Predicting prosthetic prescription after major lower-limb amputation

Resnik, Linda; Borgia, Matthew

doi:10.1682/jrrd.2014.09.0216

Cited by 25 publications

(19 citation statements)

References 28 publications

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“…The cause for this delay cannot be identified by our data. However, the time to the first prosthesis in our material is clearly shorter than the mean of 145 days reported from the United States (Resnik and Borgia 2015). A positive trend could be noted in the registry with decreasing numbers of days to first TTA prosthesis, from md 79 days during the first years of registration (year 2011-2013) to md 56 days (year 2017-2018).…”

Section: Discussioncontrasting

confidence: 54%

SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

et al. 2020

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Background and purpose — For want of national guidelines for lower limb amputation (LLA) the quality registry SwedeAmp was started in 2011 to increase knowledge around LLA and prosthetic rehabilitation. We now present data from the first 8 years of registration. Patients and methods — We present descriptive data from the first 8 years (2011–2018) of registration. Patient-reported outcome was collected at baseline and at follow-up 12 and 24 months after surgery for patients with prosthetic supply and included generic (EQ-5D-5L) and amputee-specific (e.g., LCI-5L and Prosthetic Use Score) measures. Sex differences were investigated. Results — As at December 31, 2018, 5,762 patients, 7,776 amputations, 2,658 prosthetic supplies, 1,848 baselines, and 2,006 follow-ups were registered. 61% of the patients were male, and mean age by the time of the first registered amputation was 74 years (SD 14). Women were older, more frequently had vascular disease without diabetes and more often underwent amputation at a higher level compared with men (p < 0.001). Time from amputation to fitting of first individual prosthesis was median 69 days (6–500) after transtibial amputation (TTA) and 97 days (19–484) after transfemoral amputation (TFA). The outcomes were lower after TFA than after TTA. Interpretation — SwedeAmp shows sex differences concerning amputation level, diagnosis, and age, leading to the conclusion that women have worse preconditions for successful prosthetic mobility after LLA. With increasing coverage, SwedeAmp can provide deeper knowledge with regard to patients undergoing LLA in Sweden.

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Section: Discussioncontrasting

confidence: 54%

SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

et al. 2020

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“…However, most studies [30][31][32][34][35][36] had a small sample size and/or did not report outcomes for different amputation levels. Davie-Smith et al [29] as well as Resnik et al [33] found fit rates in transfemoral amputees of 21.6% and 19.2%, respectively. While Davie-Smith et al [29] analyzed age effects separately for transfemoral and transtibial amputations, Resnik et al [33] reported only a combined age coefficient.…”

Section: Epidemiologymentioning

confidence: 95%

“…Davie-Smith et al [29] as well as Resnik et al [33] found fit rates in transfemoral amputees of 21.6% and 19.2%, respectively. While Davie-Smith et al [29] analyzed age effects separately for transfemoral and transtibial amputations, Resnik et al [33] reported only a combined age coefficient. Hence, we applied data from Davie-Smith et al [29].…”

Section: Epidemiologymentioning

confidence: 95%

“…Several studies investigated prosthesis use and prosthesis fitting rates in lower limb amputees [29][30][31][32][33][34][35][36]. However, most studies [30][31][32][34][35][36] had a small sample size and/or did not report outcomes for different amputation levels.…”

Section: Epidemiologymentioning

confidence: 99%

“…Hence, we applied data from Davie-Smith et al [29]. Estimated age effects of both studies were comparable though (0.97 vs. 0.98) [29,33].…”

Section: Epidemiologymentioning

confidence: 99%

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

et al. 2020

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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.

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Factors that influence time to prosthesis receipt after lower limb amputation: A Cox proportional hazard model regression

Miller

Paul

Forthofer

et al. 2022

PM&R

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Background Early mobility, functional independence, and ambulation are associated benefits after lower limb amputation (LLA), whereas an increased risk of clinical complications is associated with no prosthesis. Objective To describe time to prosthesis receipt after amputation and to assess the impact of patient demographic and health factors on the rate of prosthesis receipt within 12 months post LLA. Design A retrospective cohort analysis using commercial administrative claims data. Kaplan‐Meier and Cox proportional‐hazards models were applied to assess time to prosthesis receipt. Setting Watson/Truven administrative database 2014‐2016. Participants Adults aged 18‐64 years with LLA who maintained their current insurance enrollment for 12 months after amputation. Interventions Independent variables included diabetes/vascular disease status, amputation level, age, gender, and region. Main Outcome Measures Prosthesis receipt was defined based on the presence of codes billed for prosthesis services. Time was measured in days from date of amputation surgery. Results Among the sample, 510 individuals maintained insurance enrollment for 12 months after amputation, of which 443 individuals received a prosthesis within that period (79% below knee and 21% above knee). The adjusted average rate of time to prosthesis receipt was 138 (95% confidence interval [CI]: 113–185) days. Individuals with diabetes/vascular disease were 22% (hazard ratio: 1.22, 95% CI: 1.02–1.49) more likely to receive a prosthesis earlier than individuals without diabetes/vascular disease and women received a prosthesis later than men at 141 (95% CI: 126–162) days versus 106 (95% CI: 96–119) days, respectively. Conclusions This study expands the understanding of factors that influence the likelihood of receiving a prosthesis along with the timing of prosthesis receipt after LLA among commercially insured adults. At least half of this sample received a prosthesis within 5 months or less. Disparities in timing and access to a prosthesis based on amputation level and gender were noted; future efforts are needed to address these issues.

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Predicting prosthetic prescription after major lower-limb amputation

Cited by 25 publications

References 28 publications

SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

SwedeAmp—the Swedish Amputation and Prosthetics Registry: 8-year data on 5762 patients with lower limb amputation show sex differences in amputation level and in patient-reported outcome

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

Factors that influence time to prosthesis receipt after lower limb amputation: A Cox proportional hazard model regression

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