RAND Value Simulation Study
As part of the Prosthetics 2020 Initiative, the RAND Corporation conducted a value simulation, the “Economic Value of Advanced Transfemoral Prosthetics” where they simulated the differential clinical outcomes and costs of microprocessor-controlled knees (MPKs) compared with non-MPKs (NMPKs), and conducted a literature review of the clinical and economic impacts of prosthetic knees, convened technical expert panel meetings, and implemented a simulation model over a ten-year time period for unilateral transfemoral Medicare amputees with Medicare Functional Classification Levels of 3 and 4.
Data Regarding Provision and Utilization of Orthotic and Prosthetic Services
AOPA, through its partnership with the research and data firm Dobson DaVanzo & Associates, LLC, has obtained a plethora of data specific to the provision and utilization of Orthotic & Prosthetic services. This data, which is only available to current AOPA members, tells a compelling story about the type of O&P services Medicare patients are receiving as well as what provider categories (O&P, physicians, DME suppliers, pharmacies, etc.) are providing them. It also provides valuable information regarding patients who initially receive off the shelf (OTS) items who later require custom fitted or custom fabricated items. In addition, the compendium contains valuable information regarding the cost effectiveness of O&P services relative to their effect on overall healthcare expenditures for Medicare patients. Member login required to access.
Medicare Spending on Prosthetics from 2010-2014
Overall spending on prosthetics has decreased 15%, while spending on outdated technology has actually decreased.
February 2016 Military Medicine Supplement
Military Medicine is the official journal publication of the Association of Military Surgeons of the United States (AMSUS), and this edition contains two articles of note: 1) Suggested Guidelines for the Prescription of Orthotic Services, Device Delivery, Education, and Follow-up Care: A Multidisciplinary White Paper and 2) Economic Value of Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study
Center for O&P Learning/ Evidence-Based Practice (COPL)
2019
- Leigh Clarke, B.PO, MPH, “Patient and payor perspective of the benefit of prosthetic interventions and services: informing measures for future health economic evaluations.”
- Reza Safari, PhD, “Activity, Mobility, Social Functioning, Mental Health and Quality of Life Outcomes in Limited Mobility Transfemoral and Knee Disarticulation Amputees Using Microprocessor-Controlled Knees or Non-Microprocessor Controlled Knees in the United Kingdom: A Cohort Study.”
- Jenny A. Kent, PhD, “Vacuum Assisted Suspension: The effect of residuum-socket interface integrity on perception and control in individuals with a transtibial amputation.”
- Christopher Hovorka, PhD, CPO, LPO, FAAOP, “Quality of life, satisfaction, gait and motion control outcomes of articulated passive dynamic, non-articulated passive dynamic and solid ankle foot orthoses in hemiparetic stroke survivors.”
- Geoff Balkman, BA, MS, CPO “Large-scale administration and calibration of a patient-reported item bank for assessing mobility of lower limb orthosis users”
2018
- Balkman, Geoff, BA, MS, CPO, “Development of a Mobility Outcome Measure for People who use Lower Limb Orthoses”
- John DesJardins, PhD, “The Quantification of Containment Conditions Used for Directed Growth Within Infant Cranial Remolding Orthoses: A Pilot Study”
- Sun Hae Jang, M.Sc., CO, FAAOP, “Normative Values, Reliability, and Validity of the Global Visual Gait Assessment for Measuring Orthotic Biomechanical Outcomes for Use in Post-Stroke Patients”
- Shannon Mathis, Ph.D. “Gait Analysis Using Video: Defining K-Level in Lower-Limb Prosthesis Users”
- Shane Wurdeman, PhD, MSPO, CP, FAAOP, “Prospective Falls Analysis Among Lower Limb Prosthesis Users- Understanding the Role of Prostheses in Reducing Fall Risk”
- Eric Weber, CPO, FAAOP, “Longitudinal Tracking of Stability Events and AFO Compliance Among Stroke Survivors During Sub-Acute and Chronic Phases of Recovery”
2017
- Sarah Anderson, La Trobe University, “Comparison of quality of life in people with partial foot or transtibial amputation”
- Brian Kaluf, BSE, CP, Ability Prosthetics and Orthotics, Inc., “Hydraulic and Microprocessor Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study”
- Sarah Chang, PhD, Northwestern University, “A pilot study to evaluate the effects of the hydraulic ankle-foot prostheses on standing and walking in K2-level ambulators”
- Benjamin Padilla, MD, University of California San Francisco Benoiff Children’s Hospital, “The Effects of a Custom Pectus Carintum Orthosis on Dosing Response and Quality of Life”
- Eric Weber, CPO, FAAOP, Hanger Clinic – Department of Clinical and Scientific Affairs, “Mobility and Global Health among Users of Lower Limb Orthoses: The Establishment of a National Data Base”
- Chris Hovorka, Ph.D., CPO, LPO, FAAOP, Georgia Institute of Technology, “Gait and Motion Control Benefits of Custom Molded Passive-Dynamic AFOs versus Custom Fit Carbon Composite AFOs in Persons with Neuromuscular Impairment”
- Kenton Kaufman, PhD, Mayo Clinic, “Prevalence, correlates, and risk of prescription drug use and abuse in individuals with above knee amputations”
2016
- Walter Lee Childers, PhD, MSPO, CP, Alabama State University, “Stumble recovery mechanisms utilized by people using different types of microprocessor knees”
- Kenton Kaufman, PhD, PT, Mayo Clinic, “Risk factors and costs associated with secondary health conditions of individuals with above-knee amputations”
- Staci Shearin, UT Southwestern, “Impact of Carbon Fibre AFOs on gait and resulting changes in quality of life across time in persons with PD”
- Nicholas LeCursi, CO, Becker Orthopedic Appliance Company, “Relative influence of orthotic support features within an open frame AFO versus a total contact AFO on function, endurance, and activity level in patients with spastic equinovarus secondary to chronic stroke”
- Ignacio Gaunaurd, PhD, MSPT, University of Miami, “Utilizing an innovative Timed-Up-and-Go test for fall risk detection in people with unilateral lower limb loss”
- Sai Vikas Yalla, PhD, Rosalind Franklin University of Medicine and Science, “Activity Based Quality Life Assessment to Compare Prostheses with and without Microcontrollers in Transfemoral Amputees”
- Shane Wurdeman, PhD, MSPO, CP, FAAOP, Hanger Clinic – Department of Clinical and Scientific Affairs, “Improved mobility with lower limb prostheses: the establishment of a national multi-site outcomes database”
2015
- Fan Gao, PhD, UT Southwestern Medical Center at Dallas. “Does Vacuum Assisted Socket System Improve Knee Proprioception and Dynamic Balance in Transtibial Amputees?”
- Jason Highsmith, PT, PhD, CP, FAAOP, University of South Florida, “Concurrent Validation of the Continuous Scale Physical Functional Performance Test (CS PFP-10) in Transfemoral Amputees”
- Jason Kahle, MSMS, CPO, FAAOP, The University of South Florida, School of PT and Rehab. “Transfemoral interfaces with vacuum assisted suspension comparison of biomechanics using the CAREn: Ischial containment versus brimless”
2015 Special Projects
Systematic Review Projects
- Jason Highsmith, DPT, PhD, CP, FAAOP, Morsani College of Medicine, University of South Florida “Cost Efficacy of Transtibial Interventions”
- Jason Kahle, CPO, MSMS, FAAOP, “Prosthetic Design and Research: A Systematic Review of Established Treatment Guidelines to Determine Post Amputation Functional Performance Level and Develop a Prosthetic Candidacy Treatment Algorithm”
- Michael Dillon, PhD, La Trobe University, Department of Rehabilitation, Nutrition and Sport,
- “Outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review for the development of shared decision-making resources”. (Biomed Central)
- “While Mortality Rates Differ After Dysvascular Partial Foot and Transtibial Amputation, Should They Influence the Choice of Amputation Level?” (Archives of Physical Medicine and Rehabilitation, 2017)
- “A systematic review describing incidence rate and prevalence of dysvascular partial foot amputation; how both have changed over time and compare to transtibial amputation” (Systematic Reviews, 2017)
- Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations (Prosthetics and Orthotics International, 2018)
- Uncertainty with long-term predictions of lower limb amputation prevalence and what this means for prosthetic and orthotic research.
Journal of Prosthetics and Orthotics. Epub ahead of print. - Describing the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision making resources. Systematic Review
- Describing the outcomes of dysvascular partial foot amputation and how these compare to transtibial amputation: a systematic review protocol for the development of shared decision making resources. PROSPERO 2015
Special Projects
- Kenton Kaufman, PhD, PE, Mayo Clinic, “Risk factors and costs associated with accidental falls among adults with above-knee amputations: a populations-based study”
- AOPA will commission Dobson/DaVanzo to analyze Medicare claims data from 2011-2014 and Part D prescription claims information for expanded and updated research into the cost effectiveness of timely O&P intervention and patient outcomes, continuing in the pathway of the prior cost-effectiveness report and the Mobility Saves Initiative.
Previous COPL Research Grants
2014
- Walter Lee Childers, PhD, MSPO, CP, Alabama State University, “The world is not flat: Justifying prosthetic feet with multi-axial features being used on uneven terrain”
- Goeran Fiedler, PhD, CPO, University of Pittsburgh, “Physiologic range of step-by-step variations in lower limb prosthesis forces during walking”
- Dennis E. Clark, CPO, Clark and Associates Prosthetics and Orthotics, “Comparison of Post-Operative Care Following Trans-Tibial Amputation”
2013
- Silvia Raschke, PhD, British Columbia Institute of Technology – “The Impact of Step Targeting During Normal Gait for Persons Wearing Either a SACH or a Dynamic Response Foot”
- Nicoleta Bugnariu, PT, PhD, University of North Texas Health Science Center – “Performance and Evaluation of Dynamic Response Feet”. This article was published in the Journal of Biomechanics – access it here.
- Noah J. Rosenblatt, PhD, University of Illinois at Chicago – “The Influence of Vacuum-assisted Suspension on Clinical Outcomes in Lower Limb Amputees” (Pending publication in JPO)
2013 (Research Grant Awards In Progress)
- Vibhor Agrawal, PhD, University of Miami – “Determining Efficacy of Dynamic Response Prosthetic Feet in K-level 3″
2012 (Research Grant Awards In Progress)
- Tamara Bushnik, PhD, FACRM, NYU Langone Medical Center, Rusk Institute of Rehabilitation Medicine — “Developing an Evidence Based Approach to Address Functional Level Change in Persons Following Transfemoral Amputation”
- Jason Maikos, PhD, Department of Veterans Affairs, New York Harbor Healthcare System — “A Biomechanical and Functional Evaluation of a Microprocessor Controlled Knee Paired with a Powered Ankle-Foot Prosthesis”
2012
- Sean Deeny, PhD, Rehabilitation Institute of Chicago – “Cognitive Workload During Prosthetic Use: A Quantitative EEG Measure”
2011
- Christopher Hovorka, MS, CPO, LPO, FAAOP, Georgia Institute of Technology – “Influence of the Rocker Profile in an Orthosis-footwear Combination to Modulate Neuromuscular Behavior”
2010
- Christopher Hovorka, MS, CPO, LPO, FAAOP, Georgia Institute of Technology – “Exploiting Lower Limb Orthotic Constraint of Movement as a Strategy for Neuromuscular Recalibration”
- Fan Gao, PhD, UT Southwestern Medical Center at Dallas – “Investigation of Prosthetic Socket Interface Pressure: Effects of Suspension Types and Socket Alignment”
2009
- Robert Kistenberg, Georgia Tech Research Corporation, “Comparison of Liner Assisted suspensions in Transtibial Prosthetics”
- Geza Kogler, PhD, Georgia Tech Research Corporation, “Functional Outcomes of a Custom, Energy, Harvesting ‘Bullfrog’ AFO”
- Andrew Sawyer, University of Washington – “Estimation of the Axis at Rotation Position in Non-articulated Energy Storage and Return Prosthetic Foot-Ankle Mechanism”
Other Special Projects
Systematic Reviews (2013)
- Marcus Besser, PhD, Thomas Jefferson University, “Orthotic Management of Stroke Patient”
- Jason Highsmith, DPT, PhD, CP, University of South Florida, “Prosthetic Management following Transtibial Amputation”
Funded by AOPA and Participating Manufacturer Members
- AOPA’s Prosthetic Foot Project
- Silvia Raschke, PhD, British Columbia Institute of Technology – “A Comparative Effectiveness Study Of Subject-Generated Ankle Kinetics as a Measure Of Prosthetic Foot Function Across A Range Of K Levels”
- Kenton Kaufman, PhD, Mayo Clinic, “MPK vs Non-MPK Prosthetic Knees”
Funded by AOPA and Commissioned by the Amputee Coalition
- The Dobson-DaVanzo Report, “Retrospective Cohort Study of the Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries”