospective chart review. A central database containing data on prosthetic services was examined. Incidence and etiology were extracted through independent review of each patient chart. A total of 537 unique patients were identified, with 109 meeting the inclusion criteria. Chi-square testing showed that comfort ( p < 0.05), cosmesis ( p < 0.01), and mechanical failure ( p < 0.001) yielded statistical significance in scheduled versus unscheduled visits. Stepwise regression analysis demonstrated that both sex and K-level were important predictors of unscheduled visits. Taxonomization of clinical encounters experienced during the first 90 days provides a framework for future studies to be conducted. The data provided can serve as a basis for informing reimbursement policy, workforce planning, and advocacy. Clinical relevance Comfort is the most frequent reason for a clinical encounter during the first 90 days after delivering a lower limb prosthesis. The data on the taxonomy behind the clinical encounters can be used to guide workforce planning and advocate for just reimbursement policy that better reflect patient's needs.

Prosthetic and orthotic students' attitudes toward addressing sexual health in their future profession.

Prosthetists and orthotists have a responsibility to direct treatment toward enabling their clients to perform desired activities and to facilitate participation of their clients in all areas of life. This may include provision of assistive technologies to help clients meet goals related to participation in sexual activities. To help prosthetic and orthotic students develop competencies in dealing with the sexual health of their future clients, it is necessary to generate knowledge of their own perceived competence and capacity. To explore prosthetic and orthotic students' attitudes and competence toward working with sexual health and to evaluate reliability and validity of the Students' Attitudes Towards Addressing Sexual Health questionnaire. Cross-sectional study. Students enrolled in all three years of an undergraduate prosthetic and orthotic program were requested to complete the Students' Attitudes Towards Addressing Sexual Health questionnaire ( n = 65). Reliability and validity were evaluated using the content validity index and Cronbach's alpha. Students felt unprepared to talk about sexual health with future clients and thought that they would be embarrassed if they raised the issue. No differences were identified between students enrolled in each of the three years of the program and few differences were observed between male and female students. The content validity index values were low but improved as the students' level of education increased. Internal consistency of the questionnaire was acceptable ( α = 0.86). Prosthetic and orthotic students are unprepared to address sexual health issues with their future clients. There is a need to provide students with training related to sexual health issues. This study indicates the need for additional education of prosthetic and orthotic students in issues related to sexual health and how to address sexual health issues with clients. Results can be used to develop training programs for students and will serve to improve the sexual health of individuals who receive prosthetic and orthotic services.

Evaluation of Users’ Satisfaction with Prosthesis and Prosthetic Services in Tehran

Evaluation of Users’ Satisfaction with Prosthesis and Prosthetic Services in Tehran

A personalised exercise programme for individuals with lower limb amputation reduces falls and improves gait biomechanics: A block randomised controlled trial

BackgroundLower limb amputees (LLAs) are at increased risk of falling due to the inherent asymmetry resulting from their limb loss, muscle weakness and other neuro-musculoskeletal limitations. Research questionThe aim of this study was to evaluate the effects of a personalised exercise programme on falls prevention and gait parameters in LLAs. MethodsFifteen LLAs, recruited from their local prosthetic services centre, were block randomised, by age and level of amputation, into two groups: exercise group (transfemoral, n = 5; transtibial, n = 2) and control group (transfemoral, n = 5; transtibial, n = 3). The exercise group completed a 12-week programme, focusing on strength, balance, flexibility and walking endurance, delivered in group sessions at the University, and combined with a personalised home exercise programme. Temporal-spatial, 3D kinematic and kinetic gait parameters were collected at baseline and post-intervention. Falls incidence was also followed up at 12 months. ResultsThe exercise group experienced significantly fewer falls in the one-year period from baseline, compared with the average annual falls rate, obtained at baseline (P = 0.020; d = 1.54). Gait speed in the exercise group increased by 0.21 m∙s−1, to 0.98 m∙s−1 (P < 0.001; d = 0.91), through increased intact limb cadence. In the pre-swing phase, there were significant increases in intact limb peak vertical force, and affected limb peak propulsive (anterior) force for the exercise group. Power absorption and generation significantly increased at both the intact and affected hip joints (H3) and the intact ankle (A1 and A2) for the exercise group, resulting in significant group*time interactions. SignificanceThis is the first study to document the clinically meaningful benefits of an exercise intervention for falls prevention and gait performance in LLAs. Specialised exercise programmes for community-dwelling LLAs should be implemented as a method to reduce falls and improve walking performance in this population.

Mobility outcomes for those with primary lower limb amputation attending a regional outpatient prosthetic rehabilitation service

Mobility outcomes for those with primary lower limb amputation attending a regional outpatient prosthetic rehabilitation service

Materials library collections as tools for interdisciplinary research

ABSTRACTThis paper examines how materials libraries are used as tools for interdisciplinary collaboration in 3 research projects that inhabit a disciplinary triangle between materials research, design and user needs: PhysFeel, which explores how materials collections can be used in psychological therapies; Light.Touch.Matters, a design-led project to develop new smart materials; and Hands of X, which uses materials collections to develop a bespoke prosthetics service. The paper analyses and contrasts these case studies to better understand the affordances and limitations of materials collections when used as research, translational and design tools. We conclude that in collaborations between materials researchers, designers and end users, tensions arise as a result of the primacy that each partner gives to creativity, the development of new knowledge and to solving societal problems. The use of a materials library addresses many of these issues but is not a panacea for all the problems associated with interdisciplinary working.

The modular socket system in a rural setting in Indonesia.

Background:Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop.Objectives:This study aimed to evaluate the patient’s performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting.Study design:A quantitative longitudinal descriptive study design was followed.Methods:A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4–6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting (t0), at 1–3 months post fitting (t1) and at the end evaluation at 4–6 months post fitting (t2).Results:Performance did not change between t0 and t2. The comfort of the socket fit reduced between t0 and t2. Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h.Conclusion:The modular socket system can be considered a useful alternative for use in rural settings.Clinical relevanceThe use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.

How Many Dentists Are Needed in 2040: Executive Summary

Five background articles in Section 2 of the "Advancing Dental Education in the 21st Century" project examined some of the factors likely to impact the number of dentists needed in 2040: 1) the oral health of the population, 2) changes in the utilization of dental services, 3) new technologies, 4) the growth of large capitated dental group practices, and 5) the demand for dental care. With this information, a sixth background article estimated the number of dentists needed in 2040 compared to the number expected if current trends continue. This executive summary provides an overview of findings from these six articles. The data indicate major improvements in oral health, especially in upper income groups that account for 65% of practice revenues. At the same time, per capita utilization of restorative and prosthetic services has declined dramatically. No major new technologies are likely to impact the need for dentists by 2040. In a large capitated group practice, full-time general dentists treated an average of 2,100 patients per year; solo general dentists averaged 1,350. Based on the examined factors, growth in demand for traditional forms of care may slow substantially, raising the potential for a surplus of dentists in 2040. If these trends continue, the key national policy issue then would be: should schools reduce the number of graduates before market forces require them to downsize or close, or are other alternatives available?

The influence of staff training and education on prosthetic and orthotic service quality: A scoping review.

Education and training in prosthetics and orthotics typically comply with International Society for Prosthetics and Orthotics standards based on three categories of prosthetic and orthotic professionals. This scoping study sought to describe the evidence base available to answer the question, How are prosthetic and orthotic services influenced by the training of staff providing them? Scoping review. A structured search of the peer-reviewed literature catalogued in major electronic databases yielded 3039 papers. Following review of title and abstract, 93 articles were considered relevant. Full-text review reduced this number to 25. Only two articles were identified as providing direct evidence of the effects of training and education on service provision. While both suggested that there was an impact, it is difficult to see how the more specific conclusions of either could be generalised. The other 23 articles provide a useful background to a range of issues including the specification of competencies that training programmes should deliver (3 articles), descriptions of a range of training programmes and the effects of training and education on student knowledge and skills. Although it is considered axiomatic, the service quality is dependent on practitioner education and training. There is insufficient evidence to establish whether levels of training and education in prosthetics and orthotics have an effect on the quality of prosthetic and orthotic services. Clinical relevance There is very little evidence about the effects of training and education of prosthetists and orthotists on service quality. While this is a somewhat negative finding, we feel that it is important to bring this to the attention of the prosthetics and orthotics community.

Mikolay Petrovich Novachenko — large seen from a distance (1898–1966 years)

The article briefly describes the scientific and pedagogical way of the great organizer, scientist, brilliant teacher, talented doc­tor, corresponding member of the Academy of Medical Sciences of the USSR, honored worker of science of Ukraine, doctor of medical sciences, professor Novachenko Nikolai Petrovich, the director of the Scientific research institute of orthopedics and traumatology named by M. I. Sytenko, head of the depart­ment of orthopedics and traumatology of the Ukrainian institute of postgraduate education, editor-in-chief of the journal «Ortho­paedics, traumatology and prosthetics». Born in a peasant family, he was educated at the church and parish schools in Sumy region, the gymnasium of Kharkov, and entered the medical faculty of Kharkov university, after which, in 1922, he began working at the Ukrainian institute of orthopedics and traumatology (now the «Sytenko Institute of Spine and Joint Pathology»). Having passed the way of the resident, the head of the radiology room and the clinical department, the chief physician of the in­stitute, became its director. He was engaged in clinical prac­tice and scientific research (in 1936 he defended his Candidate, and in 1940 — his doctoral dissertation). After demobilization in 1943 N. P. Novachenko devoted himself to the restoration of the institution and the education of cadres. Clinical works of N. P. Novachenko considers the topical issues of all sections of our specialty. His name is associated with: restoration and development of orthopaedic and traumatological and prosthetic services, organization of strong points, injuries treatment, de­velopment of functional techniques for the treatment of traumatic injuries; development of new reconstructive and restorative interventions on large joints with bone defects, preservation and transplantation of tissues (bones, tendons, skin), creation of tis­sue bank, restoration of the journal «Orthopaedics, traumatolo­gy and prosthetics» after the war.

Lower limb amputations: Our experience single centre study

Background and objectives: Major limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where the prosthetic services are poor. Amputation has implications on both mobility and functionality. The purpose of this study was to outline the patterns, indications and short term complications of major limb amputations and to compare our experience with that of other published data. Material and methods: This was a cross-sectional descriptive study involving all patients who underwent major lower limb amputations at Bowring and Lady Curzon Hospital between March 2008 and February 2016. All patients who underwent major limb amputation were, after informed consent for the study, enrolled into the study Amputation was performed by the attending surgeon who also prescribed the postoperative care of the patient. Patients were followed up till discharge or death. Results: A total of 162 patients were entered into the study. Their ages ranged between 2180 years. The most common indication for major limb amputation was diabetic foot complications in 87.6% followed by chronic non healing ulcer and peripheral vascular disease. Above knee amputation was the most common procedure performed in 88.8%. Conclusion: Complications of diabetic foot ulcers and chronic non healing ulcer were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications.