Comment on

Abstract

MADAM: It was with much interest I read the recent publication by Gordon and colleagues 1 given the potential of this work to influence the provision of interim prosthetic services in New South Wales, Australia and abroad.While it was laudable of the investigators to compare different models of service delivery in terms of cost, satisfaction and functional outcomes, there are a number of limitations that reduce confidence in the authors' conclusion that the provision of an interim prosthetic service using a contracted private company was more expensive and resulted in lower satisfaction compared to an 'in-house' service.Satisfaction with the prosthesis (SATPRO) score for the private model seems unusually low (49.91 + 12.13) compared to another investigation which reported a mean score of 73.1 + 20.3 for a similar population. 2 The SATPRO tool comprises 15 questions, each measured on a four-point scale, which raises the question of whether the result for the private model were reported out of 60, without expressing the result out of 100 as is normally the case. 2 Personal communication with the authors on the 10th and 21st May 2010 confirmed this error. Correction of this error would bring the private model results in line with a previous investigation 2 and find satisfaction with the prosthesis to be comparable between the two experimental groups.It was disappointing that a breakdown of the SATPRO data by question were not reported. The SATPRO instrument offers a great deal of information, such as whether repairs or adjustments were carried out in a reasonable time (Q.8), which would have helped inform the discussion and avoid the need for speculation which biased the discussion.Given that the authors reported using the Locomotor Capability Index (LCI) it was surprising that the LCI basic score exceeded 21 for both the public and private model. The LCI consists of 14 items broken into two subscales (basic and advanced). Each subscale includes seven items graded on a 4-point scale from 0 (not able to) to 3 (yes, independently). Therefore, the maximum score on each subscale can only be 21. 3,4 It is hoped the authors can clarify this error.The Functional Autonomy Measurement System (SMAF) is a complex instrument to administer requiring the rater to determine the level of autonomy based on synthesis of information obtained by talking with the participant/family, observing the participant in their environment and evaluating the extent to which physical or social resources are available to compensate for the disability. 5 When preceded with a 3-hour training session, good interrater reliability has been observed. 5 In reporting results for SMAF, authors should document the training and experience of assessors and indicate whether more than one rater was involved in doing the assessments.While the authors conservative interpretation of the SMAF scores in the conclusion and abstract was appreciated, it was concerning to see elsewhere in the article the suggestion that greater function was observed with clients managed...