Prosthetic prescription in the Netherlands: An interview with clinical experts (original) (raw)
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Prosthetics and Orthotics International, 2005
In the process of guideline development for prosthetic prescription in the Netherlands the authors made a study of the daily clinical practice of lower limb prosthetics. Besides the evidence-based knowledge from literature the more implicit knowledge from clinical experts is of importance for guideline development. In order to obtain this information the authors performed both an observational study of clinical practice and an interview study with 11 clinical experts from the three key disciplines in this field. The latter study is presented here as a descriptive and qualitative study. The combination of the opinions on prescription criteria given in these semi-structured interviews appeared divided with regard to various options in the prescription of a lower limb prosthesis. However, the implicit knowledge is considered by the authors of importance for the consensus procedure on guideline development. Prosthetic prescription criteria seem to be based on local experience and partly on assumptions. A consensus procedure can lead to improvement of the knowledge about prosthetic prescription.
Prosthetic prescription in the Netherlands: An observational study
Prosthetics and Orthotics International, 2003
Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carri...
Prosthetic prescription in the Netherlands
Prosthetics & Orthotics International, 2003
Prosthetic prescription for lower limb amputees and the methodology used are primarily based on empirical knowledge. Clinical expertise plays an important role that can lead to an adequate prescription; however, a clear evidence based motivation for the choices made cannot be given. This can lead to local prescription variations with regard to overuse or underuse of prosthetic care and a lack of transparency for consumers and health insurance companies. Hence a clinical guideline may lead to a more consistent and efficient clinical practice and thus more uniformly high quality care. The purpose of this study was to get insight into potential similarities in prescription criteria in clinical practice in the Netherlands. Secondly, the authors were interested to know if prosthetic prescription was primarily based on the level of activity or intended use of the prosthesis. As part of the development of a consensus-based clinical guideline a multi-centred, cross-sectional study was carri...
Disability and Rehabilitation, 2012
Purpose: There is an ongoing concern in lower limb prosthetic rehabilitation with underuse and nonuse of prosthetic technology. The aim of this study was to gather expert opinion on the most important outcomes, predictors and facilitators of lower limb prosthetic prescription and use, with a long-term goal of improving satisfaction with prosthetic technology. Method: An electronic Delphi study was conducted using an expert panel of 21 service providers and users and was undertaken over three iterations. Results: The process resulted in the identification of 13 outcomes, 19 predictor and 34 facilitator factors. Conclusions: Psychosocial factors related to service provision and prosthetic use have not been widely recognized or incorporated into clinical practice. We highlight the need for creating standardized measures that incorporate psychosocial factors and that can contribute to a broadly applicable evidence base for optimal prosthetic prescription.
Purpose.While lower limb prosthetic prescription is reliant on many physical indicators, it is clear that psychosocial factors need to be emphasised to a greater extent within this field if the needs of users are to be appropriately addressed. The aim of this study is to explore and identify the outcomes of prosthetic prescription through qualitative inquiry. Method.Six focus groups with prosthetic service users and 10 semi-structured interviews with service providers were conducted and then analysed with inductive thematic analysis. Results.The outcomes identified were: independence, not being in a wheelchair, balance and safety, improved quality of life and reaching potential. Conclusions.These emergent themes challenge the predominating focus on physical functioning that many practitioners have. These findings are important for developing a user-based model of service provision and outcome evaluation.
The Journal of Rehabilitation Research and Development, 2005
The aim of this project was the development of evidence-and consensus-based clinical practice guidelines for lower-limb prosthesis prescription for achieving transparency and consensus among clinicians, manufacturers, and insurance companies. This article describes a modified Delphi Technique, which is based on different methods of collecting evidence, and its role in the development of national clinical guidelines for prosthesis prescription. We used a multimethod approach to develop guidelines for the clinical practice of prosthesis prescription for lower-limb amputees. The Delphi Technique was central in the process, and the panel was made up of experts from three key disciplines on a national level. Our approach involved various methods: a systematic review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The views of the national expert panel were then presented at a consensus development conference. The participants in the Delphi Technique sessions reached a consensus on 37 of the postulates on prosthesis prescription for lower-limb amputees. The postulates were categorized according to amputation level and partitioned into different domains. The total process resulted in the development of draft clinical guidelines comprising guidance for prescribing prostheses for the lower limb. The scope and applicability of these guidelines will have to be measured and evaluated in future work.
JPO Journal of Prosthetics and Orthotics, 2017
Introduction: Individuals using a lower-limb prosthesis need knowledge about many aspects of management to maximize use and comfort and minimize secondary complications. Knowledge assessments are used in other health fields, yet no assessment has been published in prosthetics. Therefore, a knowledge assessment was developed for international use and pilot tested in the United States and East Africa. Materials and Methods: The assessment contained 36 questions and was written at a 4.7-grade reading level. Content was based on professional input and literature. The assessment was pilot tested with 16 prosthetic users in the United States, 19 prosthetic users in East Africa, and 24 nonprosthetic users in the United States. Assessment scores were analyzed across questions, between prosthetic users and nonprosthetic users, and correlated with patient demographics. Results: We found the assessment was understandable among all subject groups. United States prosthesis users scored higher than nonprosthesis users. Prosthetic experience was positively correlated with assessment scores in the United States and negatively correlated with assessment scores in East Africa. Conclusions: Clinicians can use this knowledge assessment to identify gaps or misunderstanding and track progress in comprehension with their patients. Clinicians can adapt questions to their local context, individual needs and componentry, and time constraints.
South African Journal of Physiotherapy, 2018
Background: Major lower limb amputation has a severe impact on functional mobility. Mobility can be salvaged with a prosthesis, but this is not always the best option. It is often difficult to decide whether to refer someone for a prosthesis or not. A prosthetic screening tool ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ was developed and is used for prosthetic prescription in parts of the Western Cape province of South Africa.Objectives: This study aimed to explore the suitability of the tool ‘Guidelines for Screening of Prosthetic Candidates: Lower Limb’ for use in the Eastern Cape province of South Africa.Method: A qualitative study was conducted with conveniently sampled occupational therapists (OTs) (n = 10), physiotherapists (PTs) (n = 12) and prosthetists (n = 6) in government employment in the Buffalo City Metro Municipality. Participants were trained in the use of the tool and used it for four weeks with patients. Their experiences of the tool were assess...
The Journal of Rehabilitation Research and Development, 2004
A correct prosthetic prescription can be derived from adapting the functional benefits of a prosthesis to the functional needs of the prosthetic user. For adequate matching, the functional abilities of the amputees are of value, as well as the technical and functional aspects of the various prosthetic components. No clear clinical consensus seems to be given on the precise prescription criteria. To obtain information about different prosthetic components and daily functioning of amputees with a prosthesis, we performed a systematic literature search. The quality of the studies was assessed with the use of predetermined methodological criteria. Out of 356 potentially relevant studies, 40 studies eventually qualified for final methodological analysis and review. Four satisfied all the criteria and were classified as A-level studies, 26 as B-level, and 10 studies as C-level studies. Despite a huge amount of literature, our formal clinical knowledge had considerable gaps concerning the effects of different prosthetic components and their mechanical characteristics on human functioning with a lowerlimb prosthesis. Therefore, with regard to prosthetic guideline development, we must still largely rely on clinical consensus among experts. The integration of knowledge from research with the expert opinion of clinical professionals and the opinions and wishes of consumers can form a solid base for a procedure on guideline development for prosthetic prescription.