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Diment L, Curtin S, Kenney L, Reynolds KJ, Granat MH. Priorities when designing a service-focused delivery model for mobility devices: a systematic review. Disabil Rehabil Assist Technol 2024; 19:2442-2453. [PMID: 38349125 DOI: 10.1080/17483107.2024.2313077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/28/2023] [Accepted: 01/26/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE Throughout the world, mobility devices are usually distributed using product-based business models, where a device is provided to a user, and serviced or replaced when the user returns to the clinic with an issue. Moving to a service-based business model can provide continuous and customised support for the user, and provide the clinicians and manufacturers with better data to base their decisions on. This study reviews papers on assistive technology service-based business models and considerations in designing such a model to optimise economic and social value. It then applies the findings to the mobility device space. METHOD A systematic literature search was undertaken in PubMed, Web of Science, and OVID databases to analyse studies that discuss service delivery models used to provide assistive products. Inductive thematic analysis determined the themes, facilitators and barriers associated with providing a service. Findings were applied to mobility device service provision. RESULTS AND CONCLUSION Themes from the 29 relevant papers were grouped into four categories: Access (affordability/availability/education), Utility (customisability/usability/adaptability), Integrity (quality/sustainability/impact), and Compliance (policy/privacy/security). The most common themes were customisability, affordability, availability, and education. There is a need for service-based delivery models to replace conventional product-based models, and many considerations to optimise their design. No publications discussed the design and implementation of a service-based model for mobility device provision that uses modern sensors, software and other digital technologies to optimise the service. Service-based models that use modern digital technologies are new for the mobility device field, but much can be learnt from other fields.
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Affiliation(s)
- L Diment
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, Australia
| | - S Curtin
- School of Health and Society, University of Salford, Salford, UK
| | - L Kenney
- School of Health and Society, University of Salford, Salford, UK
| | - K J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, Australia
| | - M H Granat
- School of Health and Society, University of Salford, Salford, UK
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Oldfrey B, Holloway C, Walker J, McCormack S, Deere B, Kenney L, Ssekitoleko R, Ackers H, Miodownik M. Repair strategies for assistive technology in low resource settings. Disabil Rehabil Assist Technol 2024; 19:1945-1955. [PMID: 37466362 DOI: 10.1080/17483107.2023.2236142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To investigate the practices of repair that exist for users of mobility assistive products in low resource settings, as well as the psychosocial impact that the repair, or non-repair, of these devices has on users' lives. MATERIALS AND METHODS This article collates data on repair practices and the responses from participants on the topic of repair from studies conducted by the authors across four different low resource settings in Kenya, Uganda, Sierra Leone, and Indonesia. This data was then analyzed to identify the common themes found across geographies. RESULTS Three major models of repair practice emerged from the data: "Individual or Informal Repair in the Community"; "Local Initiatives"; and "Specialist AT Workshop Repair". Additionally, the wider impact on the participants' lives of "Problems & Concerns with Repair"; "Experiences of Breakages & Frequencies of Repair" and the "Impact of Broken Devices" are explored. CONCLUSIONS The results of this analysis demonstrate the paramount importance of community-based repair of devices, and how despite this importance, repair is often overlooked in the planning and design of assistive products and services. There is a need to further incorporate and support these informal contributions as part of the formal provision systems of assistive device.
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Affiliation(s)
- Ben Oldfrey
- Global Disability Innovation Hub (GDI Hub), London, UK
- Institute of Making, University College London, London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Cathy Holloway
- Global Disability Innovation Hub (GDI Hub), London, UK
- Interaction Centre (UCLIC), University College London, London, UK
| | - Julian Walker
- The Bartlett Development Planning Unit, University College, London, UK
| | - Steven McCormack
- Orthopaedic Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Bernadette Deere
- Division of Imaging Sciences and Biomedical Engineering, Department of Medical Engineering and Physics, King's College London, London, UK
| | - Laurence Kenney
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Robert Ssekitoleko
- Biomedical Engineering, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Helen Ackers
- School of Health and Society, University of Salford, Manchester, UK
| | - Mark Miodownik
- Institute of Making, University College London, London, UK
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Anderson CB, Fatone S, Mañago MM, Swink LA, Kittelson AJ, Magnusson DM, Christiansen CL. Development and alpha testing of a patient shared decision aid for prosthesis design for new lower limb prosthesis users. Prosthet Orthot Int 2024:00006479-990000000-00229. [PMID: 38506643 PMCID: PMC11411013 DOI: 10.1097/pxr.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user's needs, values, and preferences. OBJECTIVE To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility. STUDY DESIGN Exploratory mixed methods. METHODS PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10. RESULTS The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users. DISCUSSION The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users' informational needs. Future iterations of the PDA should undergo beta testing in clinical settings. CONCLUSIONS A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible.
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Affiliation(s)
- Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
- James M. Anderson Center for Health Systems Excellence and the Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH
| | - Stefania Fatone
- Division of Prosthetics and Orthotics, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
| | - Laura A Swink
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
| | - Andrew J Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
| | - Dawn M Magnusson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
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4
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McDonald CL, Kahn A, Hafner BJ, Morgan SJ. Prevalence of secondary prosthesis use in lower limb prosthesis users. Disabil Rehabil 2024; 46:1016-1022. [PMID: 36843538 PMCID: PMC11182650 DOI: 10.1080/09638288.2023.2182919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/28/2023]
Abstract
PURPOSE Prostheses designed for daily use are often inappropriate for high-level activities and/or are susceptible to water damage and mechanical failure. Secondary prostheses, such as activity-specific or back-up prostheses, are typically required to facilitate uninterrupted participation in desired life pursuits. This study estimated the prevalence of secondary prosthesis use in a large, national sample of lower limb prosthesis users (LLPUs). METHODS We conducted a secondary analysis of survey data from three cross-sectional studies that assessed mobility in LLPUs. Descriptive statistics were used to determine the percentage of secondary prosthesis users and percentages of LLPUs that used different type(s) of secondary prosthesis(es). Secondary prosthesis users and non-users were compared to identify differences in participant characteristics between groups. RESULTS Of participants in the analysis (n = 1566), most (65.8%) did not use a secondary prosthesis. The most common secondary prosthesis types were back-up (19.2%) and activity-specific prostheses (13.5%). Secondary prosthesis users differed significantly from non-users with respect to gender, race, and other characteristics. CONCLUSIONS Results suggest that secondary prosthesis use for most LLPUs is limited and may differ based on users' demographic and clinical characteristics. Future research should determine how LLPUs' health-related quality-of-life outcomes are affected by access to and use of secondary prostheses.Implications for RehabilitationSecondary prostheses, including activity-specific, back-up, and shower prostheses, have the potential to improve function, mobility, and participation for people who use lower limb prostheses.Most lower limb prosthesis users do not use secondary prostheses, and access to these devices may be related to users' demographic and clinical characteristics.Rehabilitation professionals play a key role in facilitating prosthesis users' access to secondary prostheses and should advocate for those who need them.
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Affiliation(s)
| | | | | | - Sara J. Morgan
- University of Washington, Seattle, WA
- Gillette Children’s, St. Paul, MN
- University of Minnesota, Minneapolis, MN
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5
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Resnik LJ, Borgia M, Clark MA, Ni P. Out-of-pocket costs and affordability of upper limb prostheses. Prosthet Orthot Int 2024; 48:108-114. [PMID: 36897203 DOI: 10.1097/pxr.0000000000000223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/18/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians. OBJECTIVES Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse. STUDY DESIGN Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans. METHODS Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated. RESULTS Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment. CONCLUSIONS Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.
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Affiliation(s)
- Linda J Resnik
- Research Department, Providence VA Medical Center, Providence, RI
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, RI
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI
- University of Massachusetts Medical School, Worcester, MA
| | - Pengsheng Ni
- Boston University School of Public Health, Boston, MA
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Resnik LJ, Borgia ML, Clark MA. Prevalence and predictors of unmet need for upper limb prostheses: An observational cohort study. JOURNAL OF PROSTHETICS AND ORTHOTICS : JPO 2023; 2023:10.1097/JPO.0000000000000477. [PMID: 37565066 PMCID: PMC10411186 DOI: 10.1097/jpo.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
ABSTRACT
Introduction
No prior studies have examined the prevalence of unmet prosthesis need among prosthesis nonusers.
Objectives
The aim of this study was to describe the prevalence of unmet need for an upper-limb prosthesis and identify independent covariates associated with unmet need for a prosthesis.
Study Design
This study is a telephone survey of 742 persons with upper-limb amputation (ULA).
Methods
Differences between users and nonusers and between nonusers with and without an unmet need were compared statistically. Covariates associated with unmet need P ≤ 0.2 in bivariate analyses were included in a multivariate logistic regression model predicting unmet need.
Results
Odds of unmet need were higher for those who stopped using a prosthesis within the past year compared with 20 years or more ago (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.28–14.51) and those on disability (OR, 4.01; 95% CI, 0.95–16.85). Odds of unmet need were lower for those with higher upper-limb function scores (OR, 0.94; 95% CI, 0.96–1.00), who were unemployed versus employed/student (OR, 0.15; 95% CI, 0.02–0.98), and those who had abandoned a prior prosthesis because it was “too much fuss” (OR, 0.41; 95% CI, 0.18–0.92).
Conclusions
Unmet need was prevalent, impacting approximately 50% of persons with upper-limb amputation who were not using a device and 14% who reported never having used a prosthesis. Independent correlates of greater unmet included worse upper-limb function, prosthesis use within the prior year, and disability status. Correlates of lesser unmet need included being unemployed and having abandoned a prosthesis because it was perceived as an undue burden. Further studies are needed to understand barriers to prosthesis use among nonusers with an unmet need.
Clinical Relevance
Persons with ULA who do not use a prosthesis should be reevaluated regularly to identify unmet needs. Our findings suggest recent prosthesis users, those with poorer upper-limb function, and those who are employed or on disability are more likely to have unmet needs.
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Affiliation(s)
- Linda J. Resnik
- Research Department, Providence VA Medical Center, Providence, Rhode Island
- Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - Matthew L. Borgia
- Research Department, Providence VA Medical Center, Providence, Rhode Island
| | - Melissa A. Clark
- Health Services, Policy and Practice, Brown University, Providence, Rhode Island
- University of Massachusetts Medical School, Worcester, Massachusetts
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Anderson CB, Kittelson AJ, Wurdeman SR, Miller MJ, Stoneback JW, Christiansen CL, Magnusson DM. Understanding decision-making in prosthetic rehabilitation by prosthetists and people with lower limb amputation: a qualitative study. Disabil Rehabil 2023; 45:723-732. [PMID: 35389313 PMCID: PMC9537359 DOI: 10.1080/09638288.2022.2037745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Little has been published about the process of decision-making between prosthetists and people with lower limb amputation (LLA). The purpose of this study is to identify decisions and factors influencing decision-making in prosthetic rehabilitation from the perspectives of prosthetists and prosthesis users, to identify barriers and opportunities for shared decision-making (SDM). METHODS Qualitative semi-structured individual interviews were conducted with 13 prosthetists and 14 prosthesis users from three clinics in three states of the Rocky Mountain and Southwest regions of the United States. Transcripts were analyzed using thematic analysis. RESULTS Four main themes were identified: perceived decision points, importance of relationship, balancing competing priorities, and experience. Contrasts between perceptions of prosthetists and prosthesis users were related to prosthesis design decisions, and the purpose of communication (e.g., goals for a prosthesis vs. goals informing prosthesis design). Both prosthetists and prosthesis users described balancing priorities that contribute to prosthetic rehabilitation decisions, and the role of experience for informing realistic expectations and preferences necessary for participating in decision-making. CONCLUSION Opportunities for improving SDM between prosthetists and prosthesis users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences.IMPLICATIONS FOR REHABILITATIONMany people with lower limb amputation experience poor physical function and psychosocial outcomes, which may be further compounded by under informed prosthesis-user expectations for function with a prosthesis.Shared decision-making offers an opportunity for improving realistic prosthesis-user expectations, reducing healthcare costs, and improving prosthesis-user satisfaction and adherence to care plans.Opportunities for improving shared decision-making between prosthetists and prosthesis-users include (1) clarifying key rehabilitation decisions, (2) identifying the purpose of initial communications, (3) support for balancing priorities, and (4) utilizing experience to achieve informed preferences.
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Affiliation(s)
- Chelsey B. Anderson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Andrew J. Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA
| | - Shane R. Wurdeman
- Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA
| | - Matthew J. Miller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Cory L. Christiansen
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
- Department of Geriatrics, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, USA
| | - Dawn M. Magnusson
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado, Aurora, CO, USA
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Reimagining Prosthetic Control: A Novel Body-Powered Prosthetic System for Simultaneous Control and Actuation. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Globally, the most popular upper-limb prostheses are powered by the human body. For body-powered (BP) upper-limb prostheses, control is provided by changing the tension of (Bowden) cables to open or close the terminal device. This technology has been around for centuries, and very few BP alternatives have been presented since. This paper introduces a new BP paradigm that can overcome certain limitations of the current cabled systems, such as a restricted operation space and user discomfort caused by the harness to which the cables are attached. A new breathing-powered system is introduced to give the user full control of the hand motion anywhere in space. Users can regulate their breathing, and this controllable airflow is then used to power a small Tesla turbine that can accurately control the prosthetic finger movements. The breathing-powered device provides a novel prosthetic option that can be used without limiting any of the user’s body movements. Here we prove that it is feasible to produce a functional breathing-powered prosthetic hand and show the models behind it along with a preliminary demonstration. This work creates a step-change in the potential BP options available to patients in the future.
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Resnik L, Borgia M, Cancio J, Heckman J, Highsmith J, Levy C, Webster J. Upper limb prosthesis users: A longitudinal cohort study. Prosthet Orthot Int 2021; 45:384-392. [PMID: 34469939 DOI: 10.1097/pxr.0000000000000034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND No previous studies have followed prosthesis users with upper limb loss or limb deficiency using their own prostheses to assess change over time. OBJECTIVES (1) To describe prostheses and terminal device types used at baseline and 1-year follow-up; (2) to examine changes in functional outcomes and device satisfaction over time; and (3) to examine whether changes in outcomes varied across level of amputation and type of prosthesis used. STUDY DESIGN Multisite, observational time series design with in-person functional performance and self-report data collected at baseline and 1-year follow-up. METHODS Baseline and follow-up outcome scores were compared using Wilcoxon signed-rank tests. Analyses were stratified by amputation level, time since amputation, prosthesis type, and change in device type. Published minimal detectable change (MDC) values were used to determine whether detectable change in outcome measures occurred. RESULTS The longitudinal cohort consisted of 64 participants (mean age 64 years, 56% body-powered users). The only significant differences in outcome measures between baseline and follow-up (after adjustment for false discovery) were hours/day of prosthesis use, which increased from 6.0 (4.4) to 7.3 (5.3) hours (P = 0.0022). Differences in prosthesis use intensity remained significant in analyses stratified by amputation level, time since amputation, prosthesis type, and change in device type. Between 14 and 20% of the sample had change in one or more outcome measures that was greater than the known MDC. CONCLUSIONS Most participants had stable outcomes over a year's time, whereas 14-20% experienced either improvement or decline in one or more tests indicating the importance of annual follow-up visits.
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Affiliation(s)
- Linda Resnik
- Research Department, Providence VA Medical Center, Providence, RI, USA
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, RI, USA
| | - Jill Cancio
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, USA
- Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, TX, USA
- US Army Burn Center, US Army Institute of Surgical Research, Ft. Sam Houston, TX, USA
| | - Jeffrey Heckman
- Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jason Highsmith
- Rehabilitation & Prosthetic Services (10P4R), Orthotic, Prosthetic & Pedorthic Clinical Services, US Department of Veterans Affairs, Washington DC, USA
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Charles Levy
- Physical Medicine and Rehabilitation Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Joseph Webster
- Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University, Richmond, VA, USA
- Staff Physician, Physical Medicine and Rehabilitation, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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10
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Resnik L, Borgia M, Biester S, Clark MA. Longitudinal study of prosthesis use in veterans with upper limb amputation. Prosthet Orthot Int 2021; 45:26-35. [PMID: 33834742 DOI: 10.1177/0309364620957920] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little is known about the patterns of prosthesis use and satisfaction of those who cease use or begin to use upper limb prostheses. OBJECTIVES Among a longitudinal sample of Veterans with upper limb amputation, (1) describe changes in prosthesis use over 1 year, (2) examine rates of receipt of new prostheses, and (3) compare prosthesis satisfaction in respondents who received a new prosthesis to those who did not. STUDY DESIGN Longitudinal survey. METHODS 808 Veterans who had participated in a baseline interview 1 year earlier were invited to participate in structured telephone interviews. RESULTS A total of 562 persons with unilateral and 23 with bilateral amputation participated in the interviews (Response rate = 72.4% and 85.2%, respectively). Prosthesis use, frequency and intensity of use, and types of prostheses used were stable over 1 year. About 24% reported using a different primary terminal device type at follow-up than baseline. Prosthesis use was less frequent/intense at baseline among those who discontinued use compared with those who did not (P < 0.05), and less frequent/intense for those who started compared with those who continued using a prosthesis (P < 0.0001). Rates of prosthetic training were higher among those who received a different prosthesis type compared with those using the same type (P = 0.06). Satisfaction scores were higher (P < 0.01) for new prosthesis recipients, and lower at baseline for prosthesis abandoners compared with continued users (P = 0.03). CONCLUSION Prosthesis abandonment appears to be predicated on dissatisfaction with the device, as well as less frequent/intense prosthesis use. These findings can be used to identify those at risk for prosthesis abandonment and improve their prosthesis experience.
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Affiliation(s)
- Linda Resnik
- Research Department, Providence VA Medical Center, Providence, RI, USA
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
| | - Matthew Borgia
- Research Department, Providence VA Medical Center, Providence, RI, USA
| | - Sarah Biester
- Research Department, Providence VA Medical Center, Providence, RI, USA
| | - Melissa A Clark
- Health Services, Policy and Practice, Brown University, Providence, RI, USA
- University of Massachusetts Medical School, Worcester, MA, USA
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11
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Lee SP, Chien LC, Chin T, Fox H, Gutierrez J. Financial difficulty in community-dwelling persons with lower limb loss is associated with reduced self-perceived health and wellbeing. Prosthet Orthot Int 2020; 44:290-297. [PMID: 32484076 PMCID: PMC8247678 DOI: 10.1177/0309364620921756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Socioeconomic status has been shown to be an important factor in the disparate prevalence and selected treatment of limb loss, but how personal financial difficulty affects patients' health outcomes is currently unclear. OBJECTIVE Examining how presence and experience of personal financial difficulty affects perceived health and wellbeing in individuals with lower limb loss. STUDY DESIGN Cross-sectional study. METHODS A total of 90 participants (68 males, mean age 58.7 ± 16.7 years) were recruited from local physical therapy and prosthetic and orthotic clinics, rehabilitation hospitals, and a regional amputee patient support group. All participants were community-dwelling, non-military adults with amputation involving at least one major lower limb joint. Participants were interviewed, and each completed a survey that included basic demographic/medical information, self-reported health and wellbeing (Short-Form Health Survey, SF-36v2), and a question to determine their financial situation after limb loss. Multiple regression analyses were used to examine the effect of financial difficulty on the eight subscales of SF-36v2 while accounting for age, gender, and amputation level. RESULTS Experiencing financial difficulty significantly and negatively affected Role-Physical and Role-Emotional subscale scores (p < 0.01 and p = 0.02, respectively). Individuals with financial difficulty scored approximately 60% lower in these two specific subscales. CONCLUSION Experiencing financial difficulty is a significant predictor for diminished work or daily activity participation due to physical and emotional stresses. Clinicians and health policy makers need to understand how socioeconomic factors may prevent individuals with lower limb loss from achieving higher levels of functional recovery and community re-integration after amputation. CLINICAL RELEVANCE Our findings showed that presence or experience of financial difficulty was significantly associated with diminished community re-integration in community-dwelling, non-military adults with lower limb loss. It affects both physical and emotional aspects of wellbeing. Clinicians should be aware how socioeconomic factors may affect social re-integration after amputation.
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Affiliation(s)
- Szu-Ping Lee
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Lung-Chang Chien
- Epidemiology and Biostatistics, Department of Environmental and Occupational Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Tyler Chin
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Heather Fox
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Juan Gutierrez
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, USA
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12
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Kerver N, van Twillert S, Maas B, van der Sluis CK. User-relevant factors determining prosthesis choice in persons with major unilateral upper limb defects: A meta-synthesis of qualitative literature and focus group results. PLoS One 2020; 15:e0234342. [PMID: 32603326 PMCID: PMC7326229 DOI: 10.1371/journal.pone.0234342] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/23/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Considering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis. METHODS A qualitative meta-synthesis using a 'best-fit framework' approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users' opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group. RESULTS Out of 6247 articles, 19 studies were included. An overview of six main themes ('physical', 'activities and participation', 'mental', 'social', 'rehabilitation, cost and prosthetist services' and 'prosthesis related factors') containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were 'work/school', 'functionality' and 'reactions from public'. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control. CONCLUSION The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness.
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Affiliation(s)
- Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Sacha van Twillert
- Centre of Expertise on Quality and Safety, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart Maas
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Lee DJ, Wininger M, Mahler D, Parisi M. Taxonomy of clinical encounters during the first 90 days post-delivery of an initial lower limb prosthesis. Prosthet Orthot Int 2018; 42:490-497. [PMID: 29775130 DOI: 10.1177/0309364618774053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND 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. OBJECTIVES Quantify and categorize clinical encounters by incidence and etiology. STUDY DESIGN Retrospective chart review. METHODS A central database containing data on prosthetic services was examined. Incidence and etiology were extracted through independent review of each patient chart. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | - Michael Wininger
- 1 University of Hartford, West Hartford, CT, USA
- 3 Cooperative Studies Program, Department of Veterans Affairs, West Haven, CT, USA
- 4 Yale University, New Haven, CT, USA
| | - David Mahler
- 2 New England Orthotic & Prosthetic Systems, Branford, CT, USA
| | - Mark Parisi
- 2 New England Orthotic & Prosthetic Systems, Branford, CT, USA
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14
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Affiliation(s)
- Ivan Vujaklija
- Department of Bioengineering, Imperial College London, London, UK
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, UK
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15
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Resnik L, Borgia M. Predicting prosthetic prescription after major lower-limb amputation. ACTA ACUST UNITED AC 2016; 52:641-52. [PMID: 26562228 DOI: 10.1682/jrrd.2014.09.0216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 04/23/2015] [Indexed: 11/05/2022]
Abstract
We describe prosthetic limb prescription in the first year following lower-limb amputation and examine the relationship between amputation level, geographic region, and prosthetic prescription. We analyzed 2005 to 2010 Department of Veterans Affairs (VA) Inpatient and Medical Encounters SAS data sets, Vital Status death data, and National Prosthetic Patient Database data for 9,994 Veterans who underwent lower-limb amputation at a VA hospital. Descriptive statistics and bivariates were examined. Cox proportional hazard models identified factors associated with prosthetic prescription. Analyses showed that amputation level was associated with prosthetic prescription. The hazard ratios (HRs) were 1.41 for ankle amputation and 0.46 for transfemoral amputation compared with transtibial amputation. HRs for geographic region were Northeast = 1.49, Upper Midwest = 1.26, and West = 1.39 compared with the South (p < 0.001). African American race, longer length of hospital stay, older age, congestive heart failure, paralysis, other neurological disease, renal failure, and admission from a nursing facility were negatively associated with prosthetic prescription. Being married was positively associated. After adjusting for patient characteristics, people with ankle amputation were most likely to be prescribed a prosthesis and people with transfemoral amputation were least likely. Geographic variation in prosthetic prescription exists in the VA and further research is needed to explain why.
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Affiliation(s)
- Linda Resnik
- Providence Department of Veterans Affairs Medical Center, Providence, RI
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16
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Ayers CA, Fisher LE, Gaunt RA, Weber DJ. Microstimulation of the lumbar DRG recruits primary afferent neurons in localized regions of lower limb. J Neurophysiol 2016; 116:51-60. [PMID: 27052583 DOI: 10.1152/jn.00961.2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/31/2016] [Indexed: 11/22/2022] Open
Abstract
Patterned microstimulation of the dorsal root ganglion (DRG) has been proposed as a method for delivering tactile and proprioceptive feedback to amputees. Previous studies demonstrated that large- and medium-diameter afferent neurons could be recruited separately, even several months after implantation. However, those studies did not examine the anatomical localization of sensory fibers recruited by microstimulation in the DRG. Achieving precise recruitment with respect to both modality and receptive field locations will likely be crucial to create a viable sensory neuroprosthesis. In this study, penetrating microelectrode arrays were implanted in the L5, L6, and L7 DRG of four isoflurane-anesthetized cats instrumented with nerve cuff electrodes around the proximal and distal branches of the sciatic and femoral nerves. A binary search was used to find the recruitment threshold for evoking a response in each nerve cuff. The selectivity of DRG stimulation was characterized by the ability to recruit individual distal branches to the exclusion of all others at threshold; 84.7% (n = 201) of the stimulation electrodes recruited a single nerve branch, with 9 of the 15 instrumented nerves recruited selectively. The median stimulation threshold was 0.68 nC/phase, and the median dynamic range (increase in charge while stimulation remained selective) was 0.36 nC/phase. These results demonstrate the ability of DRG microstimulation to achieve selective recruitment of the major nerve branches of the hindlimb, suggesting that this approach could be used to drive sensory input from localized regions of the limb. This sensory input might be useful for restoring tactile and proprioceptive feedback to a lower-limb amputee.
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Affiliation(s)
- Christopher A Ayers
- Center for Neural Basis of Cognition, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Lee E Fisher
- Center for Neural Basis of Cognition, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert A Gaunt
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Douglas J Weber
- Center for Neural Basis of Cognition, Pittsburgh, Pennsylvania; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania
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