Benefits for Adults with Transfemoral Amputations and Peripheral Artery Disease Using Microprocessor Compared with Nonmicroprocessor Prosthetic Knees

Wong, Chi Song; Rheinstein, John; Stern, Michelle

doi:10.1097/phm.0000000000000265

Cited by 25 publications

(48 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our model, the risk of falling depended on the prosthesis type, while the probability of a medical event following a fall was assumed to be independent of that type. We identified five clinical trials [4,[8][9][10][11][12]] that compared the number of falls of MPK versus NMPK usage. Two of these trials [9,12] provided patient level fall outcomes, while the other studies only reported average fall numbers over a specific time period.…”

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

“…We identified five clinical trials [4,[8][9][10][11][12]] that compared the number of falls of MPK versus NMPK usage. Two of these trials [9,12] provided patient level fall outcomes, while the other studies only reported average fall numbers over a specific time period. Due to the small sample size (n = 8) of the study by Wong et al [12], we populated our model with data from Kahle et al [9].…”

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

“…Two of these trials [9,12] provided patient level fall outcomes, while the other studies only reported average fall numbers over a specific time period. Due to the small sample size (n = 8) of the study by Wong et al [12], we populated our model with data from Kahle et al [9]. We excluded two outliers from the sample due to implausible model outcomes in 40-49 years old: for NMPKs, fall-related mortality would have been higher than the estimated all-cause mortality in 40-49 years old.…”

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

“…The safe use of a prosthesis in activities of daily living is key for transfemoral amputees [4]. Several clinical and biomechanical studies as well as two systematic reviews [4][5][6][7][8][9][10][11][12][13][14][15] investigated the safety of using the microprocessor-controlled knee joint C-Leg (C-Leg). Compared with non-microprocessor-controlled (mechanical) knee joints (NMPK), the C-Leg reduced the number and frequency of stumbles and falls of up to 80% [6,8,9].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

et al. 2020

View full text Add to dashboard Cite

Background The safe use of a prosthesis in activities of daily living is key for transfemoral amputees. However, the number of falls varies significantly between different prosthetic device types. This study aims to compare medical and economic consequences of falls in transfemoral amputees who use the microprocessor-controlled knee joint C-Leg with patients who use non-microprocessor-controlled (mechanical) knee joints (NMPK). The main objectives of the analysis are to investigate the costeffectiveness and budget impact of C-Legs in transfemoral amputees with diabetes mellitus (DM) and without DM in Germany. Methods A decision-analytic model was developed that took into account the effects of prosthesis type on the risk of falling and fall-related medical events. Cost-effectiveness and budget impact analyses were performed separately for transfemoral amputees with and without DM. The study took the perspective of the statutory health insurance (SHI). Input parameters were derived from the published literature. Univariate and probabilistic sensitivity analyses (PSA) were performed to investigate the impact of changes in individual input parameter values on model outcomes and to explore parameter uncertainty. Results C-Legs reduced the rate of fall-related hospitalizations from 134 to 20 per 1000 person years (PY) in amputees without DM and from 146 to 23 per 1000 PY in amputees with DM. In addition, the C-Leg prevented 15 or 14 fall-related death per 1000 PY. Over a time horizon of 25 years, the incremental cost-effectiveness ratio (ICER) was 16,123 Euro per quality-adjusted life years gained (QALY) for amputees without DM and 20,332 Euro per QALY gained for amputees with DM. For the period of 2020-2024, the model predicted an increase in SHI expenditures of 98 Mio Euro (53 Mio Euro in prosthesis users without DM and 45 Mio Euro in prosthesis users with DM) when all new prosthesis users received C-Legs instead of NMPKs and 50% of NMPK user whose prosthesis wore out switched to C-Legs. Results of the PSA showed moderate uncertainty and a probability of 97-99% that C-Legs are cost-effective at an ICER threshold of 40,000 Euro (≈ German GDP per capita in 2018) per QALY gained. Conclusion Results of the study suggest that the C-Leg provides substantial additional health benefits compared with NMPKs and is likely to be cost-effective in transfemoral amputees with DM as well as in amputees without DM at an ICER threshold of 40,000 Euro per QALY gained.

show abstract

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

Section: Risk Of Falling and Fall-related Medical Eventsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Amputees fall more often than their able‐bodied counterparts [56]. Compared with N‐MPK and N‐MPA, amputees on P‐MPKs have shown fewer falls [69] and increased balance [69]. In case of stumbling, one recovery strategy investigated with transfemoral amputees (TFAs) employs (1) elevating the limb for obstacle avoidance, (2) lowering the obstructed limb to the floor and stepping with the contralateral limb [70], or (3) an option described as hopping [71].…”

Section: Discussionmentioning

confidence: 97%

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Lechler

Frossard

Whelan

et al. 2018

PM&R

View full text Add to dashboard Cite

People with major limb amputations are severely impaired when it comes to activity, body structure and function, as well as participation. Demographic statistics predict a dramatic increase of this population and additional challenges with their increasing age and higher levels of amputation. Prosthetic use has been shown to have a positive impact on mobility and depression, thereby affecting the quality of life. Biomechatronic prostheses are at the forefront of prosthetic development. Actively powered designs are now regularly used for upper limb prosthetic fittings, whereas for lower limbs the clinical use of actively powered prostheses has been limited to a very low number of applications. Actively powered prostheses enhance restoration of the lost physical functions of an amputee but are yet to allow intuitive user control. This paper provides a review of the status of biomechatronic developments in upper and lower limb prostheses in the context of the various challenges of amputation and the clinically relevant outcomes. Whereas most of the evidence regarding lower limb prostheses addresses biomechanical issues, the evidence for upper limb prostheses relates to activities of daily living (ADL) and instrumental ADL through diverse outcome measures and tools.

show abstract

Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation

2020

View full text Add to dashboard Cite

Benefits for Adults with Transfemoral Amputations and Peripheral Artery Disease Using Microprocessor Compared with Nonmicroprocessor Prosthetic Knees

Abstract: People with peripheral artery disease and transfemoral amputations had fewer falls and improved balance confidence and walking performance when using prostheses with MK.

Cited by 25 publications

References 29 publications

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

Motorized Biomechatronic Upper and Lower Limb Prostheses—Clinically Relevant Outcomes

Current and Emerging Trends in the Management of Fall Risk in People with Lower Limb Amputation

Contact Info

Product

Resources

About