Perioperative and early rehabilitation outcomes following osseointegration in UK military amputees

Wood, Paul; Small, C; Mahoney, Peter F.

doi:10.1136/jramc-2019-001185

Cited by 7 publications

(3 citation statements)

References 18 publications

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“…Although critical to successful clinical outcomes, rehabilitation procedures (e.g., training exercises) and prosthetic fitting recommendations (e.g., setting of components) for new solutions are often areas of continuous development and, therefore, are under-reported (53)(54)(55)(56)(57)(58)(59). The level of understanding and acceptance of pre-and postoperative clinical care may vary between interventions for lower or upper bionic limbs.…”

Section: Need For More Information About Rehabilitation and Prostheti...mentioning

confidence: 99%

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Frossard

Conforto²,

Aszmann³

2022

Front. Rehabilit. Sci.

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Importance of residuum healthThe use of a prosthesis is essential to maintain function and wellbeing of individuals suffering from limb absence (1, 2). Consequently, providers of prosthetic care recommend bespoke interventions to sustain lenient interactions between individuals' residual limb and their prosthesis (3-7). The clinical management of this interface is critical because it greatly affects the residuum health (8).Residuum health is influenced by intrinsic determinants inherent to personal demographics (e.g., gender, age, weight, and height) and surgical amputation (e.g., length of bone, muscle reassignments, muscle strength, and adipose tissue distribution) and extrinsic determinant-associated attachment (e.g., socket design and direct skeletal attachment) and prosthetic components (e.g., choice and alignment of components, control of the prosthetic joint movements, use of walking aids, and level of activity) (8). In all cases, interactions between intrinsic and extrinsic determinants are critical as residual tissues have limited physiological capacity to withstand direct loading applied by typical socket-suspended prostheses during daily activities (e.g., chafing and rubbing) (5, 9-12). In addition to general neurological residuum and phantom pain, individuals can experience a range of incapacitating neuromusculoskeletal dysfunctions compromising residuum health, such as acute and chronic skin issues, edema, neuroma, tendinitis, muscle contractures, stress fractures, osteopenia, and heterotopic bone growth, which altogether increases the risks of sound lower joints osteoarthrosis, and hyperlordosis (6,13, 14).Consequently, satisfactory residuum-prosthesis interface is difficult to achieve and sustain (15). Individuals with compromised residuum health are more at risk to experience unsuccessful prosthetic fitting arrangements (4, 16). Those with healthy residuum are more likely to maximize comfort, stability, and mobility when using a TYPE

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Section: Need For More Information About Rehabilitation and Prostheti...mentioning

confidence: 99%

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Frossard

Conforto²,

Aszmann³

2022

Front. Rehabilit. Sci.

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“…, reimbursement standards) including surgical (e.g., one-off and on-going cost for primary surgical implantation, refashioning of residuum, reamputation, reimplantation), rehabilitation (e.g., physiotherapy), medical (e.g., pain killers, antibiotics), and prosthetic (e.g., socket fittings, interim and definitive prostheses) care costs More holistic CUAs could reveal the true costs of infections and subsequent surgical revisions. 2,98,99 Future studies should also focus on societal perspective (e.g., the impact of BAP on employment, productivity, living assistance costs). Finally, future studies should also consider consumer perspective, often neglected but equally relevant (e.g., gap fees, out-of-pocket expenses, overseas travelling costs, prosthetic components, medication).…”

Section: Future Workmentioning

confidence: 99%

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

Frossard

Berg²

2021

Can. Prosthet. Orthot. J.

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The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: laurentfrossard@outlook.comORCID number: https://orcid.org/0000-0002-0248-9589

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“…It has been proposed to avoid sockets entirely and attach prosthetic limbs directly to the residual bone using osseointegrated implants. Despite the great advancements that have been achieved with this approach in recent years 14 , osseointegration may not be indicated for many individuals, either due to bone composition and co-morbidities 15 , or to its incompatibility with high-impact activities such as running and sprinting 16 that military amputees may experience in the eld. The more viable approach instead is to improve socket prostheses for this patient population.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Within-subjects Effects of Standardized Prosthetic Socket Modifications on Physical Function and Patient-Reported Outcomes

Anderst

Fiedler

Onishi

et al. 2021

Preprint

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• Background: Among the challenges of living with lower limb loss is the increased risk of long-term health problems that can be either attributed directly to the amputation surgery and/or prosthetic rehabilitation or indirectly to a disability-induced sedentary lifestyle. These problems are exacerbated by poorly fit prosthetic sockets. There is a knowledge gap regarding how the socket design affects in-socket mechanics, and how in-socket mechanics affect patient-reported comfort and function. The objectives of this study are: 1) to gain a better understanding of how in-socket mechanics of the residual limb in transfemoral amputees are related to patient-reported comfort and function, 2) to identify clinical tests that can streamline the socket design process, and 3) to evaluate the efficacy and cost of a novel, quantitatively informed socket optimization process.• Methods: Users of transfemoral prostheses will be asked to walk on a treadmill wearing their current socket plus 8 different check sockets with designed changes in different structural measurements that are likely to induce changes in residual limb motion, skin strain, and pressure distribution within the socket. Dynamic biplane radiography and pressure sensors will be used to measure in-socket residual limb mechanics. Patient-reported outcomes will also be collected after wearing each socket. The effects of in-socket mechanics on both physical function and patient-reported outcomes (aim 1) will be assessed using a generalized linear model. Partial correlation analysis will be used to examine the association between research grade measurements and readily available clinical measurements (aim 2). In order to compare the new quantitative design method to the Standard of Care, patient reported outcomes and cost will be compared between the two methods, utilizing the Wilcoxon Mann-Whitney non-parametric test (aim 3).• Discussion: Knowledge on how prosthetic socket modifications affect residual bone and skin biomechanics itself can be applied to devise future socket designs, and the methodology can be used to investigate and improve such designs, past and present. Apart from saving time and costs, this may result in better prosthetic socket fit for a large patient population, thus increasing their mobility, participation, and overall health-related quality of life. • Trial registration: clinicaltrials.gov: NCT05041998

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Perioperative and early rehabilitation outcomes following osseointegration in UK military amputees

Cited by 7 publications

References 18 publications

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Editorial: Bionics limb prostheses: Advances in clinical and prosthetic care

Health Service Delivery and Economic Evaluation of Limb Lower Bone-Anchored Prostheses: A Summary of the Queensland Artificial Limb Service’s Experience

Within-subjects Effects of Standardized Prosthetic Socket Modifications on Physical Function and Patient-Reported Outcomes

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