Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

Miller, Taavy A.; Paul, Rajib; Forthofer, Melinda; Wurdeman, Shane R.

doi:10.1097/phm.0000000000001473

Cited by 15 publications

(15 citation statements)

References 32 publications

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“…Early ambulation can be advantageous as it helps to minimize joint contractures and deconditioning, and is associated with higher levels of prosthesis use. 32 , 33 A recent study by Miller et al found that receiving a prosthesis earlier, within the first 3 months’ post-amputation, reduced health care costs by $25,000 during the following year. 32 Past studies have found that only 26% 34 to 57% 35 of people with a transfemoral amputation receive a prosthesis.…”

Section: Discussionmentioning

confidence: 99%

“… 32 , 33 A recent study by Miller et al found that receiving a prosthesis earlier, within the first 3 months’ post-amputation, reduced health care costs by $25,000 during the following year. 32 Past studies have found that only 26% 34 to 57% 35 of people with a transfemoral amputation receive a prosthesis. A study in the U.S. Department of Veterans Affairs found that patients who received a prosthesis within a year from amputation had a 25% 3-year mortality rate versus 45% for those who did not receive a prosthesis.…”

Section: Discussionmentioning

confidence: 99%

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A Prospective Assessment of an Adjustable, Immediate Fit, Subischial Transfemoral Prosthesis

Dillingham

Kenia

Shofer

et al. 2022

Archives of Rehabilitation Research and Clinical Translation

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Prospective Assessment of an Adjustable, Immediate Fit, Subischial Transfemoral Prosthesis

Dillingham

Kenia

Shofer

et al. 2022

Archives of Rehabilitation Research and Clinical Translation

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“…23 It should be noted that the cost of prosthetic provision has been shown to be less than 10% of the total cost of an amputation, 45 with delayed rehabilitation adding considerable expense to the total cost. 2 It has also been demonstrated that less time between amputation and weight bearing or ambulation therapy can both contribute to faster restoration of the walking ability after a lower limb amputation 46 and reduce the cost of rehabilitation of these patients. 2 Using DS-TF a prosthetist can potentially reduce the time between amputation and start of weight bearing and physical therapy down to 6 weeks as shown in study when using the DS-TT.…”

Section: Cpojmentioning

confidence: 99%

Transfemoral Socket Fabrication Method Using Direct Casting: Outcomes Regarding Patient Satisfaction with Device and Services

Marable¹,

Johannesson²,

Smith³

et al. 2021

Preprint

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BACKGROUND: Direct Socket for transfemoral (DS-TF) prosthetic user is a novel method of fabricating a laminated interface on to the residual limb but requires different training, production method and service model than what most prosthetists are familiar with. This method and model may improve patient satisfaction by enabling interface fabrication and delivery in one visit.OBJECTIVES: Document patient satisfaction regarding DS-TF interface versus the prosthetic users' previous socket in terms of interface function and the clinic service model. METHODOLOGY:In this longitudinal study (from July 2018 to April 2020), the DS-TF was implemented in six prosthetic clinics across the United States. Certified prosthetists (CP) and assistants were trained using a standard protocol. 47 prosthetic users participated, both those in need of a new socket and those without need. Two modules from the Orthotics and Prosthetics Users' Survey (OPUS), involving questions related to satisfaction with the Device and Services, was used to evaluate each DS-TF user outcome vs. baseline. The only part of the prosthesis that was replaced was the interface, except in 2 cases.FINDINGS: Each DS-TF interface was fabricated, fit and delivered in a single clinic visit. At 6-months follow-up, 38 users reported an average of 29.8% increase in satisfaction with their new interface compared with original, and a 14.8% increase in satisfaction with the services they received from the clinic in providing of the new prosthesis vs. their original prosthesis. The main outcome increases were between baseline (initial fitting) and 6-week follow-up and remained consistent after 6 months. This improvement was consistent irrespective if the user needed a new socket for clinical reasons or not.CONCLUSION: This study shows that after a standardized training and implementation, the DS-TF fabrication process including a new interface, improves the user's satisfaction with their prosthetic device and services. ARTICLE INFO

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“…It is understood that the sooner a patient can begin gait training with their definitive socket, the better. 21,22 The Direct Socket TF (DS-TF) enables a prosthetist to fabricate a custom-made interface directly on the residual limb in a single visit, similar to Direct Socket TT. 23 The proximal portion of a DS-TF interface design differs from the proximal portion of sockets, typically included in the above described IRC sockets designs, 16 as the proximal part of the DS-TF incorporates a size-specific silicone brim instead.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome of Transfemoral Direct Socket Interface (Part 2)

Walker

Marable

Smith

et al. 2021

Can. Prosthet. Orthot. J.

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BACKGROUND: Amputation at the transfemoral (TF) level reduces the rate of successful prosthetic fitting, functional outcome, and quality of life (QoL) compared with transtibial amputation. The TF socket interface is considered the most critical part of the prosthesis, but socket discomfort is still the most common user complaint. Direct Socket for transfemoral prosthesis users is a novel interface fabrication process where the socket is shaped and laminated directly on the residual limb and delivered in a single visit. OBJECTIVE(S): The aim of this study was to investigate if prosthetic users' quality of life (QoL), comfort, and mobility with a Direct Socket TF interface were comparable to their experience with their previous prostheses. METHODOLOGY: The pre/post design prospective cohort study included 47 subjects. From this cohort, 36 subjects completed the 6-months follow-up (mean age 58 years, 27 males). Outcomes at baseline included EQ-5D-5L®, PLUS-M™, CLASS, ABC, AMPPRO, and TUG. At 6-weeks and 6-months, subjects repeated all measures. Seven Certified Prosthetist (CP) investigators performed observations and data collection at six different sites (from July 2018 to April 2020). FINDINGS: Results showed significant improvement in all outcome measures for the 36 subjects that completed both 6-weeks and 6-months follow-ups. CLASS sub-scales showed significantly improved stability, suspension, comfort, and socket appearance. Improvement in K-Level and less use of assistive devices were observed with the AMPPRO instrument, indicating improved user mobility and performance. QoL was also increased, as measured in Quality-Adjusted-Life-Years (QALY) from the EQ-5D-5L. CONCLUSION: Evidence from the findings demonstrate that the Direct Socket TF system and procedure can be a good alternative to the traditional method of prosthetic interface delivery. Layman's Abstract After lower limb amputation, the goal for most people is to regain mobility and independence and return to normal daily activities. Typically, people with transfemoral amputation are less likely to receive a prosthesis or fully use a prosthesis as compared to people with transtibial amputation. Moreover, their quality of life is also lower. The Direct Socket TF method is a new way of fabricating a prosthetic socket for users with above-knee amputation, enabling fabrication directly onto the residual limb and delivery of the socket in a single visit. In this study, we wanted to understand how the effect of Direct Socket TF on prosthetic 'user's quality of life, health, mobility level, and balance would compare to their previous prosthesis. This new Direct Socket TF procedure was implemented in six different prosthetic clinics across the United States and used by 36 prosthetic users for six months. Our first article on this study describes increased user satisfaction with their new interface and the single visit service model. This second article on the same clinical investigation documents the significant improvement in outcomes compared to their original interface in terms of quality of life, confidence, mobility, comfort, stability, and activity level. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36065/27923 Direct Socket TF – Summary (YouTube): https://www.youtube.com/watch?v=-fvVFqjgxjo How To Cite: Walker J, Marable W.R, Smith C, Sigurjónsson B.Þ, Atlason I.F, Johannesson G.A. Clinical outcome of transfemoral direct socket interface (part 2). Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.6. https://doi.org/10.33137/cpoj.v4i1.36065 Corresponding Author: Anton Johannesson, PhDTeamOlmed, Kistagången 12, 164 40 Kista, Stockholm, Sweden.E-mail: ajohannesson@teamolmed.seORCID: https://orcid.org/0000-0001-8729-458X

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Impact of Time to Receipt of Prosthesis on Total Healthcare Costs 12 Months Postamputation

Abstract: Supplemental digital content is available in the text.

Cited by 15 publications

References 32 publications

A Prospective Assessment of an Adjustable, Immediate Fit, Subischial Transfemoral Prosthesis

A Prospective Assessment of an Adjustable, Immediate Fit, Subischial Transfemoral Prosthesis

Transfemoral Socket Fabrication Method Using Direct Casting: Outcomes Regarding Patient Satisfaction with Device and Services

Clinical Outcome of Transfemoral Direct Socket Interface (Part 2)

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