Education in prosthetic and orthotic training: Looking back 50 years and moving forward

Travellers with prosthetic limbs, a neglected population. A perspective on what travel health practitioners need to know

BACKGROUND

The benefits of travel for the wellbeing of people of all ages and abilities are well known, though travellers with prostheses have so far been excluded. Limb loss, due to trauma, vascular disease, cancer, or infections requires a prosthesis for cosmesis and functionality. The life-changing event of losing a limb and the considerable psychological adjustment to accept an altered body image influence rehabilitation and self-management as well as the participation in social activities, such as sport and travel. The challenge of travel lies not only in transferring practical impediments encountered at home to another location; familiar coping strategies may require unexpected adjustments. After presenting background information on limb loss and prostheses, the purpose of this paper was to review literature on health advice for travellers with prosthetic limbs.

METHOD

All major data bases were searched for peer-reviewed literature using a variation of keyword combinations around travel and prosthetics. Relevant journals were searched individually, and selected authors and university departments contacted. No evidence-based results were obtained. The search then moved to grey literature including documents from relevant organisations, professional bodies, government websites, manufacturers, airlines, prosthetic/physiotherapy clinics, sport organisations to approaching amputees, including veterans and athletes, directly.

RESULT

The list of collated travel advice for people with artificial limbs relates to (1) trip preparation, (2) packing (especially considering the mechanical and/or electrical requirements of the prosthesis), (3) travelling by plane as the most covered mode of travel, and (4) navigating airports and airport security, which may be used by travel health practitioners while awaiting evidence-based guidelines.

CONCLUSION

This is the first paper on travel with a prosthetic limb in any field, including travel medicine. Therefore, travel health practitioners have no evidence-based guidelines at their disposal required for high-quality care for this neglected population. Preliminary recommendations for clinical practice, advice for required updates in education, and suggestions for urgently needed research are provided to replace current hints and tips with evidence so that travellers with prostheses are no longer 'out on a limb'.

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence (BN, KKQ), and ethics of advanced technologies (KKQ). The target audience for this article includes developers, manufacturers, and researchers of prosthetic devices and related technology. We present several ethical considerations for current advances in prosthetic technology, as well as topics for future research, that may inform product and policy decisions and positively influence the lives of those who can benefit from advances in prosthetic technology.

Patient-practitioner interaction within the field of prosthetics and orthotics: A scoping review

Patient-practitioner interaction has been shown to positively affect patient outcomes and experiences in various medical fields. However, the career of prosthetics and orthotics (P&O) includes components and processes unique to its field. Therefore, the concepts, practices, and information of patient-practitioner interaction need to be identified to understand how P&O practitioners can positively influence patient outcomes. A scoping review of PubMed, PsycINFO, and CINAHL was conducted for empirical research involving patient-practitioner interaction in P&O between the years of 1990 and 2021. Initial searches discovered 646 unique articles. Only 2 quantitative studies and 3 qualitative studies were included in the final analysis. Three interconnected themes were prevalent across the 5 articles: the knowledge available to the patient and the practitioner, the difference in expectations of both patient and practitioner, and communication processes. These 3 concepts create a feedback loop of consequences that can be addressed by ensuring that adequate and useful patient-practitioner communication is applied during the care process. Despite multiple calls for research in this area over the past 50 years, very few articles have addressed patient-practitioner interactions. Future research is needed to understand how interactions in P&O can be optimized to positively affect patient experience and outcomes.

Fostering integration among students with different backgrounds using an orthotic community service program

BACKGROUND

In this globalization era, institutions are developing strategies including international service-learning pedagogies to integrate global perspectives and dimensions into the learning and teaching processes to develop students' capacity in intercultural competence.

OBJECTIVE

This study aimed to assess the students' intercultural learning outcome through provision of orthotic community service to the less-privileged children.

METHODS

A Hong Kong-based university collaborated with 2 American universities to conduct an orthotic community service program for the children with cerebral palsy in mainland China. In the process of service delivery, the students with different backgrounds worked closely and students' professional knowledge, intercultural understanding, and communication skills were evaluated. A mixed-method approach was adopted to investigate on how this international program could facilitate meaningful interactions in clinical practices. Preprogram and postprogram surveys and focus group interviews were conducted. Statistical analyses were performed on the quantitative data, while interview data were analyzed thematically.

RESULTS

A comparison of preprogram and postprogram surveys showed that the students perceived this community service program important for enhancement of their capabilities to communicate with people from other cultures (n = 39, p < 0.05). It also showed an increase in local students' willingness to work with people from other cultures. Some themes related to intercultural competences were identified from the interview: "intercultural awareness, understanding, and communication" as well as openness to work/socialize with people from other cultures."

CONCLUSIONS

This study demonstrated that an international community service program could initiate positive changes in students' intercultural communication capability and interest to work with culturally different people.

Overcoming Challenges and Innovations in Orthopedic Prosthesis Design: An Interdisciplinary Perspective

Recent advances in the orthopedic prostheses design have significantly improved the quality of life for individuals with orthopedic disabilities. However, there are still critical challenges that need to be addressed to further enhance the functionality of orthopedic prostheses improving biocompatibility to promote better integration with natural tissues, enhancing durability to withstand the demands of daily use, and improving sensory feedback for better control of movement are the most pressing issues. To address these challenges, promising emerging solutions such as smart prosthetics, 3D printing, regenerative medicine, and artificial intelligence have been developed. These innovative technologies hold the potential to significantly enhance the functionality of orthopedic prostheses. Realizing the full potential of these next-generation orthopedic prostheses requires addressing several critical factors. These include interdisciplinary collaboration between experts in orthopedics, materials science, biology, and engineering, increased investment in research and development, standardization of components to ensure quality and reliability, and improved access to prosthetics. A comprehensive review of these challenges and considerations for future orthopedic prosthesis design is s provided in this paper addressing the further advances to the field. By addressing these issues, we can continue to improve the lives of individuals with orthopedic disabilities and further enhance the field of orthopedic prosthetics.

Work-related musculoskeletal pain in prosthetists and orthotists: a comparison between Australia and other countries

BACKGROUND

Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics professionals working in Australia have previously reported a high prevalence of MSP; however, little is known about the prosthetic and orthotic communities in other countries.

OBJECTIVES

To explore the prevalence and range of workplace exposures associated with MSP in a convenience sample of the international prosthetic and orthotic profession.

STUDY DESIGN

A cross-sectional study using a convenience sample was conducted with prosthetists and orthotists worldwide.

METHODS

Prosthetists and orthotists were invited to participate in a survey to explore work-related factors associated with MSP. Bivariate and regression modelling was used to examine associations between self-reported demographic and workplace characteristics including job satisfaction, work-life balance, and physical and psychosocial hazards.

RESULTS

Seventy-six percent of respondents (n = 173) reported MSP in the previous 6 months. However, MSP was associated with different factors in Australia compared with other countries. Among Australia-based prosthetists and orthotists, MSP was associated with sex, physical hazards, and psychosocial hazards. For the international sample, MSP was only associated with length of employment.

CONCLUSIONS

Three-quarters of all respondents reported having MSP. Differences in associations between MSP and other factors by respondents' geographical location suggest the need for context-specific identification of hazards to enable the development of targeted and contextually appropriate prevention strategies.