Canadian Prosthetics Orthotics Journal最新文献

{"title":"The Hybrid Subischial Socket for Persons With Transfemoral Amputation: Gait Parameters and Clinical Assessment of a Case Series.","authors":"R Pellegrini,&nbsp;G Denza,&nbsp;S Brunelli,&nbsp;D Zenardi,&nbsp;M Imperio,&nbsp;G Vannozzi,&nbsp;M Traballesi","doi":"10.33137/cpoj.v4i1.36252","DOIUrl":"https://doi.org/10.33137/cpoj.v4i1.36252","url":null,"abstract":"<p><strong>Background: </strong>The subischial socket interface design is a promising new shape of socket for persons with transfemoral amputation. Typically, the proximal trim line is located distal to the ischial tuberosity, improving comfort in prosthetic users without interfering with gait parameters compared to Ischial Containment Socket (ICS). No studies have investigated the performances of a subischial sockets with suction suspension system. A new subischial socket (Hybrid Subischial Socket - HySS) combined with a hypobaric passive suspension system has been recently developed.</p><p><strong>Objective: </strong>To assess the effects of HySS in terms of comfort, hip range-of-motion and gait parameters.</p><p><strong>Methodology: </strong>Three persons with transfemoral amputation were tested first using their usual ICS and then after one month of continuous use of HySS.</p><p><strong>Findings: </strong>The following parameters improved in all participants using HySS: 1) hip range-of-motion, 2) walking speed and distance, 3) Timed-Up-and-Go-Test time, 4) stride length, 5) double support duration, 6) peak value of hip extension during stance, 7) satisfaction with the prosthesis.</p><p><strong>Conclusion: </strong>These findings suggest that the use of HySS could allow improvements for prosthetic use.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 1","pages":"36252"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(IN) Access to Artificial Limbs: the Patient's Perspective According to the War Amps of Canada.","authors":"A Petlock,&nbsp;K DiMario","doi":"10.33137/cpoj.v4i2.35972","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.35972","url":null,"abstract":"<p><p>Funding agencies, both public and private, do not adequately meet the needs of Canadian amputees. This often leaves amputees without access to appropriate prosthetic care due to outstanding balances that are to be paid out of pocket, or by charitable organizations. There are several factors that result in these inadequacies. As healthcare is a provincial responsibility in Canada, provinces and territories have the authority to create individual public regimes, each with their own weaknesses. In fact, there are a few provincial regimes which do not include prosthetic funding at all. Private healthcare is meant to offset the remaining balance; however, their lack of knowledge regarding amputation has resulted in the creation of policies with ambiguous language, limiting the funding available for prosthetic care. Attitudinal barriers and missed legislative opportunities further exacerbate the shortcomings of prosthetic funding provided by public and private funding agencies, requiring action.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"35972"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustable-Volume Prosthetic Sockets: Market Overview and Value Propositions.","authors":"T D Klenow,&nbsp;J Schulz","doi":"10.33137/cpoj.v4i2.35208","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.35208","url":null,"abstract":"<p><p>The prosthetic socket is commonly considered to be the most important part of the prosthesis and lack of fit can lead to skin breakdown, reduction in wear, reduction in activity, and consequential deleterious health effects. Furthermore, approximately 90% of amputations are due to a vascular etiology, which affect fluid retention regularity, and even small limb volume fluctuations can lead to lack of fit. Adjustability in the socket volume has been suggested as a potential solution to common fit issues but has lacked market penetration mostly due to lack of reimbursement. Despite this there are several adjustable-volume sockets emerging on the market today including prefabricated, modular, custom with adjustable-volume component, custom with adjustable-volume feature, and adjustable-hybrid sockets. Prefabricated sockets are mass produced in common sizes and fit directly to the patient by a prosthetist using pad kits, BOA dials, or straps. Modular sockets are assembled to a patient or model with panels or struts attached to an adjustable base. Custom sockets with adjustable-volume elements are traditionally-fabricated sockets made to a model of a patient's limb with a volume-adjustable component added or volume-adjustable feature built in. Custom-hybrid sockets are made custom to a model of the patient's limb and incorporate several aspects of the previous socket types and include some radically-unique design aspects which cannot be limited to one category. These adjustable-volume sockets offer several advantages to traditional rigid-volume sockets for the patient, prosthetist, and providing clinic. The micro-adjustability for the patient allows them to alter fit without removing the socket, maintaining a more intimate fit throughout the day than traditional sockets. The macro-adjustability for the prosthetist allows for increased options for fit customization including the ability to reverse or undo changes without necessarily re-making the socket. This allows for the most optimal fit for the patient. Adjustable volume also present efficiencies in the fitting process by simplifying or eliminating steps including residual limb shape capture, form modification, diagnostic fabrication, iterative alteration, and definitive fabrication with the different socket types affecting different steps. Due to these factors, adjustable-volume sockets have disrupted the market to the point where reimbursement reform is needed including additional L-codes in the United States and fee-for-service or fee-for-outcome associated with prosthetic follow-up care. Prosthetic care should also be separated from durable medical equipment to allow for alternative reimbursement models. As reimbursement adapts prosthetists must adapt correspondingly to differentiate their skillset from other allied health providers including incorporating more objective methods to show superior care outcomes. This adaptation should include a continued push for state and municipal licensu","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"35208"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Brief Introduction to Game Theory and its Potential Implications for the Economics of Orthotics & Prosthetics.","authors":"G Fiedler,&nbsp;A Schikorra","doi":"10.33137/cpoj.v4i2.36661","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.36661","url":null,"abstract":"<p><p>The economic viability of Orthotics & Prosthetics (O&P) service provision is an important concern for policy makers, patients, and practitioners. Against the background of limited funds that can be distributed for healthcare expenses overall, it is critical to identify the most cost-effective treatment options within and across disciplines, including surgical and pharmacological interventions. When those decisions are being negotiated, whether in the context of an individual case in the clinic or of general payer policies that allocate spending budgets, the O&P discipline is often perceived to be at a disadvantage due to its relatively young age, underdeveloped evidence base, and small economic clout as compared to other fields. Such asymmetrical negotiations have been the subject of economic theories and mathematical models, such as the \"Game theory\", work on which has been awarded with several Nobel Prizes and other recognitions across the years. In this paper, we are introducing core concepts of this theory and discuss how they may be applied in negotiations on treatment approaches and reimbursement schedules with the goal to improve outcomes for the O&P profession.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"36661"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value and Applicability of Large Administrative Healthcare Databases in Prosthetics and Orthotics Outcomes Research.","authors":"T A Miller,&nbsp;S Wurdeman","doi":"10.33137/cpoj.v4i2.35958","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.35958","url":null,"abstract":"<p><p>The goal of health economics and outcomes research is to improve healthcare decision making. In the absence of high-value clinical data, the availability and quality of administrative healthcare data could be vital in the generation of evidence for orthotics and prosthetics services. The purpose of this article is to provide a stronger understanding of administrative healthcare data analysis, an area that has been scarcely examined within prosthetics and orthotics despite the wealth of information available within such data. Examples of common datasets in this arena currently available are provided, as well as an overview of the limitations and advantages of studies utilizing such datasets.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"35958"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Mixed-methods Study on Prosthesis Use Among Older Canadians With Lower-limb Amputations.","authors":"B Pousett,&nbsp;C Budzinski,&nbsp;D Labbé,&nbsp;W C Miller","doi":"10.33137/cpoj.v4i1.36833","DOIUrl":"https://doi.org/10.33137/cpoj.v4i1.36833","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of lower-limb amputations (LLA) in older adults is increasing. Due to the substantial resources required for rehabilitation, there is growing interest in exploring prosthesis use as well as the factors that impact use for individuals with LLA.</p><p><strong>Objectives: </strong>To examine how older adults, those over 50 years old, with a new LLA use their prostheses following rehabilitation and to identify factors that increase or decrease prosthesis use after discharge from a rehabilitation hospital.</p><p><strong>Methods: </strong>The StepWatch Activity Monitor, the Prosthetic Profile of the Amputee Questionnaire, and a semi-structured interview were used to measure prosthesis use and factors affecting use at 12 weeks post-discharge from a rehabilitation hospital. Descriptive statistics were calculated for the quantitative data and the qualitative interviews were analyzed using the International Classification of Functioning and Disability.</p><p><strong>Results: </strong>Two user profiles emerged from the 11 participants' use patterns. The Regular Users integrated their prosthesis into their lives, using it for various types of activities, while the Strategic Users wore their prosthesis to perform specific activities of daily and instrumental activities of daily living tasks. Body functions (e.g., pain), personal (e.g., feeling of independence), and environmental factors (e.g., home adaptations or social support) impacted prosthesis use.</p><p><strong>Conclusions: </strong>The emergence of profiles suggests variability in how older adults with LLA use their prosthesis after rehabilitation. However, the factors affecting prosthesis use were similar between the profiles. Therefore, while it is important for rehabilitation teams to consider patients' individual needs when setting goals for prosthetic training, they must also consider common factors affecting prosthesis use.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 1","pages":"36833"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Perspective on Health Economics in Prosthetics and Orthotics.","authors":"S U Raschke","doi":"10.33137/cpoj.v4i2.37135","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.37135","url":null,"abstract":"<p><p>There is a scarcity of literature exploring Health Economics in Prosthetics and Orthotics (P&O). The P&O sector has, over the past decades, moved to a Bachelor's or Masters Degree level as the requirement for entry to practice and, with that, there has been a growing body of research and knowledge generation focusing primarily on clinical aspects and engineering advances. No corresponding body of research has emerged on the economic aspects of P&O, creating a fundamental weakness in both technical and clinical research efforts to advance this field within an economically sustainable framework. This weakness will become critical as data driven engineering advances (e.g. exoskeletons, mass customizable prostheses) and clinical improvements (e.g. osseointegration, diabetes treatments) will make reimbursement for devices ever more complex and challenging. The tension between what is possible and what is fundable will increase unless what is possible also drives down costs. Finding the right balance in Prosthetics and Orthotics will be a challenge, as this sector already struggles to justify current standards of care. This Special Edition takes a snapshot of stakeholder perspectives and opinions on the topic of Health Economics in P&O and is organized around the following stakeholder groups: End-user, Researcher (Engineering and Clinical), Prosthetic and Orthotic Practitioner and, of critical importance, four papers describing an interdisciplinary project on the Health Economics of Osseointegration that was led by a payor. Each author was also asked to provide a \"Call to Action\" in which they identify one or more key areas that need to be addressed in order to move forward with the barriers or opportunities they have identified in their paper. The intent of the Special Edition is to generate discussion and encourage more in-depth research on this topic.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"37135"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exoseketons: A Rehab Tech Consumer's Unexpected March to Action.","authors":"C Angus","doi":"10.33137/cpoj.v4i2.37250","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.37250","url":null,"abstract":"<p><p>This paper is both a stakeholder perspectives as well as a 'case study' describing a journey from sudden disability to participant and investor in exoskeleton design. It tells of my experiences and opinions, as a successful fashion designer, when my life took a drastic turn on becoming paralysed from the waist down over the course of 24 hours, by a spinal tumour. Getting this diagnosis was 'the worst day in my life', and it was quickly followed by the 'second worst' when, in my determination to walk again, I received Knee Ankle Foot Orthotics (KAFOs) and was shocked to learn that this appeared to be the best technology solution available on the market 'suitable' for use in the community. Initial anger at the system for not being better, at the rehab team for their complacency, and at myself for allowing a feeling of helplessness to take over led to questions such as: what does this say about our society? and what are we all willing to accept, for ourselves and others? This is professional opinion and an essay about how we see ourselves and how others see us. The journey from pre-injury 'consumer' to post-injury 'disabled' person and learning that being labeled 'disabled' leads to the additional handicap of the narrow vision of \"cost\" taken by the mobility industry where innovative ideas are stripped down to the bare minimum with the excuse that patients are \"lucky\" to have what they have been \"given\". Grappling with these labels and inequities and seeking a better outcome, I became an integral team member of an exoskeleton development team, leading to the design of The Next Generation Exoskeleton! This is MY story, the story of Chloe Angus. It is the story of inclusive, user focused design and is a call to include and respect the end users of all assistive device technology design early in the design process and it is being told from the perspective of a person having experience and success in the world of business.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"37250"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10069825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a Prosthetic Foot With Increased Coronal Adaptability on Cross-Slope Walking.","authors":"B Altenburg,&nbsp;M Ernst,&nbsp;P Maciejasz,&nbsp;T Schmalz,&nbsp;F Braatz,&nbsp;H Gerke,&nbsp;M Bellmann","doi":"10.33137/cpoj.v4i1.35206","DOIUrl":"https://doi.org/10.33137/cpoj.v4i1.35206","url":null,"abstract":"<p><strong>Background: </strong>Walking on cross-slopes is a common but challenging task for persons with lower limb amputation. The uneven ground and the resulting functional leg length discrepancy in this situation requires adaptability of both user and prosthesis.</p><p><strong>Objectives: </strong>This study investigated the effects of a novel prosthetic foot that offers adaptability on cross-slope surfaces, using instrumented gait analysis and patient-reported outcomes. Moreover, the results were compared with two common prosthetic feet.</p><p><strong>Methodology: </strong>Twelve individuals with unilateral transtibial amputation and ten able-bodied control subjects participated in this randomized cross-over study. Participants walked on level ground and ±10° inclined cross-slopes at a self-selected walking speed. There were three prosthetic foot interventions: Triton Side Flex (TSF), Triton LP and Pro-Flex LP. The accommodation time for each foot was at least 4 weeks. The main outcome measures were as follows: frontal plane adaptation of shoe and prosthetic foot keel, mediolateral course of the center of pressure, ground reaction force in vertical and mediolateral direction, external knee adduction moment, gait speed, stance phase duration, step length and step width. Patient-reported outcomes assessed were the Activities specific Balanced Confidence (ABC) Scale, Prosthetic Limb Users Survey of Mobility (PLUS M) and Activities of Daily Living Questionnaire (ADL-Q).</p><p><strong>Findings: </strong>The TSF prosthetic foot adapted both faster and to a greater extent to the cross-slope conditions compared to the Triton LP and Pro-Flex LP. The graphs for the mediolateral center of pressure course and mediolateral ground reaction force showed a distinct grouping for level ground and ±10° cross-slopes, similar to control subjects. In the ADL-Q, participants reported a higher level of perceived safety and comfort when using the TSF on cross-slopes. Eight out of twelve participants preferred the TSF over the reference.</p><p><strong>Conclusions: </strong>The frontal plane adaptation characteristics of the TSF prosthetic foot appear to be beneficial to the user and thus may enhance locomotion on uneven ground - specifically on cross-slopes.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 1","pages":"35206"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10063614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemplating Health Economics, Coding and Reimbursement in Orthotics, Prosthetics and Pedorthics.","authors":"M J Highsmith,&nbsp;C M Fantini,&nbsp;D G Smith","doi":"10.33137/cpoj.v4i2.36125","DOIUrl":"https://doi.org/10.33137/cpoj.v4i2.36125","url":null,"abstract":"<p><p>Reimbursement to U.S. healthcare service providers is largely transitioning from fee for service to fee for value for those clinicians who code using current procedural terminology and through their coding, describe their professional services. The Orthotic, Prosthetic and Pedorthic profession (O&P), currently codes using a system that describes the devices they evaluate for, fabricate, fit and maintain and their professional services are incorporated into their codes. These O&P codes, in contrast to those for other healthcare disciplines, are predominantly product based rather than service based, focusing on product features and function more than clinical service. This editorial manuscript provides a brief overview of the system the US O&P profession uses currently, particularly in the context of other healthcare professions transitioning to value based coding and reimbursement and culminates in a call to action for the profession to academically consider the strengths and weaknesses of the current system relative to alternative systems.</p>","PeriodicalId":32763,"journal":{"name":"Canadian Prosthetics Orthotics Journal","volume":"4 2","pages":"36125"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10443486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}