Editorial Opinion: Value Within the Prosthetic and Orthotic Provision Process

Out-of-pocket costs and affordability of upper limb prostheses

BACKGROUND

Given the funding policies in the Department of Veterans Affairs, the affordability of prostheses may be less of a concern among Veterans as compared to civilians.

OBJECTIVES

Compare rates of out-of-pocket prosthesis-related payments for Veterans and non-Veterans with upper limb amputation (ULA), develop and validate a measure of prosthesis affordability, and evaluate the impact of affordability on prosthesis nonuse.

STUDY DESIGN

Telephone survey of 727 persons with ULA; 76% Veterans and 24% non-Veterans.

METHODS

Odds of paying out-of-pocket costs for Veterans compared with non-Veterans were computed using logistic regression. Cognitive and pilot testing resulted in a new scale, evaluated using confirmatory factor and Rasch analysis. Proportions of respondents who cited affordability as a reason for never using or abandoning a prosthesis were calculated.

RESULTS

Twenty percent of those who ever used a prosthesis paid out-of-pocket costs. Veterans had 0.20 odds (95% confidence interval, 0.14-0.30) of paying out-of-pocket costs compared with non-Veterans. Confirmatory factor analysis supported unidimensionality of the 4-item Prosthesis Affordability scale. Rasch person reliability was 0.78. Cronbach alpha was 0.87. Overall, 14% of prosthesis never-users said affordability was a reason for nonuse; 9.6% and 16.5% of former prosthesis users said affordability of repairs or replacement, respectively, was a reason for abandonment.

CONCLUSIONS

Out-of-pocket prosthesis costs were paid by 20% of those sample, with Veterans less likely to incur costs. The Prosthesis Affordability scale developed in this study was reliable and valid for persons with ULA. Prosthesis affordability was a common reason for never using or abandoning prostheses.

Next-generation devices to diagnose residuum health of individuals suffering from limb loss: A narrative review of trends, opportunities, and challenges

OBJECTIVES

There is a need for diagnostic devices that can assist prosthetic care providers to better assess and maintain residuum health of individuals suffering from neuromusculoskeletal dysfunctions associated with limb loss. This paper outlines the trends, opportunities, and challenges that will facilitate the development of next-generation diagnostic devices.

DESIGN

Narrative literature review.

METHODS

Information about technologies suitable for integration into next-generation diagnostic devices was extracted from 41 references. We considered the invasiveness, comprehensiveness, and practicality of each technology subjectively.

RESULTS

This review highlighted a trend toward future diagnostic devices of neuromusculoskeletal dysfunctions of the residuum capable to support evidence-based patient-specific prosthetic care, patient empowerment, and the development of bionic solutions. This device should positively disrupt the organization healthcare by enabling cost-utility analyses (e.g., fee-for-device business models) and addressing healthcare gaps due to labor shortages. There are opportunities to develop wireless, wearable and noninvasive diagnostic devices integrating wireless biosensors to measure change in mechanical constraints and topography of residuum tissues during real-life conditions as well as computational modeling using medical imaging and finite element analysis (e.g., digital twin). Developing the next-generation diagnostic devices will require to overcome critical barriers associated with the design (e.g., gaps between technology readiness levels of essential parts), clinical roll-out (e.g., identification of primary users), and commercialization (e.g., limited interest from investors).

CONCLUSIONS

We anticipate that next-generation diagnostic devices will contribute to prosthetic care innovations that will safely increase mobility, thereby improving the quality of life of the growing global population of individuals suffering from limb loss.