Lower limb prosthesis utilisation by elderly amputees

This study compared the outcomes of an interim mechanical prosthesis program for lower limb amputees operated under a public and private model of service. Over a two-year period, 60 transtibial amputees were fitted with an interim prosthesis as part of their early amputee care. Thirty-four patients received early amputee care under a public model of service, whereby a prosthetist was employed to provide the interim mechanical prosthesis service. The remaining 26 patients received early amputee care under a private model of service, where an external company was contracted to provide the interim mechanical prosthesis service. The results suggested comparable clinical outcomes between the two patient groups. However, the public model appeared to be less expensive with the average labour cost per patient being 29.0% lower compared with the private model. The results suggest that a public model of service may provide a more comprehensive and less expensive interim prosthesis program for lower limb amputees.

Section: Methodsmentioning

confidence: 99%

An Interim Prosthesis Program for Lower Limb Amputees

Gordon

Magee

Frazer

et al. 2010

“…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.…”

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confidence: 51%

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confidence: 99%

“…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.…”

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confidence: 99%

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Comment on

2010

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...

“…After the screening of their titles and abstracts four studies were identified as potentially eligible and their full-texts were retrieved. [19][20][21][22] Two of these papers were excluded after reading the whole text 20,21 as they did not meet the inclusion criteria with two papers qualifying for final inclusion. 19,22 These papers were critiqued independently by both reviewers.…”

Section: Resultsmentioning

confidence: 99%

Is occupational therapy practice for older adults with lower limb amputations evidence-based? A systematic review

Spiliotopoulou

Atwal

2012

Background: Although occupational therapists are integral to the rehabilitation process of people with amputations, the effectiveness of the occupational therapy intervention for older adults with lower limb amputations has not been investigated. Objectives: To identify the effectiveness of the occupational therapy interventions with older adults aged 65 years and older with lower limb amputations. Study Design: Systematic review. Methods: A systematic search was conducted in CINAHL, PUBMED, OTSEEKER and OTDBASE from January 1985 to January 2011. The eligible papers were critiqued using a typology, which involved designation of levels of evidence and quality markers. Results: The databases yielded 2,664 potential publications. Of these, only two were included in the final review. These studies suggested that the frequency of the occupational therapy sessions was found to be statistically significantly related to prosthesis use and that service users perceived positive benefits about the provision of stump boards. Both studies had limitations resulting in a need for further investigation in these areas. Conclusion: Research evidence on the occupational therapy interventions with this population is limited and scarce. Occupational therapists need to take urgent action to address the identified evidence-based gaps in order to devise informed targeted rehabilitation programmes for this client group. Clinical relevanceThis systematic review has contributed to the understanding of the occupational therapy practice in the rehabilitation of older adults with lower limb amputations. It has highlighted gaps in evidence that occupational therapists need to address urgently in order to inform their rehabilitation programmes with this client group.